Medicaid coverage of doula services in the United States
Frequently asked questions
- Which states mandate coverage of doula services through Medicaid?
- Who is eligible for doula services through Medicaid?
- What doula services are covered through Medicaid?
- How much are doulas paid through Medicaid?
- Do employer-based health plans cover the cost of doulas?
Which states mandate coverage of doula services through Medicaid?
Minnesota, New Jersey and Oregon mandate coverage of doula services through Medicaid. Managed care organizations (MCOs) and coordinated care organizations (CCOs) — which oversee Medicaid plans — must reimburse doulas for their work in these three states.
Indiana’s Medicaid program also covers doula services through its community health worker benefit. Established in 2018, this benefit is somewhat new. The state does not keep a list of community health workers who are doulas.
Although only four states mandate coverage, some MCOs and CCOs cover doula services as an “extended benefit” for Medicaid enrollees. Regardless of where you live, it may be helpful to call the member hotline listed on your insurance card and ask about coverage. We found that some MCOs in California, the District of Columbia, Florida, Massachusetts, Nevada and Pennsylvania cover doula services for pregnant Medicaid enrollees.
New York launched a pilot program for Medicaid reimbursement of doula services in Erie County in 2019. The program will eventually expand to Kings County, and the pilot will end in 2023.
In April 2021, Illinois Gov. J.B. Pritzker signed a wide-ranging health care reform act into law. As a result, doulas will eventually be covered under Medicaid in Illinois. Nevada Gov. Steve Sisolak and Rhode Island Gov. Daniel McKee also signed legislation that will allow people to access doulas through Medicaid. (In Rhode Island, commercial insurance companies will also have to cover doulas.)
To see a complete list of 2019, 2020 and 2021 federal and state bills related to expanding access to doula care, click here.
Who is eligible for doula services through Medicaid?
In Indiana, Minnesota, New Jersey and Oregon, pregnant individuals living at or below the state’s federal poverty limit are eligible for doula services if they are covered by the state’s Medicaid program.*
|State||Federal poverty limit||Monthly income limit for a family of four**
Sources: Indiana Family and Social Services Administration; Minnesota Department of Human Services; NJ Family Care; Oregon Health Authority
*Coverage for undocumented pregnant individuals varies according to state policy.
**FPL limits may include coverage for pregnant individuals through the Children’s Health Insurance Program.
†Doula services available through Indiana’s community health worker benefit.
What doula services are covered through Medicaid?
Indiana offers up to 12 hours of community health worker support per month, per client.
Minnesota covers three prenatal visits, labor support and three postpartum visits with a state-registered doula. Search for a doula in Minnesota here.
New Jersey covers eight perinatal visits and labor support with a state-registered doula. If the client is 19 or younger, they will be eligible for a total of 12 support visits.
Oregon covers two prenatal visits, labor support and two postpartum visits with a state-registered doula. Search for a doula in Oregon here.
How much are doulas paid through Medicaid?*
|State||Package||Total possible amount|
|Indiana||$19.40 per hour**||Varies**|
$47 per prenatal or postpartum visit (up to 6 visits)
$488 for continuous labor support
$66.48 per hour for prenatal and postpartum visits (up to 8 visits or 8.5 hours)†
$235 for continuous labor support
$50 per prenatal or postpartum visit (up to 4 visits)
$150 for continuous labor support
*States’ fee-for-service rates
**One-on-one self-management education & training; maximum amount per patient, per month: $232.80
†The first prenatal visit can be up to 1.5 hours. If the client is 19 or younger, they will be eligible for 12 support visits (12.5 hours). New Jersey is offering doulas a $100 incentive if they ensure that their client attends a postpartum appointment with an obstetrician, midwife or similar provider.
††Total possible amount can range from $800 to $1166, depending on the circumstances
‡Doulas have negotiated higher rates with coordinated care organizations. Learn more.
Do employer-based health plans cover the cost of doulas?
For the most part, employer-based health plans do not cover the cost of doulas. However, it does not hurt to ask your benefits manager or call the member hotline listed on the back of your insurance card.
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you may be able to use those funds to pay for doula services. Make sure to ask your doula if they accept HSA or FSA funds as payment.
If your employer-based plan does cover doulas, please reach out to us via email: email@example.com.
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Last updated: July 19, 2021
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