Frequently asked questions

Please note that this page is no longer being regularly updated, and things may have changed since we compiled this information. (Last updated: Jan. 6, 2021)

For pregnant people in Minnesota
For doulas in Minnesota who want to serve the Medicaid population
For pregnant people in Minnesota

Who is eligible for doula services through public insurance in Minnesota?

Any pregnant person living at or below 278 percent of the federal poverty level (FPL) is eligible for Medical Assistance (Medicaid) in Minnesota. If you are enrolled in Medical Assistance, doula services are considered a covered benefit. This means you can have a doula throughout your pregnancy, labor and delivery and postpartum without having to pay a fee.

To learn more about eligibility for Medical Assistance, click here.

Approximations of income limits at 278% FPL
Family size Monthly income limit Annual income limit
2* $3,993 $47,927
3 $5,031 $60,381
4 $6,069 $72,836
5 $7,107 $85,290
6 $8,145 $97,744
7 $9,183 $110,199
8 $10,221 $122,653

Source: Minnesota Department of Human Services

*A family size of two includes the pregnant person and the unborn child

Note: Undocumented pregnant individuals may be eligible for MA coverage through Children’s Health Insurance Program funding

What doula services am I eligible for if I am pregnant and enrolled in Medical Assistance?

You are eligible for three prenatal visits, labor support and three postpartum visits. For more information about what you can expect if you choose to work with a doula, click here.

How can I find a doula through Medical Assistance?

One option is to ask your provider and/or your managed care organization (Blue Plus, Hennepin Health, Health Partners, PrimeWest Health, Itasca Medical Care, Medica, South Country Health Alliance or UCare) if they have any information on how to connect you to a doula. If you’re connected to any type of social service, such as your local WIC office or a home visiting program, you can ask them the same question.

Another option is to look at the Minnesota Department of Health’s doula registry. The department maintains a list of doulas who meet the state’s requirements to serve the Medicaid population. This state registry includes the doulas’ names, counties where they serve and their contact information. (Please note that doulas who are not on the state registry are capable of serving pregnant people, too. However, they cannot get paid through Medical Assistance if they are not on the state’s registry.)

Lastly, you can self-request a doula through Everyday Miracles, a nonprofit based in Minneapolis that matches pregnant people to doulas. Any pregnant person in Minnesota can fill out a request form. However, many of their doulas are located in and around the metro area.

Click here to see a list of other organizations that may be able to connect you with a doula.

For doulas in Minnesota who want to serve the Medicaid population

What should I know before I read this?

We gathered this information from public websites and more than 30 interviews with doulas, community leaders, government workers, managed care organizations, lawmakers and researchers. Please note that we are not including information below about doula organizations who serve the Medicaid population and do not bill Medical Assistance. They may pay their doulas through grant funding and/or donations or the doulas may be volunteers.

Go back to list of FAQs.

What steps do I need to take in order to be reimbursable through Medical Assistance?

1. You must apply to be a state-registered doula. The total cost of applying is $200. If you are certified through one of the following organizations, you are eligible to apply:

2. Once your registration is approved, you will appear on the Minnesota Department of Health’s doula registry. Your registration will be valid for three years. Then, you must renew and pay the fee again.

3. From here, it gets tricky. (See below.) You are eligible to work with Medical Assistance clients, but actually getting paid for your work will require additional steps.

Go back to list of FAQs.

I’m on the registry. What do I do next?

You will need to find a way to bill for your services, which may require becoming an enrolled provider with a managed care organization (MCO). A majority of people on Medicaid in Minnesota have managed care plans through the Prepaid Medical Assistance Program (PMAP). Seven MCOs have PMAP programs in Minnesota: Blue Plus, Hennepin Health, Health Partners, PrimeWest Health, Itasca Medical Care, South Country Health Alliance and UCare.

If someone is not enrolled in a managed care plan but has Medical Assistance, the person has fee-for-service coverage (FFS) through the Minnesota Department of Human Services. The department outlines what it takes to bill for doula services here. Read this thoroughly. Although these instructions are targeted toward services provided to FFS members, it is applicable to PMAP members, too.

For example, regardless of how your client recieves coverage, the state requires provider supervision. This means you will need a clinician to agree to allow you to bill under their national provider identifier (NPI). This has been a major barrier for doulas.

During our reporting process, we discovered three scenarios in which you could be paid for your work through Medical Assistance.

Scenarios:
Least likely scenario: Bill as an independent doula

We only found one independent doula who was able to bill a MCO for doula services. It was a long process, but she worked closely with her clients’ MCO to become an enrolled provider. However, the amount of time she spent on paperwork led her to give up on billing the MCO for her services.

Main takeaways: If you want to bill as an independent doula, there will be a number of barriers. However, it does not hurt to contact the MCO in your region to see if they can help you figure out the process.
Possible scenario: Establish a partnership with a local birth center

Reach out to birth centers in your area to see if the midwife (or midwives) would be willing to work with you when you have the same clients. We found one birth center who is working with a doula in a rural area and billing on her behalf.

Main takeaways: Birth centers are a good place to start. However, if your client ends up delivering at a hospital instead of the birth center as planned, you could encounter difficulties (i.e. the birth center may only be able to bill for the prenatal and postpartum visits but not labor support). This scenario may also limit which clients you can take if they plan to deliver at a hospital, not a birth center.
Most common scenario: Work with Everyday Miracles or ask other maternal health organizations if they’ve figured out a path to reimbursement

Many doulas take clients through Everyday Miracles, a nonprofit in Minneapolis that started in 2003. The organization covers the cost of liability insurance for the doulas and helps them get on MCOs’ provider lists. The organization also takes care of billing, so doulas don’t have to take on additional labor. For each Medicaid payment to doulas, Everyday Miracles absorbs the provider tax but takes a fee to “keep the doors open.”

Most doulas who take Everyday Miracles clients live in and around the metro area, but the organization is willing to work with doulas who live in other areas of Minnesota. The main caveat is that you must have a back-up doula in your area.

Main takeaway: Everyday Miracles has figured out a way to bill for doulas who are serving Medicaid clients. Given the amount of work it takes to bill, their process is hard to replicate — but it’s not impossible.

Go back to list of FAQs.

How much do doulas get reimbursed through Medical Assistance?

As of July 2019, doulas should be paid $47 per prenatal and postpartum visit and $488 for labor support. Unless you receive prior authorization for more visits, clients are eligible for six prenatal and postpartum visits and labor support per pregnancy. If you complete all six support visits and are present for the labor, the total compensation is $770.

Minnesota Medical Assistance (Medicaid) fee-for-service rates: Doula services

Time period Prenatal or postpartum visit Labor support Total possible amount
July 2019 to present* $47 per visit (up to 6) $488 $770
July 2014 to July 2019 $25.71 per visit (up to 6) $257.10 $411.36

*Managed care organizations’ new contracts went into effect at the beginning of the calendar year. For MCOs, higher rates went into effect Jan. 1, 2020.

If you need to show an MCO the rates, look at Minnesota 2019 Session Law, which reads:

Sec. 36. [256B.758] REIMBURSEMENT FOR DOULA SERVICES.
“Effective for services provided on or after July 1, 2019, payments for doula services provided by a certified doula shall be $47 per prenatal or postpartum visit and $488 for attending and providing doula services at a birth.”

Go back to list of FAQs.

Who will pay me?

If your client is enrolled in a managed care plan, that MCO will be responsible for issuing payment. If your client is not enrolled in a managed care plan but has fee-for-service coverage (FFS), the Minnesota Department of Human Services is responsible for issuing payment.

Go back to list of FAQs.

Who is obligated to pay the $770 rate?

The Minnesota Department of Human Services is obligated to pay doulas whatever the FFS rate is. Right now, the total possible amount is $770.

However, people told us that some MCOs did not immediately begin paying the higher rate. While it’s possible that the MCOs did not realize the rate increased in 2019, Diogo Reis, the fee-for-service policy and rates manager at the Minnesota Department of Human Services, said that the MCOs were notified about the rate increases going into 2020.

However, the state cannot necessarily mandate that MCOs offer the full $770, Reis said. Although MCOs oversee Medicaid enrollees, the organizations can set some of their own rates. Hypothetically, this means that a doula could negotiate a higher rate than the state’s FFS rate. (From what we can tell, this has not happened in Minnesota yet.) Unfortunately, this also means that MCOs do not have to pay the $770 rate.

However, Reis said MCOs are “obligated to have doula services within their benefit, and that means making sure there’s a rate that’s sufficient to guarantee that there are some [doulas] available.”

If you find that an MCO is not paying a sufficient rate (i.e. at least $47 per prenatal and postpartum visit and $488 for labor support), you can contact the Minnesota Department of Human Services. This could prompt an investigation into the MCO.

Go back to list of FAQs.

Are there any advocacy groups working to change current doula policy?

The Birth Equity Community Council in Ramsey County will be organizing around this issue.

Go back to list of FAQs.

If you have questions about this page, please email us at info@doulaseriesfootnotes.com.