September 2026

Policymakers and state Medicaid agencies can support the integration of doulas into maternal care models to address persistent maternal health challenges, improve birth outcomes, and expand access to supportive services for beneficiaries. Key areas of focus include:

• Make doula services easy for Medicaid members to access. Examination of states with a Medicaid doula benefit demonstrate that coverage alone does not guarantee uptake of doula care. Utilization remains low when providers and eligible members are not aware of the Medicaid benefit and the process for accessing care, or when states position providers as gatekeepers to doula services. States can increase uptake of doula services through provider education, member outreach, and streamlined referral pathways. Several states such as New York use standing orders that allow members to access doula services without a referral from a provider.
• Support doula-friendly hospital policies. Doulas may face barriers accompanying clients in hospital settings, and nurses and physicians often have varying levels of understanding about the role doulas play in maternal care. Doula-friendly hospital policies can help ensure that doulas are not denied access to their patients during labor and delivery. These policies may include training for hospital staff on the role of doulas, and the benefits doula support can provide to mothers and families.
• Reduce administrative burden for doulas. Most doulas have little experience with Medicaid provider enrollment and traditionally receive direct payments from the clients and families they serve. Common barriers for enrollment, such as credentialing and fulfilling documentation and managed care contract requirements, can be challenging for individual doulas and they may need support that is often offered to other health care providers. Potential solutions for support include streamlined credentialing and use of “doula hubs” or organizations to handle billing and administrative tasks.
• Engage doulas and communities early and continuously. States that co-design Medicaid benefits with doulas and community organizations have stronger engagement with doulas and members. Successful programs center community-based doulas, who reflect Medicaid members’ cultural and linguistic needs.
• Invest in workforce development and sustainability. Without workforce investment, Medicaid doula coverage does not necessarily translate into access. Training pipelines and certification pathways for community-based doulas is critical to expand access to doulas and meet community needs. Workforce strategies include training subsidies, certification flexibility, and support for community-based doula organizations.
• Strengthen workforce participation and program success by establishing appropriate payment rates. Early Medicaid doula programs in states such as Oregon and Minnesota experienced limited provider participation until reimbursement rates increased. Adequate reimbursement rates reflect the time-intensive nature of doula care across the prenatal and postpartum period as well as on-call labor support. Rates vary widely across states, with higher rates generally associated with stronger program participation. Sustainable implementation also requires timely payment and flexible billing structures across both fee-for-service and managed care models. These investments may be financially beneficial, as economic modeling suggests that doula care may be cost-effective or cost-saving due to reductions in cesarean delivery and preterm birth.