Doulas’ Medicaid expansion and insurer benefits bring doula care mainstream

Doulas, who provide physical and emotional support to birthing patients before, during and after delivery, are increasingly becoming part of routine maternal care as Medicaid and some private insurers expand reimbursement. The shift reflects a growing body of evidence that such trained, non-medical support can improve outcomes for both mothers and babies and help reduce disparities in maternal health.

In Memphis, Tennessee, doula Shaquoiya Stewart’s experience illustrates how that support can fit into everyday care. Stewart held one of her 6-month-old twins while another mother, her doula, attended to both parents’ needs during prenatal and postpartum stages. Stewart said she felt safe and that her doula made it “didn’t feel like I was just by myself,” adding, “She was like my homegirl,” in describing how the doula shepherded her through pregnancy and birth.

The reporting also highlights how coverage has moved beyond a limited, out-of-pocket option. Without insurance, costs for doula services can vary widely but can exceed $2,000, according to the account. In contrast, the National Health Law Program says more than 30 states reimburse doulas through Medicaid or are in the process of implementing such coverage, up from 14 in late 2022. The same reporting notes that private insurers are beginning to adopt similar benefits.

Minnesota is one example of how Medicaid doula coverage has widened over time. The AP report says Minnesota covered doulas through Medicaid in 2014, and a decade later expanded coverage to allow Medicaid recipients 18 sessions with a doula without prior authorization, more than double the amount previously allowed. “The return on investment is huge,” said Sierra Hill, a maternal care access coordinator for the Minnesota health department, in the report.

Studies cited in the report describe associations between doula use and a range of health outcomes. One set of research comparing two groups of socially disadvantaged mothers found that doula users were four times less likely to have a baby with low birth weight, two times less likely to have a birth complication, and more likely to start breastfeeding. Another study published last year found that Medicaid recipients with doulas had a 47% lower risk of C-sections and a 29% lower risk of preterm birth, and were 46% more likely to go to a postpartum checkup, according to the report’s summary of the study findings. April Falconi, a scientist at Carelon Research who co-authored the study, said the postpartum period is critical, noting that “More than half of maternal deaths occur during the postpartum period.”

The acceptance of doulas also appears to be spreading through clinical settings, even though doulas are not required to hold mandatory licenses everywhere. In the AP account, there are state qualification standards tied to Medicaid payments, and many doulas seek certification through private entities. UnitedHealthcare’s role is described as part of that mainstreaming: industry giant UnitedHealthcare is launching a new doula benefit this year, and the company’s administration of a Tennessee Medicaid program runs through UnitedHealthcare, including doula services free to members under a pilot program in Memphis.

Clinicians and hospital staff in the report describe how integration has improved. Dr. Margaret-Mary Wilson, chief medical officer at UnitedHealth Group, said she sees “doulas becoming more and more integrated and accepted by all within the health care system.” In Minnesota, Dana Morrison of Doulas of Duluth described earlier friction, including when doulas advocated for different approaches than birth teams wanted and when doulas were less integrated. But the report says Aspirus St. Luke’s hospital now contracts with Doulas of Duluth on a grant-funded program, offering patients a scholarship to hire a doula through the organization, and nurse Mallory Cummings described that “What it really comes down to is everyone’s knowledge of what a doula is.”

The report also describes how doulas support patients through challenging moments. In Memphis, Mary Bey told the doula she was frightened and protective during breastfeeding and recovery, and she tied her postpartum anxiety to a prior stillbirth before delivering her daughter last December. Bey described the doula’s presence through labor, healing and at-home support, saying, “She was there when I had to push him out. She was there after, when I was healing. She came to the house. She brought groceries.” She added that when she later worried about a C-section incision infection, the doula advised her to get it checked out and that it was.

While the AP report describes personal accounts alongside study findings and policy changes, it consistently frames the growth of doula care as both practical and data-driven. With more states reimbursing doulas through Medicaid and additional insurer programs expanding, advocates say more parents may be able to obtain sustained support during pregnancy and the postpartum period—when, as researchers say, serious complications and maternal deaths are especially likely.