While New Jersey has lower infant and maternal mortality rates than most states, there are significant disparities in these rates across the state’s white and black, non-Hispanic residents. To address this gap, Lisa Asare, New Jersey Assistant Commissioner of Family Health Services, and Mehnaz Mustafa, the state’s Lead Maternal and Child Health Epidemiologist, recently partnered to pilot a doula program in areas with high black infant mortality rates and promote opportunities to reimburse doula services. Under CHCS’ New Jersey Medicaid Academy, Ms. Asare and Ms. Mustafa expanded the pilot to focus on sustainability strategies and collaborate with the New Jersey Department of Human Services’ (NJDHS) Division of Medical Assistance and Health Services (DMAHS). Their efforts took a big leap forward in early March when New Jersey’s First Lady, Tammy Murphy, announced that Governor Murphy allocated one million dollars in the state budget to support doula care for Medicaid beneficiaries. The investment is designed to address racial disparities in health outcomes for New Jersey mothers and their children.

The Medicaid Case for Doulas

Doulas provide critical emotional, physical, and educational support to mothers who are expecting, in labor, or in the first months of motherhood. Doula care is associated with lower rates of caesarian sections, fewer obstetric interventions, fewer complications, decreased use of pain medication, shorter labor hours, and higher scores on the Apgar test, a newborn assessment. Yet, only a handful of states use Medicaid funds to support doula services. As of early spring 2019, only four states  — Indiana, Minnesota, New York, and Oregon – supported Medicaid reimbursement of doulas.

Making the Case for Doulas in New Jersey Under Academy in Action

Ms. Asare and Ms. Mustafa both participated in the Center for Health Care Strategies’ (CHCS) New Jersey Medicaid Academy, an eight-month long leadership and professional capacity-building program for state health and human service staff supported by The Nicholson Foundation. The supplementary Academy in Action (AiA) program provides select Academy graduates with an opportunity to tackle a real-world policy problem and further cross-agency collaboration.

Under AiA, Ms. Asare and Ms. Mustafa reconvened the NJDOH and NJDHS together to focus on the immense health disparities in infant and maternal mortality among black mothers and babies. Through their collaborative project, the team analyzed various policy options to address disparities and poor infant and maternal health outcomes. They built on the doula pilot. The NJDOH also partnered with NJDHS to identify strategies for sustaining the existing pilot, including reimbursement for services provided by doulas. Ultimately, their final recommendation to Medicaid leadership was to support reimbursement for doula services under Medicaid. AiA provided a firm foundation for the work ahead.

Accelerating Opportunities for Doulas in New Jersey

In early March 2019, New Jersey’s First Lady Tammy Murphy announced that the Governor allocated one million dollars in the state budget to support doula care for Medicaid beneficiaries. The announcement was a part of Nurture New Jersey, First Lady Murphy’s statewide awareness campaign committed to reducing infant and maternal mortality and morbidity, and ensuring equitable care among women and children of all races and ethnicities.

Since the First Lady’s announcement, Ms. Asare and Ms. Mustafa have worked at an accelerated pace with Medicaid staff, New Jersey Department of Health (NJDOH) leadership, and Department of Human Services leadership to move their vision for accessible doula care forward. Reflecting on their work, Ms. Asare shared, “Participation in the AiA project provided much needed background, creating a framework for sustaining the important work of the doula pilot.”

Next Steps for New Jersey Medicaid Doula Services Reimbursement

On the heels of Ms. Asare and Ms. Mustafa’s efforts is Bill S1784, which was signed into law by Governor Murphy in May 2019. The bill allows the state to expand New Jersey’s Medicaid program to cover doula services. The bill permits the state to seek federal approval through a State Plan Amendment or waiver. This approval allows doulas to receive Medicaid reimbursement as an established provider. As doula care is embraced by the state as a lever to address disparities, the efforts of Ms. Asare and Ms. Mustafa exemplify the power of strong collaboration across historically siloed agencies. When cross-agency priorities align, the opportunity for meaningful action surges.

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Martha

Well written. Thank you for sharing this important work!

Jessica Lipper

Great blog post! What a great narrative around the genesis of this legislation. I look forward to seeing it operationalized so that more Medicaid beneficiaries can access doula services as a covered benefit. A-1662 was substituted by S-1884, the Senate companion, and enacted into law on May 8, 2019 as P.L. 2019, c. 85.