Steps to becoming reimbursable through Medicaid as a birth doula in Oregon

During interviews with doulas, we consistently heard that:

We pulled together a list of steps, links and tips that we gathered during our reporting process to help future THW birth doulas:

1. Apply to become a certified traditional health worker (THW) birth doula.

You must be a certified THW birth doula to get reimbursed through Medicaid. This will require patience, time and paperwork. Although the OHA does not charge an application fee, certain aspects of this process may cost money.

If you are not a doula but would like to become one, be sure to review the OHA’s training requirements. If you are already a practicing birth doula, make sure you’ve met all of the OHA’s THW birth doula training requirements, which include becoming CPR-certified, completing an oral health training, attending a cultural competency training and more. The OHA also requires a background check.

Once you are certified, it will last three years and your name and contact information will be listed on the Oregon traditional health worker registry. Prospective clients can search for you by name, location and race/ethnicity on this site. After three years, you must apply for recertification, which requires at at least 20 hours of continuing education.

Links to more resources:
  • Review instructions on how to become a certified THW birth doula, compiled by Debra Catlin, who is a member of the Traditional Health Worker Commission. This document includes a link to a downloadable THW application. These instructions include links to some free online trainings to meet requirements surrounding cultural competency, trauma-informed care and oral health.
  • Look through the OHA’s list of THW-approved training programs and continuing education.
  • The Oregon Doula Association’s website has some educational resources.
  • Learn more about THWs.
  • Confused? The OHA said: “Any prospective applicant can send email, questions and concerns to the THW programs using this email: THW.program@dhsoha.state.or.us. This email is monitored daily and all inquiries, questions and concerns are addressed in a timely manner by staff.”
2. Obtain a national provider identifier (NPI).

Health care providers in the United States use NPIs for various reasons. You will need an NPI to bill Oregon Health Plan or your local CCO for your doula services. You can register for an NPI for free.

3. Enroll as an Oregon Medicaid provider.

Go to this website and scroll down to “OHA enrollment forms,” then type “doula” in the search function (or click here and wait for the page to load). If you are an independent THW birth doula, there are two forms to fill out. There are separate forms listed for doula billing organizations. If you are stuck, email this address: Provider.ENROLLMENT@dhsoha.state.or.us

4. Prep yourself on how to submit claims to OHA directly (for clients who have OHP “open cards”; otherwise known as fee-for-service) or to your local CCO.

When you reach this step, technically you can start taking Medicaid clients and bill for your services. However, billing is complicated, and if you’re unfamiliar with the system, you may want to consider following these tips:

  • Contact your local CCO’s traditional health worker liaison to learn more about how the CCO is working with THW birth doulas. Ask questions like, “Do I need to be contracted with the CCO in order to bill for my services?”, “What are your rates for doula services?” and “Can I still fill out a paper form, or do I have to submit a claim electronically?”

  • To submit a claim to a CCO, you will need to learn how to fill out a HCFA 1500 (also known as a CMS 1500) form, which you can purchase at places like Staples and Office Depot. The Oregon Doula Association lists some tips here.

    Warning: Once you start billing the CCO, some THW liaisons may not be able to walk you through how to fill out a HCFA 1500 form step-by-step.

  • In order to fill out a HCFA 1500, you will need to know what billing codes to use. Although this tip sheet from OHA may need updating, the billing codes remain the same. Note: There are nuances to filling out these forms. Ask fellow doulas for tips. There is a video circulating that walks doulas through how to fill out a HCFA 1500 form.
5. Find an avenue to work with Medicaid clients as a doula.

If you wish to work as an independent doula, don’t forget to ask your THW liaison questions along the way. Your peers may be willing to help you, too.

If you want additional support, know that doula hubs are forming across the state. Typically, one or two designated people handle administrative tasks, such as billing and contracting with a CCO. Click here to find a list of doula hubs in Oregon.

Last updated: Dec. 29, 2020

If you believe the information above is no longer current or if you would like to submit an addition, please email us at info@doulaseriesfootnotes.com.