Many states provide Medicaid coverage for doula services as a strategy to enhance the perinatal health workforce and support access to care. As of March 2026, more than half of all states (26 states and Washington, DC) provide Medicaid coverage for doula services within their Medicaid programs — an increase of 14 states since NASHP’s last analysis in April 2024. This brief summarizes key components and trends of NASHP’s updated analysis of state Medicaid doula benefits.
Doulas are nonclinical trained professionals who provide physical, emotional, and informational support during pregnancy, delivery, and after childbirth. Pregnant women who receive doula care are more likely to have a healthy birth outcome and a positive birth experience.i Doula care is also associated with reductions in preterm births and cesarean delivery, indicating opportunities for cost-savings.
State Medicaid Coverage of Doulas At-a-Glance
- 26 states and DC reimburse doulas in their Medicaid programs.
- 26 states and DC allow doulas to practice and bill independently under Medicaid.
- 22 states and DC allow doulas to practice and bill as part of a doula group under Medicaid.
- 17 states reimburse for doula services through 12 months postpartum under Medicaid.
- 8 states have issued a statewide standing recommendation for doula services covered by Medicaid.
- 5 states and DC provide incentive payments for select doula services under Medicaid.
Federal Authorities and Medicaid Benefit Categories
States can establish a Medicaid doula benefit through two federal Medicaid authorities: a Medicaid state plan amendment (SPA) or a Section 1115 demonstration waiver. All states with a Medicaid doula benefit provide statewide coverage for doula services through a SPA.
Doula services can be covered under multiple Medicaid benefit categories, which are classifications of services eligible for Medicaid reimbursement. All states with a Medicaid doula benefit cover doula services under the preventive services benefit category through a SPA. Minnesota also covers doula services under the extended services to pregnant women benefit category. California also covers doula services under the freestanding birth center benefit category as a professional service.
Health Care Delivery Structures
States have flexibility and broad authority in establishing how care is delivered and the billing structures for providers under Medicaid. State Medicaid programs can cover doula services in either a fee-for-service (FFS) system, managed care system, or a combination of both. Under FFS, doulas are directly reimbursed for each service provided. In a managed care system, doulas receive reimbursement directly from a Medicaid managed care organization (MCO).
All states with a statewide Medicaid doula benefit reimburse for these services under a FFS model. At least 18 states and Washington, DC, also allow doulas to contract and/or enroll with MCOs to be reimbursed for services provided to women enrolled in Medicaid who are served by an MCO. Many of these states require doulas to first enroll as a FFS billing provider prior to contracting and/or enrolling with an MCO.
Consistent with the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act, covered health care providers must have a National Provider Identifier (NPI) to be reimbursed for services. The NPI is a unique identification number assigned to health care providers by the Centers for Medicare & Medicaid Services to improve electronic transmission of health information. All states with statewide Medicaid doula benefits allow doulas to practice and bill as an individual provider using a Type 1 NPI.
Administrative burden associated with Medicaid billing can inhibit doula enrollment in Medicaid. To facilitate Medicaid billing, many states allow doula groups or provider entities to bill on behalf of doulas. Twenty-two states and Washington, DC, allow doulas to practice and bill as part of a doula group/organization that enrolls as a Medicaid provider using a Type 2 NPI. At least six states allow doulas to join a provider agency or clinic that bills on their behalf and may also allow doulas to bill independently.
Coverage, Payment, and Reimbursement of Doula Services
The scope, duration, and reimbursement rates of doula services vary significantly across states. All states with Medicaid doula benefits provide coverage for doula services during the prenatal, labor and delivery, and postpartum periods. At least 17 states provide Medicaid coverage for doula services through 12 months postpartum. Some states allow doulas to provide certain services, such as prenatal and postpartum service visits, via telehealth. Several states cover labor and delivery doula support for various types of deliveries regardless of pregnancy outcome, with each delivery type reimbursed at a specific rate. Many state Medicaid programs have increased reimbursement rates for covered doula services over time. As of March 2026, labor and/or delivery doula support ranges from $459 to $1,500 across states.
Connecticut provides Medicaid coverage for doula services under fee-for-service and the state’s HUSKY maternity bundle, a value-based maternity payment program in HUSKY Health (Medicaid). Both reimbursement models cover up to four prenatal or postpartum visits at $100 per visit and $800 for labor and delivery support at one visit. The maximum reimbursement per doula per member/birth under the HUSKY maternity bundle is $1,200.
Oregon provides a fee-for-service global doula payment of $1,505, consisting of two prenatal support visits, two postpartum support visits, and delivery support. Payment for partial services is made when a doula provides some, but not all, services included in the global doula benefit. A total of four additional prenatal and/or postpartum support visits may be provided in any combination at $215 each.
In addition to providing coverage for prenatal and postpartum service visits and labor and delivery support, some states also provide coverage for additional doula services, including fertility and pre-conception counseling, lactation consultation, pregnancy or infant loss support, newborn visits, and connecting Medicaid beneficiaries to community resources. Most states have limits on the number of doula service visits eligible for Medicaid reimbursement.
If additional doula services are medically necessary, states have a prior authorization process for doulas to be reimbursed for services beyond the standard scope or duration of services. Most state Medicaid doula benefits are only available for pregnant and postpartum women enrolled in Medicaid, but at least one state (Massachusetts) also allows Medicaid members who are adoptive parents of infants under one year of age to receive doula services.
Five states and Washington, DC have implemented incentive payments for Medicaid-enrolled doulas as part of efforts to improve health outcomes for postpartum women. Nevada provides an additional 10 percent payment to doulas that provide services to recipients in rural areas. New Jersey Medicaid-enrolled doulas are eligible to receive a $100 value-based incentive payment for performing at least one postpartum service visit within six weeks of delivery and if the client is seen by an obstetric clinician for a postpartum visit after a labor and delivery claim.
Training and Certification Requirements
States establish training and certification requirements that doulas must complete to be eligible to enroll as Medicaid providers. Two common pathways for completing doula training and certification requirements are used by more than half of states that reimburse doulas in their Medicaid programs.
These two pathways are completion of a state-approved training program focused on a set of core competencies, or completion of a legacy/experience pathway whereby doulas are required to provide proof of extensive doula experience in lieu of training. State-approved doula training programs may include those from state-based doula training organizations or national doula certification organizations. Some states also require doulas to complete applications and pay application fees, register as a certified doula on the state doula registry, hold liability insurance, and/or complete additional trainings (e.g., cardiopulmonary resuscitation training) to enroll as a Medicaid provider.
Standing Recommendations for Doula Services
Standing recommendations can increase access to doula services as Medicaid beneficiaries do not have to obtain individual recommendations/referrals from a physician or other licensed practitioner to seek doula care. Eight state Medicaid programs have issued a statewide standing recommendation for doula services.
Standing recommendations for doula services fulfill the federal requirements in Section 440.130(c) of Title 42 of the Code of Federal Regulations for a physician or other licensed practitioner of the health arts acting within their scope of practice to provide a written recommendation for preventive services. Preventive services are services recommended by a physician or other licensed practitioner to prevent disease, disability, and other health conditions or their progression; prolong life; and promote physical and mental health and efficiency.
Notes
1 Sobczak, Alexandria, Lauren Taylor, Sydney Solomon, Jodi Ho, Scotland Kemper, Brandon Phillips, Kailey Jacobson, et al. 2023. “The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review.” Cureus 15 (5). https://doi.org/10.7759/cureus.39451.
Acknowledgments
This policy brief was written by Anoosha Hasan. Karen VanLandeghem and Veronnica Thompson also contributed to this brief through guidance and review.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC54191; $396,167. This information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.
