Volume 30

It Takes A Village: Pathways for Achieving Access to Doula Services for Medicaid Enrollees

by Sarah Hart

The United States is facing a maternal health crisis, and one that has a disparate impact on communities of color. Doula services can be an effective tool to reduce maternal health disparities. There are a number of pathways that have been and can continue to be leveraged to provide doula services to Medicaid enrollees. To ensure all Medicaid enrollees can permanently access doula services, a state must formally add doula services to a state’s Medicaid benefits. In order to do so, a state must submit a state plan amendment to the Centers for Medicare and Medicaid Services. States have various tools at their disposal when pursuing a state plan amendmentincluding creating initial exploratory committees, following the traditional legislative processes to codify the requirement to add doula services, and/or enacting budget amendments to provide necessary funding. If a state cannot garner the political will required to submit a state plan amendment, Medicaid Managed Care Organizations (MCOs) can choose to include doula services in enhanced benefit packages. Given the recent proliferation of MCOs, this strategy can reach a large percentage of a state’s Medicaid enrolleeshowever, the state has less control over the specifics of MCO benefit implementation, leading to potential variability and inequity. Lastly, a state can leverage federal and local grant programs. Grants do not guarantee statewide access to doula care, but this is a creative way to obtain funding for doula services when other options are not feasible. Ultimately, success with any strategy depends on dedicated advocates who are willing to dig into the specifics of state policy and politics, and who are committed to working with both policymakers and local doula communities.

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