| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | AF | AG | AH | AI | AJ | AK | AL | AM | AN | ||
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1 | This chart was created and is maintained by the National Health Law Program's Doula Medicaid Project. You are welcome to use this as a resource, but if you do so, we ask that you please cite to us. This chart is not intended as legal advice. Doulas seeking certification in their state are advised to confirm requirements with their relevant state agencies. | ||||||||||||||||||||||||||||||||||||||||
2 | State | Implementation Status | Timeline | Implementation Strategy | Summary of Implementation Efforts | Private coverage bills? | State specific report or survey? | Available Resources | Statewide standing recommendation? | Reimbursement rate | Billing / Payment Structure | Who can bill? Individual, group, other entities? | In what physical setting are doula services covered? | Coverage for abortion doula care? | Telehealth ok? Any limitations? | Training, Credentialing, and/or Certification Requirements | Credentialing - list of orgs or core competencies? | Experience or legacy pathway? | Continuing education? | Fingerprint/ background check? | Liability insurance? | Funded outreach efforts? | Application fee? | ||||||||||||||||||
3 | Updated Sep 2025 | Green: reimbursing Yellow: in process Blue: adjacent action | NOTE: Information in these sections is primarily for states that have implemented or are in the process of implementing Medicaid coverage for doula care. | ||||||||||||||||||||||||||||||||||||||
4 | AK | Adjacent Action Taken | 2023-2024 - State funded a pilot community doula program | State funded a community doula pilot program | From 2023-2024, an Anchorage-based organization called Due North Support Services ran a community doula program funded by the State of Alaska and the Office of the Assistant Secretary of Health. The program provided free doula care to pregnant and postpartum people, with a priority on those who: • are experiencing housing instability, • have no other labor support, • have a history of trauma or previous traumatic birth experience, • have a high-risk medical condition or mental health diagnosis; and/or • are BIPOC. | No | No | • Due North Support Services Community Doula Program | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
5 | AL | Adjacent Action Taken | 2023 - Statewide committee forms to advance doula efforts | Statewide committee is exploring Medicaid coverage for doula care; doula pilot program also currently ongoing | Birmingham-based BirthWell Partners runs a Community Doula Project providing free and/or low-cost doula services to under-resourced families in the community who are at higher risk for infant and maternal mortality, with a focus on services for Medicaid enrollees. It also provides support to pregnant people with substance use disorder. The Project is funded in part by the City of Birmingham as well as the Alabama Department of Mental Health. In 2023, a group including March of Dimes, Women's Foundation of Alabama, and BirthWell Partners Community Doula Project, came together to form a committee to begin exploring Medicaid coverage for doula care in Alabama. The committee has been working to educate legislators about doula care, and plans to introduce legislation in 2025. | No | No | • BirthWell Partners Community Doula Project | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
6 | AR | Implementation in Progress | Jan 2024 - Statewide health policy organization endorses expanded access to doula care Aug 2024 - Statewide coalition forms with goal of advocating for Medicaid coverage for doula care 4/21/2025 - HB1252 signed into law 2/20/2025 - HB1427 signed into law October 2025 - Anticipated start date of benefit | Statewide coalition formed to advocate for Medicaid coverage for doula care; bill passed in Feb 2025 to implement Medicaid coverage of doula care | In January 2024, the Arkansas Center for Health Improvement formally endorsed expanded access to doulas to address the maternal and infant health crisis in the state. The announcement included an explainer about Doulas and the Birthing Journey. In February 2024, KUAF (state NPR affiliate) aired a story about doulas and their potential role in addressing the maternal health crisis. In August 2024, the Doula Alliance of Arkansas was launched, following a seed grant of $250,000 from Ingeborg Initiatives. The coalition hopes to work on championing improved maternal health outcomes in the state and to introduce legislation aiming at expanding access to doula care in private insurance and Medicaid. In January 2025, HB1252 was introduced, which lays out a mechanism for the Dept of Health to certify a category of "certified community-based doulas" and maintain a public registry of said doulas. The bill also requires that certified community-based doulas receive compensation from Medicaid as well as health benefit plans. The bill requires that the Dept of Human Services promulgate rules for doula reimbursement in Medicaid by 12/31/2025. The bill was enrolled into law on 4/21/2025. On 2/6/2025, HB1427 (companion bill SB213) was introduced, which would require the AR Medicaid Program to reimburse doulas and CHWs for home visitation services related to prenatal and postpartum care. The bill was enrolled into law on 2/20/2025. The state aims to implement Medicaid coverage for doula care by October 2025. | Yes, HB1252 will allow state certified community-based doulas to receive compensation from private health benefit plans | No | • ACHI position on doula care • Doula Alliance of Arkansas • HB1252 (2025) • HB 1427 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
7 | AZ | Actively Reimbursing | 4/26/2021 - SB 1181 passed 8/2023 - Start date for state voluntary doula licensing program 9/23/2024 - SPA approved 10/1/2024 - Start date for doula Medicaid benefit | Following legislation, state created "voluntary licensing program" to designate state-certified doulas before implementing coverage | Senate Bill 1181 passed in April 2021, outlining a multi-step process of state certification for doulas. State certification is not required to practice as a doula in the state. However, advocates anticipate that the creation of state-certified doulas will be a stepping stone to Medicaid coverage for doula care. The Dept of Health Serices launched what it calls its "voluntary licensing program for doulas" in August 2023. Doulas who apply and meet the requirements receive a three-year license to provide state-certified doula services. SB 1181 also established a Doula Community Advisory Committee to consult with the Director of the Dept of Health Services on implementation of certification practices. The Committee met from 2022-2023. In 2023, UnitedHealthcare began offering doula services as part of a statewide pilot program. (UnitedHealthcare is also running similar doula pilots in Kansas, Kentucky, Texas, and Washington.) In Sep 2024, Arizona's SPA was approved by CMS, with an effective start date of 10/1/2024. | No | No. | • SB 1181 (2021) • AZ Dept of Health Services Doula page • Approved SPA | No. | There is no maximum total reimbursement rate. The total reimbursement will depend on how many visits the doula and client decide together are appropriate, and the length of each visit. | Doula services are covered at the rate of $16.28 per 15 min for prenatal and postpartum visits. Prenatal and postpartum visits can be billed up to a maximum of two hours per visit, unless a doula requests and receives prior authorization to the health plan for a visit longer than two hours. There is no minimum or maximum. number of prenatal or postpartum visits per pregnancy. Presence at labor and delivery is billed at a flat rate of $781.32. There is no maximum total reimbursement rate. The total reimbursement will depend on how many visits the doula and client decide together are appropriate, and the length of each visit. | Individual doulas are permitted to bill. Doula groups or organizations can also enroll as "group billers" and bill on behalf of the doulas affiliated with their group/organization, so long as each doula they are billing for is also individually registered with the state. | Regulations do not contain specific limitations. | Unclear. | Regulations do not contain specific limitations. | Applicants to become state certified doulas must: • be at least 18 years old • have a high school diploma or equivalent • sign a Doula Code of Ethics Agreement form • provide documentation of training in infant and adult CPR • undergo fingerprinting • pay a nonrefundable application fee of $100 plus an initial license fee of $200 (waivers available for first time applicants at or below 200% FPL, applicants who are the spouses of an active duty military service member, or applicants who are honorably discharged veterans within the prior two years) • be U.S. citizens or have legal immigration status There are multiple pathways for certification. Pathway 1, 2, 3, and 4 all require submission of a birth observation form, and a doula attestation form for being a primary doula at three births. • Pathway 1 also requires a doula competency attestation form demonstrating at least 30 hours of instruction in core competency topics • Pathway 2 also requires a doula competency attestation form demonstrating community training in non-western doula practices and confirmation of completed core competency training through culturally specific training or education • Pathway 3 also requires a doula competency attestation form demonstrating other related individualized or experiential training or education and confirmation of completed core competency training through culturally specific training or education. • Pathway 4 also requires proof of current certification from an approved doula organization Pathway 5 is for those who have been practicing as a doula in Arizona for at least five years prior to 9/29/2021. To be considered under pathway 5, doulas must submit proof of current certification from an approved doula organization, and completed and signed Letters of Recommendation form from health care professionals who have worked with the applicant within the preceding two years who can attest to the applicant’s competency in providing doula services. Doulas who have been credentialed in another state for at least one year can apply for reciprocity. | Both. AZ has multiple pathways for credentialing, some of which require proof of current certification from an approved doula organization, and others which allow for instruction in core competencies. More details here. | Yes. Pathway 3 allows for doulas to attest to competency through "other related individualized or experiental training or education" | Yes. The initial certification is good for three years, after which time renewal is required. Renewal requires completion of 15 hours of continuing education. | Yes. Doula application requires issuance of a valid fingerprint clearance card and signed Doula Code of Ethics. | No. | No. | |||||||||||||||||||
8 | CA | Actively Reimbursing | 6/28/2021 - Doula services included in state budget 10/4/2021 - SB 65 signed 2/15/2022 - AB 2199 introduced (passed but vetoed by Gov) 1/1/2023 - Start date of doula benefit 1/26/2023 - SPA approved 2/9/2023 - AB 583 introduced (passed but vetoed by Gov) 10/7/2023 - AB 904 signed 12/19/2023 - SPA approved increasing reimbursement rate | Doula services were included in state budget in 2021, State Medicaid Agency worked to implemented benefit from 2021-2022, launched benefit in Jan 2023 following SPA approval | Doula services were included in Governor Newsom's 2021-2022 state budget in June 2021. Additional details about implementation of doula Medicaid care were also included in SB 65, the California Momnibus, which was signed by Governor Newsom in October 2021. The doula benefit were initially slated to begin on 1/1/2022. The start date was subsequently pushed back to 7/1/0222 and then again to 1/1/2023. The SPA was approved on 1/26/2023 and the benefit began on 1/1/2023. California's doula Medicaid benefit is available to all pregnant and postpartum people regardless of immigration status. Coverage is full spectrum, providing doula care for all the ways in which a pregnancy ends including not just doula care for prenatal, labor/delivery, and postpartum, but also for abortion, miscarriage, and stillbirth. The State Medicaid Agency, the CA Department of Health Care Services (DHCS) began working with doulas and other stakeholders on implementation in Sep 2021. DHCS iniitally convened a Doula Stakeholder Workgroup which met Sep 2021 to Jan 2023. As required by AB 65, DHCS then convened a Doula Implementation Workgroup which began meeting in March 2023 and will continue meeting through the end of 2024. Since 2022, there have been ongoing efforts to include doula care in private insurance: • In Feb 2022, AB 2199 was introduced, which would have created the Birthing Justice for California Families Pilot Project to provide full spectrum doula care to members of communities with high rates of negative birth outcomes who are not eligible for Medi-Cal and incarcerated people. AB 2199 was vetoed by the Governor in Sep 2022. • The Birthing Justice for California Families Pilot Project was reintroduced in Feb 2023 as AB 583 but was ultimately held in committee. • AB 904, also introduced in Feb 2023, requires most private health plans in the state to create "maternal and infant health equity programs" that address "racial health disparities in maternal and infant health outcomes through the use of doulas." The bill also authorizes the convening of workgroups to implement such programs. AB 904 was signed by the Governor in Oct 2023. • CalPERS, California's Public Employees' Retirement System, announced that it would be including doula care as a new benefit for calendar year 2025. (CalPERS manages health benefits and pensions for California public employees, retirees, and their families.) In Nov 2023, DHCS Medical Director Dr. Karen Mark, issued a statewide standing recommendation for doula services. California was the second state, after Michigan, to issue a standing recommendation of this type (Michigan's standing recommendation was issued in January 2023). In Dec 2023, a SPA was approved increasing the doula reimbursement rates. In July 2025, DHCS released its Doula Benefit Implementation Report, covering the first two years of the state's doula Medicaid benefit. | AB 2199 (2022) and AB 583 (2023), which would have created a pilot project to provide full spectrum doula care for those with private insurance in communities with the highest rates of negative birth outcomes, did not pass. AB 904 was signed into law in Oct 2023, and requires private health plans to create maternal and infant health equity programs that address racial disparities in care through the use of doulas. CalPERS, California's Public Employees' Retirement System, includes doula care as a new benefit as of Jan 2025. | • Building A Successful Program for Medi-Cal Coverage For Doula Care: Findings From A Survey of Doulas in California (2020) • California Doula Pilots Lessons Learned Project (2022) • California Doula Workforce Analysis (2024) • Doula Benefit Implementation Report (2025) | • DHCS Doula Services Page • AB 2199 (2022) • Approved SPA • AB 583 (2023) • AB 904 (2023) • Medi-Cal APL 23-024 on Doula Services • Statewide Standing Recommendation for Doula Services • Approved SPA increasing reimbursement rates | Yes, as of 11/1/2023 | $3152.65 for a vaginal delivery, $3263.31 for a cesarean birth (see DHCS Doula FAQ) | As of 1/1/2024, DHCS reimburses doula services at the following rates: • initial visit (90 min): $197.98 • prenatal visit: $162.11 • postpartum visit: $162.11 • extended postpartum support: $486.36 for a three-hour visit • support during vaginal delivery: $685.07 • support during cesarean birth: $795.73 • support during or after miscarriage: $250.85 • support during or after abortion: $250.48 Up to eight prenatal or postpartum visits can be provided after the initial 90-min visit. Up to two additional extended three-hour postpartum visits can be provided after the end of the pregnancy. No additional criteria or separate recommendation is required for the two extended postpartum visits. The total reimbursement rate for the full set of prenatal and postpartum appts and support during birth is $3152.65 for a vaginal delivery and $3263.31 for a cesarean birth. (Prior to Dec 2023, the total reimbursement rate for the full set of prenatal and postpartum appts and support during vaginal delivery or cesarean birth was $1514.43). Up to nine additional postpartum visits can be provided after the 11 visits described above, but require an additional recommendation from a licensed Medicaid provider. | Doulas can enroll and bill as individuals or groups. Community-based doula groups, organizations, and agencies can all enroll as doula groups. | There are no limitations on where doulas can provide services. Doulas can provide services in the community, at a member’s home, and in hospitals, among other locations. | Yes, doula services are available during and after pregnancies that end in miscarriage, still birth, or abortion. | Yes, doulas can provide all services via telehealth, including by telephone. | Doulas are allowed to enroll as Medi-Cal providers if they meet the requirements for one of two pathways: • Training Pathway: 16 hours of training in core areas or an attestation of completed training in the core areas with a syllabus, as well as an attestation that they provided support at a minimum of 3 births • Experience Pathway: five years of experience and three written client testimonial letters or professional letters of recommendation Doulas must possess adult and infant CPR certification and basic HIPAA training. Doulas must also complete three hours of continuing education in maternal, perinatal and/or infant care every three years. | Under the training pathway, CA requires that doulas complete at least 16 hours of training in core competencies | Yes. CA offers both training and experience pathways. | Yes, doulas must complete three hours of continuing education in maternal, perinatal, and/or infant care every three years | No. | No. | The Los Angeles Board of Supervisors in 2023 allocated funding to create a county-wide doula hub. The hub is expected to launch in late 2024. | |||||||||||||||||||
9 | CO | Actively Reimbursing | 7/6/2021 - SB21-193 signed by Governor 5/30/2023 - SB23-288 signed by Governor 3/5/2024 - SB24-175 introduced 7/1/2024 - Start date of benefit 8/19/2024 - SPA approved | Doula care included in state budget, legislation passed to support implementation work of doula care in Medicaid and ultimately private insurance | In July 2021, Colorado passed a trio of Birth Equity Bills, including SB 21-193, which among other things requires that health facilities allow doulas to be present during labor in addition to a partner or spouse. In Jan 2023, Elephant Circle and Soul 2 Soul Sisters published Advocating for Birthworkers in Colorado, a report that shares the experience of birthworkers in Colorado and advocacy recommendations. In April 2023, SB23-288 was introduced, which requires the Dept of Health Care Policy and Financing to begin a stakeholder process to explore Medicaid coverage for doula care, create a report of findings/recommendations from the stakeholder process, seek federal SPA authorization no later than 7/1/2024, and create a scholarship program for those pursuing doula training/certification to serve Medicaid enrollees. The bill also requires the Division of Insurance to to study the provision of doula coverage in private health plans and submit a report of its findings during fiscal year 2024-2025. The bill was signed by the Governor on 5/30/2023. In March 2024, SB24-175 was introduced, which would require some private health plans in the state to cover doula services "in the same scope and duration of coverage" that will be included in the Medicaid context. The bill was signed by the Governor in June 2024. Doula care was also included in the Governor's budget in April 2023. $150,000 was allocated for the stakeholder process; $30,000 was allocated for outreach to Medicaid enrollees about the benefit; and $1.1 million was allocated to create a doula hub to help support doulas and Medicaid enrollees. In April 2024, The Dept of Health Care Policy and Financing announced it would be submitting a SPA to include doula care in the state's Medicaid plan, and that the increase in expenditures (state and federal funds) would be $415,752 in FFY 2024 and $1,683,794 in FFY 2025 (Doula Services Public Notice from 4/9/2024). The doula benefit began on 7/1/2024. The SPA was approved on 8/19/2024 with a retroactive effective date of 7/1/2024. | Yes. SB24-175, signed into law in June 2024, will require some private health plans in the state to cover doula care. | Advocating for Birthworkers in Colorado (2022) | • SB 21-193 (2021) • Birth Equity Bill Package (2021) • Advocating for Birthworkers in Colorado report (2022) • SB23-228 (2023) • SB24-175 (2024) • HCPF Doula Benefit page • Approved SPA | No. | Up to $1500 | Doulas are eligible for reimbursement for up to 180 min of prenatal visits and up to 180 min of postpartum visits, at $100/60 min (for a total of $600). Doulas can also be reimbursed a flat rate of $900 for labor and delivery, for a total reimbursement rate of up to $1500. | Doulas can enroll and bill as individuals or groups. | Regulations do not contain specific limitations. | Unclear, as the doula FAQ specifically allows for reimbursement in the case of "spontaneous miscarriage," which may indicate an unwillingness to allow for reimbursement in the case of abortion. | Regulations do not contain specific limitations. | All doulas seeking to become Medicaid providers must have current CPR training and agree to follow the Doula Code of Conduct. Doulas must also meet the HCPF requirements through either a certification or experience pathway. The certification pathway requires that they: • receive atraining from an HCPF-approved doula training organization • have attended at least three births in the previous five years The experience pathway requires that they: • have attended at least ten births, at least five in the previous two years • include four letters of recommendation, two from clinical members of a birth team from a previously attended birth, and two from previous clients • attest to having knowledge and competency in the required topic areas | Both. The certification pathway requires that doulas receive training from one among a list of approved certified doula training organizations. The experience pathway requires that doulas attest to having knowledge in a list of core competencies. | Yes. CO offers both a certification and experience pathway. | No, although the Doula Code of Conduct does include a requirement that: "The Doula regularly engages in continuing education and training to improve skills, competencies, and professional knowledge, and maintain an awareness of new procedures, protocols and developments that are relevant to doula practice." | Yes, background check required. | No. | Yes. The Governor's 2023-2024 budget included an allocation of $30,000 for outreach to Medicaid enrollees about the doula Medicaid benefit, and $1.1 million to create a doula hub to help support doulas and Medicaid enrollees | |||||||||||||||||||
10 | CT | Implementation in Progress | 1/2019 - Bill No. 1078 introduced (did not pass) 6/14/21 - Public Act No. 21-35 signed by Governor 5/23/2022 - H.B. No. 5500 signed by Governor 6/26/2023 - SB 986 signed by Governor 1/1/7/2025 - SPA approved 1/24/2025 - HB 6572 introduced 2/27/2025 - HB 7102 introduced 3/12/2025 - HB 7214 introduced | Legislation passed creating a Doula Advisory Committee as well as requirements for doula certification and training; DSS is incorporating doula care as part of bundled maternity payment | In 2019, Bill 1078 was introduced, which would have required Medicaid coverage for state-certified doulas. Though the bill did not pass, it kicked off conversations in the state about doula coverage. In 2021, part of Public Act No. 21-35 required that the CT Commissioner of Public Health conduct a scope of practice review to determine whether the Dept of Public Health (DPH) should establish a state certification process for doulas. DPH put together a working group which subsequently published the Scope of Practice Review Committee Report on Doula Certification in March 2022. The Department of Social Services (DSS) is planning to incorporate doula care as part of its HUSKY Maternity Bundle Payment Program, which will shift maternity care payment to a bundled payment. DSS is working with Community Health Network of Connecticut, Primary Maternity Care, and Health Equity Solutions to design and launch the full bundled maternity payment program. There are a number of bills that have been introduced since 2021: • In March 2022, HB 5500 was introduced, which established a Doula Advisory Committee to develop recommendations for certification, training, and continuing education requirements; as well as standards for recognizing doula training program curricula sufficient to satisfy the requirements for doula certification. The Committee is also required to establish a Doula Training Program Review Committee to conduct a continuous review of doula training programs and provide a list of approved doula training programs that meet the requirements established by the Doula Advisory Committee. The bill was signed by the Governor in May 2022. • In Feb 2023, HB 986 was introduced, which lays out requirements for doula certification and affirms the role of the Doula Advisory Committee and Doula Training Program Review Committee. The bill was signed by the Governor in June 2023. • In Jan 2025, HB 6572 was introduced, which requires health care facilities that offer OB/GYN services, implement doula-friendly policies. • In Feb 2025, HB 7102 was introduced, which would increase access to birth centers and birthing hospitals in underserved regions with high numbers of Medicaid enrollees, increase Medicaid reimbursement for doulas, and expand the role of fathers in supporting maternal and infant health. • In March 2025, HB 7214 was introduced, which among other perinatal policies, would convene an advisory committee to study doula-friendly practices in hospitals. The SPA for doula services was approved on 1/17/2025 with an effective date of 1/1/2025. | No. | No. | • Bill No. 1078 (2019) • Public Act No. 21-35 (2021) • Scope of Practice Review Committee Report on Doula Certification (2021) • HUSKY Maternity Bundle • HB 5500 (2022) • Doulas4CT • HB 986 (2023) • The Connecticut Doula Integration Toolkit (2023) • HB 6572 (2025) • HB 7102 (2025) • HB 7215 (2025) • Approved SPA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Requirements are forthcoming. HB 5500 passed in May 2022 to create a Doula Advisory Committee charged with developing recommendations for certification, training, and continuing education requirements. HB 986 passed in June 2023 which lays out more detailed requirements for doula certification as well as the role of the Doula Advisory Committee and Doula Training Program Review Committee. | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
11 | DC | Actively Reimbursing | 1/15/2021 - Maternal Health Resources and Access Act introduced 7/20/2021 - 2022 Budget Support Act 9/28/2022 - SPA approved 10/1/2022 - Start date of doula benefits | Budget passed requiring coverage of doula services; SPA submitted and approved | In Jan 2021, the Maternal Health Resources and Access Act (MHRAA) was introduced, which included a pilot for Medicaid reimbursement of doula care. The DC 2022 Budget Support Act incorporated part of MHRAA, including a requirement for Medicaid coverage of doula care with the condition that a SPA be approved before benefits could begin. From Jan to Aug 2022, the Department of Health Care Finance (DHCF) held regular Maternal Health Advisory Group meetings to share information about the District's doula Medicaid implementation and seek stakeholder input. The State Plan Amendment was approved on September 28, 2022. In October 2022, DHCF began enrolling and reimbursing doulas. | No. | No. | • MHRAA • 2022 budget language • DHCF Maternal Health Projects • Approved SPA | No. | Total reimbursement is up to $1950.71. | Covered doula services are for 12 visits during the perinatal and postpartum period, and attendance at labor/delivery. The perinatal period lasts before, during, and up to six weeks after delivery. The doula postpartum period begins on the last day of pregnancy and ends at the end of the month in which 180 days (six months) after the end of the pregnancy falls. Different doula services are available and reimburseable during the perinatal and doula postpartum period. Total reimbursement is up to $1950.71. Each of the 12 visits during the perinatal and postpartum period are reimbursed at $97.04 per visit, regardless of length of time. Reimbursement for labor/delivery is $686.23. Reimbursement for postpartum services is billed and reimbursed separately at a per-unit rate and billed in 15-minute increments of $12.13/15 min. There is also a one-time incentive payment of $100 for doulas whose clients attend a postpartum appointment between 7-84 days after labor/delivery. | Doulas can enroll and bill as individuals or groups. | D.C. Mun. Regs. Tit. 29, § 11201: Doula services may be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth (when appropriate). | Unclear. | D.C. Mun. Regs. Tit. 29, § 11201: Doula services may be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth (when appropriate). | Doulas must be at least 18 years of age, have a high school diploma or equivalent, and have a current certification by a doula training program or organization approved by DHCF. The list of doula training programs and organizations approved by DHCF are: • Doula Trainings International • The Childbirth and Postpartum Professional Association (CAPPA) • Black Doula Training (formerly the Black Doula Institute) • Ancient Song Doula Services • Mamatoto Village • Doulas of North America (DONA) • International Childbirth Education Center • Childbirth International (CBI) • MaternityWise • Birth in Color RVA • Birthworks International • Childbirth Professionals International • Commonsense Childbirth, Inc. • HealthConnect One • International Center for Traditional Childbearing - Black Doulas for Black Mamas • International Childbirth Education Association (ICEA) • Mother Health International • SMC Full Circle Training • Shafia Monroe-Doula Training • ToLABOR • Urban Baby Beginnings To serve clients in managed care, doulas must enroll both as DHCF providers as well as with the managed care organization (AmeriHealth Caritas District of Columbia, CareFirst Community Health Plan District of Columbia, Health Services for Children with Special Needs, and MedStar Family Choice District of Columbia). | List of approved doula organizations. | No. | No. | No. | No. | No. | |||||||||||||||||||
12 | DE | Implementation in Progress | 7/25/2022 - HB 343 signed by Governor 8/9/2023 - HB 80 signed by Governor 6/18/2024 - SPA approved 6/30/2024 - HB 345 signed by Governor 9/24/2024 - HB 362 signed by Governor | Legislation passed for Medicaid coverage of doula care | In March 2022, HB 343 was introduced, requiring the state's Division of Medicaid and Medical Assistance (DMMA) to present the legislature with a plan for Medicaid coverage for doula care. In July 2022, HB 343 was signed by the Governor. In March 2023, HB 80 was introduced, requiring Medicaid coverage for doula services by 1/1/2024. This bill drew from the completed report that was required by HB 343. It specifies that the State Medicaid Agency establish a process for doulas to be certified and to enroll as Medicaid providers, and that a reimbursement rate be established "that supports a livable annual income for full-time practicing doulas." The bill was signed by the Governor on 8/9/2023, In March 2024, HB 345 was introduced, which requires Medicaid coverage for additional postpartum visits with a doula upon recommendation of a licensed practitioner or clinician. The bill was signed by the Governor on 6/30/2024. In April 2024, HB 362 was introduced, which would require doula coverage in private insurance. The bill was signed by the Governor in September 2024. DMMA is currently holding monthly meetings with the Doula Ad Hoc Committee on implementation of the doula Medicaid benefit, which is expected to start sometime in 2024. As of summer 2024, the Delaware Certification Board is already accepting applications for doulas to become Certified Doulas for Medicaid Reimbursement. The SPA was approved in June 2024 with an effective date of 1/1/2024. The Delaware Division of Public Health is currently funding a handful of doula training programs in the state, including the PIC Community Doula Program, Black Mothers in Power, and Do Care Doula. The goal is to help train up and certify additional doulas in the state, and to help address health disparities for women and infants in communities of color. | Yes. HB 362, signed into law in Sep 2024, will require doula coverage in private insurance. | • Doula Stakeholder Engagement: Focus Group Study Report (2023) • Doula Stakeholder Engagement: Report on Interviews with Licensed Providers of Maternal Health Care (2023) | • HB 343 (2022) • HB 80 (2023) • Doula Ad Hoc Committee • HB 345 (2024) • HB 362 (2024) • Delaware Certification Board - Certified Doula for Medicaid Reimbursement | N/A | HB 80 specifes that the State Medicaid Agency establish, "in collaboration with stakeholders... a reimbursement rate for doula services that supports a livable annual income for full-time practicing doulas." | Doula coverage for Medicaid enrollees include: • Three prenatal visits, up to 90 min/visit • Three postpartum visits, up to 90 min/visit • Attendance at labor and birth. Doula services can be provided up to 180 days after delivery. | N/A | N/A | N/A | N/A | There are two pathways to become a Certified Doula for Medicaid Reimbursement: Regular Doula • must have attended 3 births in the last 3 years, of which at least one the applicant must have been the primary doula • provide documentation of at least 16 hours of birth and labor doula education on a variety of topics including lactation support, childbirth education, nonmedical comfort measures, prenatal support, labor support techniques, and postpartum support • current CPR certification including competencies for adult and infants • 1-hour HIPAA training Legacy Doula • must have had at least 13 clients in the last 3 years, and have attended at least 9 births in the last 3 years • current CPR certification including competencies for adult and infants • 1-hour HIPAA training • must provide 2 professional evaluations • submit essay on lived experience of at least 250 words | Core competencies for certification as a Regular Doula for Medicaid Reimbursement | Yes, there is a legacy doula pathway. | Yes. For recertifcation, every three years, doulas must complete 20 hours of relevant education, and provide documentation of attendance at at least one birth. | Yes, fingerprint background check is required. | Yes, liability insurance is required. | No. | |||||||||||||||||||
13 | FL | Actively Reimbursing | 2018 - Doula care included as optional Medicaid managed care expanded benefit 2019 - Effective date of doula coverage 5/2020 - AHCA released billing codes for doula services 11/15/2023 - SB 372 introduced (did not pass) 2/17/2025 - SB 780 introduced (did not pass) | Doula services included as an optional Medicaid managed care expanded benefit; implementation ongoing at plan discretion | In 2018, Florida's Agency for Healthcare Administration (AHCA) included doula services as an optional expanded benefit for Medicaid managed care plans. This means only Medicaid enrollees in managed care plans have access to doulas (though most Medicaid enrollees in the state are in managed care plans). AHCA does not have overall control over doula Medicaid implementation because services were added as an optional expanded benefit. While most plans have adopted doula services as a plan benefit, the plans do have significant discretion in administering the benefit. Reimbursement is negotiated with each plan. Also, some plans do have restrictions on access, such as only providing doula care for high-risk pregnancies. AHCA did not release specific guidance on benefit implementation, but in May 2020 did release billing codes for doula services. There are a number of organizations in the state that have been working to support the benefits and doulas in the state. Healthy Start Florida's G.R.O.W. (Guidance, Resources and Openhearted Wisdom) Doula Model is in over half of Florida's 67 counties and has trained hundreds of 200 doulas. The G.R.O.W. model allows local Florida Healthy Start Coalitions to handle billing and payment, hospital and provider relations, connections with clients, doula training and continuing education, insurance, ongoing mentorship, and other administrative and logistical support for affiliated doulas. The Doula Network is also active in the state, and works to support affiliated doulas with administrative support, mentorship, billing, and reimbursement. On 11/15/2023, SB 372 (companion bill HB 1325) was introduced, which would create a category of state-certified doula certified by the FL Dept of Health, lay out specific standards for certification requirements, and require the Dept to create a public registry of state-certified doulas. The bill did not pass. On 2/17/2025, SB 780 (companion bill HB 747) was introduced, which would create the Doula Support for Healthy Births pilot program" in three counties in the state, aimed at serving those who are uninsured or underinsured, including those on Medicaid. The bill did not pass. | No. | No. | • AHCA Managed Care Updates (2018) • The Doula Network • G.R.O.W. Doula Program • SB 372 (2023) • SB 780 (2025) | N/A | Varies by plan. | Reimbursement is negotiated with each plan. It tends to be about $800-$1110, though at least one plan has lower rates around $450. | Varies by plan. | Varies by plan. | Unclear. | Varies by plan. | Varies by plan. Each plan can determine credentialing procedures and how the benefits are rolled out. | Varies by plan. | Varies by plan. | Varies by plan. | Varies by plan. | Varies by plan. | No. | |||||||||||||||||||
14 | GA | Adjacent Action Taken | 3/5/2021 - HB 727 introduced (did not pass) 2/8/2024 - HB 1216 introduced (did not pass) 2/4/2025 - HB 263 introduced | Medicaid managed care pilots taking place in state, which are seen as stepping stones for further statewide implementation | In 2021, HB 727 was introduced, which would have provided for Medicaid coverage of doula care. The bill did not pass. In Feb 2024, HB 1216 was introduced, which would create a pilot program for Medicaid coverage for doula care. The bill did not pass, but in Feb 2025 was reintroduced as HB 263. From 2022-2023, Healthy Mothers, Healthy Babies Georgia (HMHBGA) ran a Doula Medicaid Reimbursement Pilot program in conjunction with two Medicaid managed care plans in the state. HMHBGA also runs a Georgia Doula Access Working Group that works to advance legislation to include doula services in Medicaid reimbursement. In April 2025, HMHBGA announced that ti would be launching a new community-based doula program in partnership with HealthConnect One. In October 2022, HMHBGA and Emory University's Center for Reproductive Health Research in the Southeast, with guidance from the Georgia Doula Access Working Group, published a series of papers comprising the Georgia Doula Study, which focused on a number of topics including doula-provider relations, doulas providing contraceptive education and abortion care, and racism against Black birthing people, among others. The goal of the Georgia Doula Study is to help build full spectrum doula capacity and access in the state. As of 2025, the newly formed Georgia Community Doula Coalition is working to improve birth outcomes and advance culturally sensitive perinatal health care across the state by ensuring equitable access to community-based doula services. | No. | No. | • HB 727 (2021) • HMHBGA - Doula Access Working Group • Georgia Doula Study (2022-2023) • HB 1216 (2024) • GA Doula Medicaid Reimbursement Pilot • HB 263 (2025) • Georgia Community Doula Coalition | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
15 | HI | Adjacent Action Taken | 1/21/2022 - SB 2882 introduced (did not pass) 4/26/2022 - SCR2 SD1 adopted 1/23/2024 - HB 407 introduced 1/17/2025 - SB 945 introduced 3/7/2025 - SCR71 introduced | Resolution passed to review potential certification of community health workers, including doulas | In early 2022, SB 2882 was introduced, which would have created a certification process for community health workers. Doulas were included in this category. The legislation was deferred. However, a related resolution, SCR2 SD1, was also introduced in early 2022, requiring the state auditor to create a sunrise review of the certification and regulation of community health workers. A sunrise review occurs before legislation is enacted, in this case to assess the potential impacts, costs, and benefits of the certification and regulation of community health workers SCR2 SD1 was adopted in April 2022. The auditor published Sunrise Analysis: Regulation of Community Health Workers in September 2022. Healthy Mothers Healthy Babies Coalition of Hawaiʻi runs a community-based doula program to help decrease health disparities and improve health outcomes for communities of color in the state. In Jan 2024, HB 407 was introduced, which exempts doulas and lactation specialists who hold valid certifications from the state's midwifery licensure laws. In Jan 2025, SB 945 (companion bill HB 434) was introduced, which creates a category of doulas certified by the state, and, problematically, appears to disallow other types of doula practice. The bill was deferred after its first hearing. In March 2025, SCR71 (companion resolution HCR74) was introduced, which requests that the State Auditor conduct a sunrise review of the registration and regulation of doulas. | No. | No. | • SB 2882 (2022) • SCR2 SD1 (2022) • Sunrise Analysis (2022) • HMHB Community Based Doula Program • HB 407 (2024) • SB 945 (2025) • SCR71 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
16 | IA | Adjacent Action Taken | 1/2022 - Maternal Health Doula Project launched 1/12/2022 - SF 2013 introduced (did not pass) 1/12/2023 - SF 67 introduced (did not pass) 1/23/2025 - SF 132 introduced | Dept of Health & Human Services is running a doula pilot with hopes it can be a stepping stone for broader statewide coverage | The Iowa Dept of Health and Human Services is piloting a Maternal Health Doula Project in various counties through the state's Title V Maternal and Child Health Service Block Grant and with additional funding support from the Mid-Iowa Health Foundation. The Project is aimed at providing culturally congruent, community-based care to address disparities in Black maternal and infant health outcomes. Services are provided through EveryStep Doula Project. One of the state's Medicaid managed care plans, Iowa Total Care, is also providing doula services for their pregnant enrollees in Polk, Johnson, or Muscatine counties. In early 2022, SF 2013 was introduced, directing the state to take action necessary to provide doula services in Medicaid. This legislation did not pass. The bill was reintroduced in Jan 2023 as SF 67 but again did not pass. In Jan 2025, SF 132 was introduced, which was similar to the previous bills, but which also included a requirement that the Dept of Health and Human Services, in collaboration with stakeholders, create a process for doula certification, and establish a reimbursement rate "that supports a livable income for a full-time practicing doula." | No. | No. | • Dept Health & Human Services Maternal Health Doula Project • SF 2013 (2022) • SF 67 (2023) • Iowa Total Care doula program • SF 132 (2025) | N/A | Doulas participating in the Dept of Health and Human Services pilot project are reimbursed $1200 for three prenatal visits, presence at labor and delivery, and up to three postpartum visits. | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | No. | |||||||||||||||||||
17 | ID | We were not able to find any current efforts in this state. | |||||||||||||||||||||||||||||||||||||||
18 | IL | Actively Reimbursing | 4/27/2021 - HB 158 signed by Governor 7/29/2024 - HB 5142 introduced 6/10/2024 - SPA approved 12/19/2024 - Start date of doula Medicaid coverage 6/16/2025 - SB 2437 signed by Governor | Legislation for Medicaid coverage of doula care was passed in 2021, but implementation was delayed. Bill was signed in July 2024 to expand doula care in private insurance. | In April 2021, HB 158 was signed into law, which included coverage of perinatal doula services and home visiting services. There was some initial consternation about the two services having been included together. The benefit was originally supposed to begin on July 1, 2022, but implementation was delayed and is still ongoing. The SIU (Southern Illinois University) School of Medicine has been contracted to administer the Illinois Medicaid-Certified Doula Program. In June 2024, the SPA to include perinatal doula services delivered by state certified doulas was approved by CMS, with an effective date of 2/1/2024. In Feb 2024, HB 5142 (companion bill SB 3665) was introduced, which would require all private health plans to cover doula care, as well as midwifery care and home births. The bill also expands access to abortion care in both Medicaid and private insurance. The bill was signed by the governor on 7/29/2024. The state's doula Medicaid benefit began on 12/19/2024. Also in Dec 2024, BA NIA Inc. announced the establishment of the Chicago Illinois Doula Coalition Network (CIDCN), which aims to comprehensive plan of services and resources with the intent of leaving no birthing individual and family behind. In Jan 2025, SB 2437 (companion bill HB 2423) was introduced, which requires hospitals and birthing centers to allow a Medicaid certified and enrolled doula to accompany patients for support before, during, and after labor/childbirth and for patient's entire postpartum stay. The bill also allows the Dept of Healthcare and Family Services and the Dept of Public Health to issue standing recommendations to meet CMS requirements, including for doula services. The bill was signed into law by the Governor on 6/16/2025. | Yes. HB 5142 was signed into law in July 2024, and requires all private health plans to cover doula care. | No. | • HB 158 (2021) • HB 5142 (2024) • SIU School of Medicine Illinois Medicaid-Certified Doula Program • Approved SPA • SB 2437 (2025) | Yes, as of 12/19/2024. | There is no maximum reimbursable rate. The total reimbursement will depend on how many visits the doula and client decide together are appropriate, and the length of each visit. | Coverage includes prenatal and postpartum visits billed at $15 per 15 min, support during labor and delivery at a flat rate of $720, initial newborn visit where the doula attends the practitioner visit with their client at $50, and two postpartum visits where the doula attends the OB/practitioner visit with their client at $50/visit. Doula support during or after a miscarriage or abortion is billed at $15 per 15 min. There is no maximum reimbursable rate. The total reimbursement will depend on how many visits the doula and client decide together are appropriate, and the length of each visit. Services are covered during the entire perinatal period and up to one year postpartum, regardless of how the pregnancy ends. | Doulas can enroll and bill as individuals/sole propretors or as the rendering/servicing provider under a group practice. Doulas billing as individuals/sole proprietors are also able to associate with a group practice and have them bill on their behalf. | Regulations do not contain specific limitations. | Yes. Doula coverage is available for all the ways in which a pregnancy can end, including birth, miscarriage, and abortion. | Prenatal and postpartum services can be provided in-person or via telehealth. However, support during labor and delivery must be provided in-person. (See Fee Schedule for Doulas.) | Doulas must be at least 18 years old and certified by the Illinois Medicaid-Certified Doula Program, a partnership between the IL Department of Healthcare and Family Services and the Southern Illinois Univeristy (SIU) School of Medicine. There are two pathways to be certified by Illinois’ Medicaid-Certified Doula Program. Regardless of the pathway, all doulas must: • be at least 18 years old • have HIPAA training • have CPR/basic life support training • have cultural competency/implicit bias training • have training in trauma-informed care • have training in the anatomy and physiology of pregnancy and birth Training Program Pathway: • must be an active doula with at least 3 doula experiences within the past 12 months • have completed birth doula training from an approved provider (see approved list here) Legacy Pathway • must be an active doula with at least 5 doula experiences within the past 3 years | For the training pathway, there is a list of pre-approved training organizations. | Yes, there is both a training and legacy pathway. | Doula certification is good for three years, after which point doulas must re-certify through SIU. | Unclear. | Unclear. | No. | |||||||||||||||||||
19 | IN | Adjacent Action Taken | 4/18/2019 - SB 416 passed (no implementation) 1/11/2021 - SB 298 introduced (did not pass) 8/5/2022 - SB 2 signed by Governor 1/11/2023 - HB 1302 introduced (did not pass) 1/16/2024 - SB 269 introduced 1/9/2025 - HB 1243 introduced 1/16/2025 - HB 522 introduced | Legislation passed that allowed Medicaid coverage of doula services, but it was merely permissive and no budget was allocated; later legislation also passed to create Doula Advisory Board | In 2019, Indiana passed SB 416 which allowed doulas to be reimbursed under Medicaid. However, funds for the bill were stripped from the budget. In 2021, SB 298 was introduced that would have required, rather than allowed, reimbursement for doula care in Medicaid and some private insurance. The bill did not pass. In August 2022, the Governor signed SB 2, which among other things established a Doula Reimbursement Advisory Board. As of mid 2023, it was not clear how much progress has been made in establishing the Board. In Jan 2023, HB 1302 was introduced, which proposed to change the name of the Doula Reimbursement Advisory Board to the Pregnancy Support Professions Advisory Board and added issues for the Board to consider. This bill did not pass. On 1/16/2024, SB 269 was introduced, which would require private insurance coverage of doula care. The bill did not pass. In Jan 2025, HB 1243 was introduced, which allow doulas access to their clients who are incarcerated. Also in Jan 2025, SB 522 was introduced a broad maternal health bill which included a number of provisions, including one which mandated Medicaid reimbursement for doula care. Currently no doulas are funded directly through Medicaid, though some doulas who are also certified community health workers are able to seek reimbursement for some of their doula services through that avenue. The Indiana Minority Health Coalition maintains an Indiana for Doulas campaign that continues to work with doulas and other stakeholders in the state on public education campaigns, information gathering, and potential legislation. | Yes. SB 269 was introduced in Jan 2024, which would require private insurance coverage of doula care. | No. | • SB 416 (2019) • SB 298 (2021) • SB 2 (2022) • Indiana 4 Doulas • HB 1302 (2023) • SB 269 (2024) • HB 1243 (2025) • HB 522 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
20 | KS | Actively Reimbursing | 11/2023 - Kansas Doula Alliance formed 6/6/2024 - SPA approved 7/1/2024 - Start date of benefit | Statewide doula group formed, followed by State Medicaid Agency implementation of doula care | In September 2023, the Kansas Birth Justice Society released a white paper outlining implementation recommendations for Medicaid reimbursement of doula services in the state. In November 2023, they announced the formation of the Kansas Doula Alliance. The Alliance advocates for fair and equitable insurance reimbursement for doula services; work with hospitals, clinics, and medical providers to create doula-friendly policies; provide professional development and training to doulas; and increase consumer awareness of doulas through programs such as a statewide directory. Also in 2023, UnitedHealthcare, one of the state's three Medicaid managed care plans, began offering doula services to all pregnant and postpartum Medicaid enrollees as part of a statewide pilot program. (UnitedHealthcare is also running similar doula pilots in Arizona, Kentucky, Texas, and Washington.) The SPA to add doula services was approved by CMS in June 2024. The benefit began on 7/1/2024. | No. | Coverage of Community Based Doula Care: A Summary of Initial Stakeholder Convenings with Kansas Doulas (2023) | • Kansas Birth Justice Society white paper (2023) • Kansas Doula Alliance • Approved SPA • Doula Enrollment and Coverage Bulletin • Kansas DHE Doula Toolkit | No. | Reimbursement rate is up to $1295. | Doula care for Medicaid enrollees are allowed for prenatal visits, postpartum visits, and one labor/delivery visit. Doula services can be provided during pregnancy, labor/delivery, miscarriage, and within one year of the end of the pregnancy. Reimbursement for prenatal visits is up to 28 15-minute units at $15/unit, for postpartum visits is up to 25 15-minute units at $15/unit, and $500 for presence at labor and delivery. The maximum amount that can be billed is $1295. | Doulas can bill as individuals or as part of a doula group. | Doulas can coordinate directly with Medicaid enrollees on the appropriate location for the prenatal and postpartum visits, which may include the enrollee's residence, physician's office, doula's office, a hospital, or in the community. (See SPA) | Yes. Doula for Medicaid enrollees is covered regardless State guidance specifies that doula services may only be provided during pregnancy, labor and delivery, miscarriage, and within one year of the end of a member’s pregnancy. | Yes. Prenatal and postpartum visits can be conducted by telehealth, but labor/delivery care cannot be conducted by telehealth. | There are two pathways for doula certification. Under Training Pathway #1, doulas must obtain certification from one of a list of specific doula training programs. Under Training Pathway #2, doulas must complete at least 30 hours of training in any combination of a list of delineated core competencies. Doulas must also have provided doula support at at least three births. | Both options are available. | No. | Yes. Doulas must complete at least ten hours of continuing education every three years. | No. | No. | No. | |||||||||||||||||||
21 | KY | Adjacent Action Taken | 2/2/2021 - HB 286 introduced (did not pass) 1/4/2022 - HB 39 introduced (did not pass) 1/14/2023 - HB 275 introduced (did not pass) 1/18/2024 - HB 307 introduced 1/23/2024 - HB 350 introduced 4/18/2024 - SB 74 signed by governor 2/14/2025 - HB 553 introduced 2/19/2025 - HB 814, HB 798 introduced | A number of Medicaid managed care plans are running doula pilots; legislation has been introduced on doula Medicaid coverage but has not passed | Kentucky has introduced legislation for several years in a row requiring doula Medicaid coverage: HB 286 in 2021, HB 39 in 2022, and HB 275 in 2023. These bills did not pass. In 2024: • The doula Medicaid bill was reintroduced as HB 307. • HB 350 was introduced, which would require accommodations for midwifery and doula services for pregnant and postpartum people who are incarcerated. SB 74 was also introduced, a broad maternal health bill which included the Kentucky Momnibus. SB 74 included a piece requiring the Cabinet for Health and Family Services to conduct a study of doula certifications in the U.S. and make recommendations to the Kentucky legislature on how doula services could address those populations in the state most at risk for poor perinatal health outcomes. The bill was signed by the governor in April 2024. In Feb 2025, a number of bills relating to doula care were introduced: • The doula Medicaid bill from previous years was reintroduced as HB 814. • A similar bill was also introduced the same month, HB 553, which in addition would create a Doula Advisory Council. • HB 798 was introduced, which requires reasonable accommodations and access for the provision of certified professional midwifery services or doula services for people who are incarcerated and who are pregnant or have given birth in the last six weeks. A number of Medicaid managed care plans in the state are piloting doula services to some of their Medicaid enrollees, including Humana, Anthem, and UnitedHealthcare. (UnitedHealthcare is also running similar doula pilots in Arizona, Kansas, Texas, and Washington.) | No. | No. | • HB 286 (2021) • HB 39 (2022) • HB 275 (2023) • HB 307 (2024) • HB 350 (2024) • SB 74 (2024) • HB 553 (2025) • HB 814 (2025) • HB 798 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
22 | LA | Adjacent Action Taken | 6/11/2021 - HB 190 signed by Governor 2022 - Some Medicaid managed care plans begin offering doula services 6/7/2023 - HB 272 signed by Governor 3/1/2024 - HB 702 introduced 5/28/2024 - SB190 signed by Governor 1/1/2025 - Date by which private health plans must comply with requirement to offer doula coverage 6/10/2025 - HB 454 signed by Governor 6/11//2025 - HB 514 introduced | Legislation passed to require private health coverage plans in the state to provide doula coverage; some Medicaid managed care plans also independently reimbursing for doula care | HB 190 was introduced in April 2021 and signed by the Governor in June 2021. The legislation created a state Doula Registry Board within the Dept of Health, charged with developing criteria for doula registration, and reviewing and approving applications. In March 2023, HB 272 was introduced, which requires private health plans in the state that cover maternity services, to include doula support from doulas registered with the Doula Registry Board. HB 272 was signed into law by the Governor on 6/9/2023. Private health plans are expected to comply with the law effective 1/1/2025. In March 2024, HB 702 (companion bill SB 142) was introduced, which would provide Medicaid coverage for doula care. The same month, SB 190 was introduced, which would require Medicaid FFS and managed care rates to match Medicare rates for a variety of Medicaid providers, including doulas. SB 190 was signed by the Governor in May 2024. In April 2025, HB 272 was reintroduced as HB 454 to provide Medicaid coverage for doula care. The bill provides doula support during labor and childbirth, prenatal and postpartum support and education, breastfeeding assistance and lactation support, parenting education, and support after the loss of a pregnancy. The bill also specifies that five prenatal visits be covered for up to 90 min each, three postpartum visits be covered for up to 90 min each, and support during labor and birth including cesarean births. The bill was signed by the Governor on 6/9/2025. Also in April, HB 514 was introduced, which makes modifications to the Louisiana Doula Registry Board, including requiring inclusion of a greater number of doulas with geographic diversity from across the state. This bill was signed into law on 6/11/2025. There are also ongoing doula Medicaid efforts in the state, which have been championed by the New Orleans Maternal and Child Health Coalition Mama+ Health Policy Agenda. In 2022, some of the Medicaid managed care plans in the state revised their maternity care benefit packages to include reimbusement for doulas. However, coverage and reimbursement rates vary (see, for example, Humana Healthy Horizons in Louisiana, AmeriHealth Caritas Louisiana, and Aetna Better Health). | Yes. HB272 passed in 2023, requiring private health plans to cover doula care by 1/1/2025. | No. | • HB 190 (2021) • HB 272 (2023) • 2024 Mama+ Health Policy Agenda • Doula Registry Board • HB 702 (2024) • SB190 (2024) • HB 454 (2025) • HB 514 (2025) | N/A | N/A | HB 454, which was signed into law on 6/9/2025, will provide doula support during labor and childbirth, prenatal and postpartum support and education, breastfeeding assistance and lactation support, parenting education, and support after the loss of a pregnancy. The bill also specifies that five prenatal visits be covered for up to 90 min each, three postpartum visits be covered for up to 90 min each, and support during labor and birth including cesarean births. | N/A | N/A | N/A | N/A | The Louisiana Doula Registry Board's proposed regulations require doulas to be: • at least 18 years old; • have high school diploma or equivalent; • be a US citizen or be legally authorized to be employed in the US; and • meet either the experience or training pathway Experience pathway requires submitting three letters of recommendation from clients within the past five years AND submitting proof of having provided doula services to at least three clients within the past five years. Training pathway requires obtaining a certificate of completion of training as a doula by a Board approved doula training organization | The Louisiana Doula Registry Board is creating a list of Board approved doula training organizations. | Yes. Louisiana Doula Registry Board proposed regulations allow for both training and experience pathways. | Yes. Initial doula certification by the Doula Registry Board is good for five years, after which time registration must be renewed. Doulas must demonstrate and provide proof of having completed at least 20 contact hours of continuing education or the equivalent as part of their renewal. | No. | No. | No. | |||||||||||||||||||
23 | MA | Actively Reimbursing | 1/22/2019 - H.1182 introduced (did not pass) 3/29/2021 - H.2372 introduced (did not pass) 2/16/2023 - H.1139, H.1240, H.1154 introduced 12/8/2023 - Start date of doula Medicaid benefit 2/6/2024 - SPA approved 8/23/2024 - H.4999 signed by Governor 2/27/2025 - H.1312 introduced 2/27/2025 - H.1333 introduced 3/12/2025 - SPA approved to add doula services to adoptive parents of infants | MassHealth implemented Medicaid coverage for doula care, following legislative and stakeholder efforts | Doulas and stakeholders in the state have been organizing and advocating for Medicaid coverage for doula care since H.1182 was introduced in 2019. While that bill and a subsequently introduced H.2372 in 2021 did not pass, they did help to galvanize advocacy in the state, as well as inspire additional work and research on the topic. The Massachusetts Doula Coalition formed during this period. In early 2023, a number of bills were introduced which did not advance: • H.1139 would provide Medicaid coverage for doula care up to 12 months following the end of the pregnancy. It would also require doula care for private health plans in the state. The legislation contains additional details about the scope of services and coverage for doula care under MassHealth, as well as the creation of a Doula Advisory Committee and a Doula Workforce Development Trust Fund. • H.1240 is similar to HD. 2467, but only includes the Medicaid coverage for doula care piece, the Doula Advisory Committee, and the Doula Workforce Development Trust Fund • H.1154 would create a Maternal Health Justice Fund to expand and manage the doula workforce The MassHealth doula benefit began on 12/8/2023. On the same date, MassHealth Chief Medical Officer Dr. Jatin K. Dave issued a standing recommendation for doula services. The SPA was approved on 2/6/2024. In MA doula services are provided as a "wrap service," with MassHealth paying for all covered doula services regardless of the Medicaid enrollees' managed care status. In Aug 2024, H.4999 was signed by the Governor, which includes licensure for midwives and lactation consultants, promotes freestanding birth centers, and creates funding to address maternal mental health and substance use disorder. The bill also expands doula services to parents of adopted infants until the infants turn one. In Jan 2025, H.1312 (companion bill S.789) was introduced, which would require private health plans to cover at least 20 hours of doula services, plus care during labor and delivery; create a doula advisory committee to meet regularly with MassHealth; and amends the patient bill of rights to give patients right to have doula present during labor and delivery in addition to a support person or guest. In July 2025, the bill was updated to H.4344. In Feb 2025, H.1333 was introduced, which would create a scholarship fund to help build the doula workforce. On 3/12/2025, SPA MA-24-0040 was approved to add doula services for adoptive parents of infants. The SPA has an effective date of November 8, 2024. | Yes. H.1139 was introduced in 2023, and H.1312 was introduced in 2025, both of which would require doula care in private insurance. | • Summary of Doula Town Halls and Doula Survey in Massachusetts (2019) • Expanding doula support services in Massachusetts: Considerations for Successful Implementation (2022) • Massachusetts Doula Coalition Blueprint (forthcoming) | • H.1182 (2019) • H.2372 (2021) • H.1139 (2023) • H.1240 (2023) • H.1154 (2023) • MA Doula Coalition • MassHealth Doula Services Program: Information for Doulas • MassHealth Doula Services Program: Information for Members • H.4999 (2024) • H.1312 (2025) • H.1333 (2025) • Approved SPA • Approved SPA for adoptive parents of infants | Yes, as of 12/8/2023. | Up to $1700. | MassHealth will reimburse doulas up to a total of $1700 for: • $900 for labor and delivery support • Up to $800 for perinatal visits comprising $100/visit up to 60 minutes, and $150/visit of 60-90 minutes MassHealth will pay for up to eight hours of perinatal visits without prior authorization. MassHealth members can receive more than eight hours of perinatal visits if they receive prior authorization based on MassHealth guidelines for medical necessity for doula perinatal services. Individual doulas practicing independently and doula group practices are able to bill MassHealth, but doula group practices cannot be part of a hospital, other group practice, or other health care facility. Doula care is inclusive of all pregnancy outcomes; perinatal visits can take place during the prenatal period and up to 12 months after the end of the pregnancy. Doula services can be provided in-person and via telehealth. | Individual doulas practicing independently and doula group practices are able to bill MassHealth. See 130 CMR 463.000: Doula Services. | Regulations do not contain specific limitations. | Yes, see Subchapter 6: Doula Services Codes defining perinatal period as "The period encompassing pregnancy and labor and delivery, through 12 months following delivery, inclusive of all pregnancy outcomes." | Doula services can be provided in-person and via telehealth. See 30 CMR 463.000: Doula Services. | To be a MassHealth provider, doulas must: • Be at least 18 years old • Obtain National Provider Identifier (NPI) number • Complete free online MassHealth Doula Provider Training • Demonstrate the following required competencies through either Formal Training Pathway or Experience Pathway: 1) Maternal anatomy and physiology during perinatal period; 2) Common medical interventions during pregnancy, childbirth, postpartum period; 3) Common potential complications associated with pregnancy, childbirth, and the postpartum period, including pregnancy and infant loss, mental health conditions, substance use disorder, high blood pressure; 4) Labor and delivery comfort measures; 5) Best practices for supporting members in advocating for their needs and making informed decisions with a trauma-informed lens; and 5) Basic newborn care, including fundamentals of breast/chestfeeding. Doulas may demonstrate their required competencies through one of two pathways: • Formal Training Pathway: competencies supported by certificate of completion or other proof of doula trainings attended and/or proof of doula certification by a doula-ceritfying organization • Experience Pathway: competencies supported by letters of recommendation from three former clients from past five years; and two licensed health care providers who observed provision of doula services in last five years Out of state doulas can participate in MassHealth if they: • obtain a MassHealth provider number; • are legally authorized to perform the services of a doula in their own state; • participate in their state's Medicaid program; and • meet the conditions set forth in 130 Mass. Reg. 450.109 on Out-of-state Services Doulas must also keep relevant records for six years | List of required competencies. See 30 CMR 463.000: Doula Services. | Yes. Formal training pathway as well as experience pathway. | Though not the same as continuing education, MassHealth doula providers will need to revalidate their information at least every five years. | No. | No. | No. | |||||||||||||||||||
24 | MD | Actively Reimbursing | 7/6/2021 - Maternal and Child Health Care Initiative announced 1/1/2022 - Effective start date of doula Medicaid benefit 5/29/2022 - SB 166 signed by Governor (companion bill HB 669) 6/15/2022 - SPA approved 5/20/2025 - HB 1251 signed by Governor | Doula services covered under a state Maternal and Child Health Care Initiative, SPA approved by CMS | In 2021, Maryland underwent rulemaking as part of its Maternal and Child Health Care Initiative, which included adding Medicaid coverage for doula services.The rule went into effect in February 2022. The Initiative funding was authorized for four years. Legislation passed in 2022 made the doula Medicaid services permanent. The SPA was approved by CMS on 6/15/2022 with an effective start date of benefits of 1/1/2022. In January 2022, SB 166 was introduced, along with companion bill HB 669. The bills, which were signed by the Governor in May 2022, codified the regulations put in place by the Department of Health, and made permanent doula services for Medicaid enrollees. In 2023, the state's reimbursement rate for attendance at labor and delivery increased from $350 to $800. The Doula Alliance of Maryland is an advocacy coalition that is working to ensure that doulas have a voice in policy. In July 2024, the Maryland Department of Health issued guidance that as of June 27, 2024, the doula benefit would be considered a self-referred benefit through December 31, 2025, and that any doula enrolled in Maryland Medicaid in good standing, could receive payment for services rendered, without the need for physician referral. In Feb 2025, HB 1251 was introduced, which lays out certain requirements around obstetric care, including the requirement for health care facilities to allow certified doulas to be present during birth, in addition to other authorized guests. The bill was signed by the Governor on 5/20/2025. | No. | No. | • Dept of Health Medicaid Doula Program • Dept of Health Doula Provider Information • SB 166 (2022) • HB 669 (2022) • Approved SPA • Doula Alliance of Maryland • HB 1251 (2025) • Maryland Doula Directory | No. However, in July 2024, the Maryland Department of Health issued guidance that as of June 27, 2024, the doula benefit would be considered a self-referred benefit through December 31, 2025, and that any doula enrolled in Maryland Medicaid in good standing, could receive payment for services rendered, without the need for physician referral. | Up to $1331.84 to $1427.84, depending on the combination of prenatal and postpartum visits utilized. | Prenatal care is reimbursed at $16.62/15 min, up to four units per visit; labor and delivery services are reimbursed at a flat rate of $800; postpartum care is reimbursed at $19.62/15 min, up to four units per visit. Up to eight prenatal and/or postpartum visits are allowed. Total reimbursement is between $1331.84 to $1427.84, depending on the combination of prenatal and postpartum visits utilized. Medicaid managed care organizations are required to pay at least the minimum FFS rate for doula services. | Doulas can enroll and bill as individuals or groups. | Services can be provided in the home, at a provider or doctor's office, and other community-based settings. See Doula Program Manual. | Unclear. However, doulas are able to reallocate prenatal and postpartum visits to support Medicaid enrollees whose pregnancies do not result in a live birth. See Doula Program Manual. | Prenatal and postpartum services can be virtual but must have the option of being in person. Labor and delivery is only permitted in person. See FAQS for Doula/Birth Worker Coverage. | Participating doulas must maintain up-to-date certification through a doula certification program and must have adequate liability insurance. See Medicaid Enrollment Guide for Doulas. The complete list of doula certification organizations approved by the MD Dept of Health is available on the Doula Provider Information page. | List of approved doula organizations. | No. | No. | Yes, background check required. See FAQS for Doula/Birth Worker Coverage. | Yes. Doulas are required to have and maintain adequate liability insurance, which for MCOs may be $1,000,000 per incident/$3,000,000 aggregate. See Medicaid Doula Services Program Manual. | No. | |||||||||||||||||||
25 | ME | Implementation in Progress | 2022 - Maine Doula Coalition launched 1/17/2023 - LD 198 introduced (did not pass) 1/30/2023 - LD 312 introduced (did not pass) 1/30/2025 - LD 376 introduced (did not pass) 6/24/2025 - LD 1523 passed unsigned | Statewide doula coalition formed and worked to expand access to doula care; legislation was passed to lay groundwork for implementation by 2028 | In 2022, the Maine Doula Coalition launched, to work towards expanding access to doula care in the state, equitable reimbursement for doulas, and improving birth experiences and perinatal outcomes in Maine. The coalition is working with the Maine Women’s Lobby to hopefully introduce a doula reimbursement bill in 2025. The Coalition has helped to create a number of resources, including the Maine Doula Workforce Assessment and the Maine Doula Directory. In Jan 2023, LD 198 was introduced, which would have required MaineCare to reimburse for doula services, as well as LD 312, which would have expanded the perinatal professional workforce, including CHWs and doulas. Both bills were withdrawn in 2023. In Jan 2025, LD 376 (SP 172) was introduced, which requires MaineCare to reimburse for doula services. In April 2025, LD 1523 (HP 1008) was introduced, which is similar to LD 376 but with the addition of a requirement to also establish a doula advisory committee to provide advice and make recommendations on doula services. LD 1523 requires that the Department of Health and Human Services by January 1, 2026, begin a process to determine a reimbursement rate for doula services under MaineCare. The bill further requires that MaineCare begin reimbursing for doula services, subject to appropriations from the Legislature, on January 1, 2028. The bill further creates a statewide doula council to provide and make recommendations to the department on implementation of MaineCare coverage of doula services. Lastly, the bill requires that the Department submit a report by February 1, 2027 to the Legislature of their progress on implementation. The bill was passed unsigned on 6/24/2025. | No. | Maine Doula Workforce Assesment (2024) | • Maine Doula Coalition • LD 198 (2023) • LD 312 (2023) • LD 376 (2025) • LD 1523 (2025) • Maine Doula Workforce Assessment • Maine Doula Directory | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
26 | MI | Actively Reimbursing | 6/10/2020 - SB 965 introduced (did not pass) 4/2022 - Dept of Health and Human Services announced they would include doula care as a new benefit for Medicaid enrollees 6/21/2022 - SPA approved 10/11/2022 - HB 6445 introduced (did not pass) 1/1/2023 - Start date of doula benefit 2/15/2023 - HB 4115 introduced (did not pass) 4/10/2024 - SB 826 introduced, SB 820 introduced 12/31/2024 - HB 5826 signed by Governor 2/4/2025 - SB 31 introduced | Dept. of Health and Human Services implemented Medicaid coverage for doula care | In June 2020, SB 965 was introduced, which would have included Medicaid coverage for doula care in the state. The bill did not pass but helped launch discussions in the Dept of Health and Human Services on including doula services as a Medicaid benefit. In April 2022, the Dept announced it would be including doula care as a new benefit for Medicaid enrollees. It subsequently shared proposed policy drafts for public comment and created a Michigan Doula Advisory Council. Michigan Black Mothers Breastfeeding did extensive organizing and advocacy in the state around the benefit. In 2021, they held a Community-Based Doula Summit, from which they published a SWOT analysis and policy recommendations to support community based doula sustainability. They also submitted public comments on the policy drafts shared by the Dept of Health and Human Services. CMS approved Michigan's SPA in June 2022. The Dept released MMP 22-47, its final Medicaid Approved Doula Policy, in Dec 2022. The Michigan Doula Initiative began on January 1, 2023. Also in Jan 2023, Michigan's Chief Medical Executive, Dr. Natasha Bagdasarian, issued a standing recommendation for doula services, which met the federal requirement for doula services to be recommended by a licensed health care provider. In Feb 2024, the state launched its doula registry. In October 2022, HB 6445 was introduced, which would have established a doula scholarship fund to support the training and certification of new doulas. The bill did not pass. In February 2023, HB 4115 was introduced, which excludes doulas from inclusion as an "attending health care professional" and specifies the definition of a doula. The bill did not pass. In April 2024, HB 6445 was reintroduced as SB 826. The same month, SB 820 was introduced, which lays out a number of policies hospitals must follow with regards to birthing patients, including the requirement that a patient's doula be allowed in the hospital with them. Neither of these bills passed. However, a similar bill to HB 6445 was introduced in June 2024, HB 5826. This bill was signed by the Governor in December 2024. Meanwhile, a similar bill to SB 820 was introduced in Feb 2025, SB 31. In Sep 2024, there was money allocated in the state budget to increase reimbursement rates to $1500 for labor support, and $100 each for a total of 12 prenatal and postpartum appointments, for a new total reimbursement rate of $2700. The new rates were effective 10/1/2024. | No. | No. | • SB 965 (2020) • Approved SPA • MDHHS Doula Initiative • HB 6445 (2022) • SB 1196 (2022) • MMP 22-47: Final Medicaid Approved Doula Policy • Statewide Standing Recommendation for Doula Services • HB 4115 (2023) • Michigan Doula Registry • SB 826 (2024) • SB 820 (2024) • HB 5826 (2024) • SB 31 (2025) • Michigan Doula Medicaid Provider Toolkit | Yes, as of 1/13/2023. | Up to $2270. See MMP 24-40. | Doula services are for a maximum of twelve total visits during the prenatal and postpartum period, and one visit for attendance at labor/delivery. Each visit must be at least 20 min to be eligible for reimbursement. An additional six visits are permitted with prior authorization. Reimbursement was originally $75 each for a total of six prenatal or postpartum visits, and $700 for presence at labor/delivery, for a total of $1150. Effective 10/1/2024, the reimbursement rate increased to $100 each for a total of twelve prenatal and postpartum visits, and $1500 for labor/delivery, for a total possible reimbursement rate of $2700. In order to be eligible for reimbursement, doulas must be enrolled with Medicaid and listed on the Michigan Department of Health and Human Services Doula Registry. | Doulas can enroll and bill as individuals or groups. | Regulations do not contain specific limitations. | Unclear. | Doula visits are permissible when delivered face-to-face via a secure platform consistent with current Medicaid telemedicine policy. See MDHHS Doula Provider FAQ. | Doulas must be at least 18 years of age and possess a high school degree or equivalent. They must be on the Michigan Dept of Health and Human Services Doula Registry and enroll as a Medicaid provider. They must complete a training and receive a training certificate from a doula training program or organization approved by the Dept. The doula training programs must include skill development in the areas of: • Communication, including active listening, cross-cultural communication, and interprofessional communication; • Perinatal self-care measures; • Coordination of and linkage to community services and resources; • Labor and coping strategies; and • Newborn care and supportive measures. The current Dept approved doula training programs can be found here. To enroll as a Medicaid provider, prospective doulas must: • Complete and submit a MDHHS Doula Registry Application • Apply for a Type 1 (Individual) National Provider Identifier (NPI) • Register for SIGMA Vendor Self-Service (VSS) • Complete an online application in the Community Health Automated Medicaid Processing System (CHAMPS) • Enroll/Credential with Medicaid Health Plan(s) | List of approved doula organizations. | No. | No. | No. | Yes. Doulas enrolled with a Medicaid Health Plan must have liability insurance. | Not state funded. However, the Center for Civil Justice was awarded funding from the Michigan Health Endowment Fund to conduct an education and awareness campaign on doula services for the Eastern region of Michigan. | |||||||||||||||||||
27 | MN | Actively Reimbursing | 2013 - SF 699 passed 7/1/2014 - Start date of benefit 9/25/2014 - SPA approved 7/1/2019 - Reimbursement rates increased 6/29/2021 - HF 33 signed by Governor 3/30/2022 - HF 4706 introduced (did not pass) 3/2023 - HF 2900 and HF 2846 introduced 12/11/2024 - SPA approved increasing reimbursement rates 1/12/2024 - elimination of supervision requirement | Legislation passed followed by approval of State Plan Amendment | The MN State Legislature passed SF 699 (companion bill HF 768) in 2013, which added doula care as a covered Medicaid benefit. The SPA was approved in September 2014 with an effective start date of 7/1/2014. The original reimbursement rate was $26 for each prenatal and postpartum visit and $257 for labor/delivery for a total of $411. In 2019, reimbursement rates increased to $47 for each prenatal and postpartum visit and $488 for labor/delivery for a total of $770. There were initially significant obstacles for Medicaid enrollees trying to access the benefit, as well as doulas trying to enroll as Medicaid providers and obtain reimbursement, including barriers to enrollment, the clinician supervision requirement, and lack of adequate outreach and awareness about doula care. During the first several years, uptake and usage of the benefit lagged. In June 2021, the Governor signed HF 33, legislation aimed at addressing health disparities and requiring investigation into barriers to accessing care including doula care. In March 2022, HF 4706 was introduced, which would have required that the state enroll and provide direct reimbursement to doula agencies and individual doulas. This legislation did not pass. In March 2023, two bills were introduced. HF 2846 would have increased payments for certified doula services from $47 per prenatal and postpartum visit and $488 for services at birth (a total of $770), to $100 per prenatal or postpartum visit up to a total of six visits and $1400 for services at birth (a total of $2000). HF 2900 would have allowed doula agencies and individual doulas to enroll and be reimbursed directly by the state In Dec 2023, Minnesota's SPA increasing the doula reimbursement rate as proposed in HF 2846, was approved with an effective date of 1/1/2024. Also effective 1/1/2024, Minnesota doulas were required to enroll as individual Medicaid providers and bill on their own directly rather than having to bill through a supervising medical professional. On 1/9/2024, MinnesotaCare Medical Director Dr. Nathan Chomilo issued a statewide standing recommendation for doula services. In May 2024, the allowed number of covered sessions was increased from six prenatal and postpartum visits, to 18 prenatal and postpartum visits, which in turn increased the total reimbursement rate to up to $3200. | No. | Medicaid Coverage of Doula Services in Minnesota: Preliminary findings from the first year (2015) | • SF 699 (2013) • Approved SPA • MN Dept of Human Services Doula Services • Minnesota Doula Registry • HF 33 (2021) • HF 4706 (2022) • HF 2846 (2023) • HF 2900 (2023) • Statewide standing recommendation • Approved SPA increasing reimbursement rate | Yes. As of 1/9/2024. | Up to $3200. See SPA 23-0018. | When the MN doula benefit first began, doulas billing Medicaid for their services had to provide all services under the supervision of a doctor, a nurse practitioner, or a certified nurse midwife. Doulas must bill through the supervising medical professional's NPI (National Provider Identifier). Effective 1/1/2024 this is no longer a requirement, and doulas are now required to sign up as individual Medicaid providers and bill on their own. Reimbursement rates are $100 per prenatal and postpartum visit, and $1400 for labor and delivery. As of May 2024, a total of 18 prenatal and postpartum visits are covered, for a total possible reimbursement of $3200. (Prior to 1/1/2024, up to six prenatal and postpartum visits were reimbursed at $47 per visit, and labor and delivery services was reimbursed at $488, for a total of $770.) | Doulas can enroll and bill as individuls or groups. | Regulations do not contain specific limitations. | Unclear. | Prenatal and postpartum services may be delivered via telehealth. Telehealth services are also permitted during labor and delivery if the member's needs were met and doula was available by phone or video with no other commitments during the entire time. If doula was unavailable the whole time but provided key support during some of the labor and delivery, they may bill for a non-labor and delivery visit for their time spent. See MN Dept of Human Services Doula Services. | Doulas must have a certification from an organization on a list of designated Doula Certificatoin Organizations, which is maintained by the MN Dept of Health. The current list is here. | List of approved doula organizations. | No. | Doulas are eligible to be included in the Minnesota Doula Registry for three years, after which time they must reapply to remain on the registry. Continuing education is not required, but doulas must provide evidence of maintaining a certification from one of the designated Doula Certification Organizations. | Yes, the Minnesota Department of Health requires a criminal background check in order to join the Minnesota Doula Registry. | No. | No. | |||||||||||||||||||
28 | MO | Actively Reimbursing | 6/30/2022 - HB 3010 signed in part, vetoed in part 1/19/2023 - HB 900 introduced (did not pass) 2/21/2023 - HB 1190 introduced (did not pass) 12/1/2023 - SB 1238 introduced 1/3/2024 - HB 1446 introduced 10/1/2024 - SPA approved 10/1/2024 - Start date for doula Medicaid benefit 12/1/2024 - SB 260 introduced 1/24/2025 - HB 890 introduced 1/28/2025 - HB 1095 introduced 2/27/2025 - SB 816 introduced | Medicaid managed care plan in the state running doula pilot program; ongoing legislative efforts | Since 2021, the Missouri Community Doula Council has worked to advocate for access and coverage to community-based doula services for pregnant women and birthing families, as well as sustainable pay for community doulas. The Council is also currently handling enrollment of doulas as MO HealthNet providers. In 2021, at least one Medicaid managed care organization in the state, Healthy Blue Missouri, launched a Doula Pilot Program to reimburse doula services for its members in the St. Louis and Kansas City metro areas, or in Greene County. In March 2024, the State Medicaid Agency shared its proposed rule 13 CSR 70-25.160 on Doula Services (later finalized), which established guidelines for Medicaid coverage and reimburseemnt for community doula services. Then in September 2024, the MO Dept of Social Services issued an emergency rule calling for doula services to be reimbursed through MO HealthNet, the state's Medicaid program, for six months starting on 10/1/2024. This was followed shortly after by CMS approving the state's SPA adding doula services to its Medicaid program, on 10/1/2024. There have been several bills pertaining to expanding access to doula care over the years. • In Feb 2022, appropriations bill HB 3010 was introduced, including $500,000 for a statewide community doula training program. On June 30, 2022, the Governor voted part of the bill but signed the remainder, including the appropriations for the doula training program. • In Jan 2023, HB 900 (identical bills SB 713 and HB 1148) was introduced, which would have allowed for health insurance reimbursement of doula services. The bill required the Dept of Health and Senior Services to create criteria for the doula registration application, review and approve such applications, and maintain a statewide doula registry. The bill explicitly stated that others could continue practicing as doulas even if not registered with the state. The bill also required health plans in the state to cover midwifery services. The bill did not pass. In Feb 2023, HB 1190 was introduced, which would have required coverage for doula care in both Medicaid and private insurance. The bill language included requirements around doula certification, training, and competencies. Neither bill passed. • In Dec 2023, SB 1238 (identical bill SB 1222) was introduced, which is similar to HB 900. In Jan 2024, HB 1446 was introduced, which requires the Dept of Health and Senior Services to create criteria for doulas to register with the Dept and to create a statewide registry of approved doulas. In Feb 2024, HB 2632 was introduced, which would require the Dept of Health and Senior Services to create a mechanism for doulas to register for reimbursement by Medicaid and private health insurance. • In Dec 2024, SB 260 was introduced, which requires that private health plans in the state cover midwifery care, and additionally requires the promulgation of rules for doula reimbursement. •In Jan 2025, HB 890 was introduced, which creates a process for doulas to register with the Dept of Health and Senior Services for purposes of insurance reimbursement. The same month, HB 1095 was introduced, which lays out the scope of services and standards for doula reimbursement by Medicaid. • In Feb 2025, SB 816 was introduced, which would allow the chief medical officer of the Dept of Health and Senior Services, chief medical director of the Dept of Mental Health, or a physician acting with the express written consent of the Directors of such, or the Director of the MO HealthNet Division, to issue various standing orders including a "nonspecific recommendation of doula services." | Yes. Bills including coverage for doula care in private insurance were introduced in 2023 (HB 900, HB 1190), 2024 (SB 1238, HB 2632, SB 260). | Medicaid Reimbursement for Doula Services: Definitions and Policy Considerations (2022) | • Missouri Community Doula Council • HB 3010 (2022) • HB 900 (2023) • HB 1190 (2023) • SB 713 (2023) • SB 1238 (2023) • HB 1446 (2024) • HB 2632 (2024) • Proposed Rule on Doula Services • Approved SPA • SB 260 (2024) • HB 890 (2025) • HB 1095 (2025) • SB 816 (2025) • Missouri Department of Social Services Doula Program | No. | Up to $1600. (See Public Notice Regarding Doula Services 9/26/2024) | Services are authorized to all pregnant women during the prenatal period, during labor/delivery, and during the postpartum period up to 12 months after delivery. Available doula services include: • Six prenatal and postpartum support sessions • Attendance at birth • Up to two visits for general consultation on lactation • Additional community navigation services that occur outside of these visits may be billed up to ten times The total reimbursement amount for all authorized services is $1600 | Doulas can bill as individuals or as part of a supervising organization. | Regulations do not contain specific limitations. | Unclear. | Regulations do not contain specific limitations. | Doula providers in the Medicaid program must: • be enrolled as MO HealthNet providers • be at least 18 years old • have a current certificate issued by a national or Missouri-based doula training organization whose curriculum meets the specified definition and standards If there is a statewide organzation composed of doula trainers from three or more independent, well-established doula training organizations located in Missouri, then MO HealthNet may verify that an individual's training and experience satisfies the above criteria through a public roster maintained by such an organization. Otherwise, future doula training organizations must prove that their training satisfies the definition above to be added to the list of all approved certification programs. Enrollment as a MO HealthNet provider is being facilitated by the Missouri Community Doula Council. | List of approved doula organizations. | No. | Yes. Doulas must complete at least six continuing education units per year. | Unclear. | Yes. Doulas must hold liability insurance as an individual or through a supervising organization. | No. | |||||||||||||||||||
29 | MS | We were not able to find any current efforts in this state. | |||||||||||||||||||||||||||||||||||||||
30 | MT | Implementation in Progress | 11/2023 - Montana Doula Collaborative formed 5/12/2025 - SB 319 signed by governor | Statewide doula association formed advocating for doula Medicaid | A group of doula advocates in Montana came together in November 2023 to start the Montana Doula Collaborative, a statewide doula-led association to advance efforts towards Medicaid coverage for doula care, and to support Montana doulas in sustainable practice. The collaborative is conducting a survey of doulas in Montana and publishing a white paper with findings and recommendations to help support ongoing advocacy efforts. In Feb 2025, SB 319 was introduced, which creates a process for becoming licensed as a doula with the state Department of Labor & Industry, and allows the Dept of Public Health and Human Services to provide Medicaid coverage of care provided by such doulas. The bill was signed by the Governor on May 12, 2025. The bill does require that in order to use the title “doula,” one must obtain licensing from the state, with some exceptions for volunteers, doulas in training, and AI/AN traditional tribal healers. | No | No | • Montana Doula Collaborative • SB 319 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
31 | NC | Adjacent Action Taken | 5/13/2020 - S732 introduced (did not pass) 3/30/2021 - S393 introduced (did not pass) 5/27/2022 - S845 introduced (did not pass) 3/9/2023 - H321 introduced (did not pass) 3/21/2023 - H421 introduced (did not pass) 3/24/2025 - SB463 introduced 3/26/2025 - S483 introduced | Legislation for Medicaid coverage for doula care has been introduced but has not passed; ongoing efforts from Dept of Health and Human Services and advocacy orgs; Medicaid managed care plan is running a doula pilot program | Since 2020, a number of bills have been introduced pertaining to Medicaid coverage for doula care. Thus far none of the bills have passed. • In 2020, S732 was introduced, which would have required Medicaid coverage for doula care, in addition to instructing the Dept of Health and Human Services on specific aspects of implementation. The bill was reintroduced in 2021 as S393. • In 2022, S845 was introduced, which would have established a Community-Based Doula Certification Board to certify community-based doulas and set up educational and training requirements in the state • In March 2023, H321 was introduced, which would have required Medicaid coverage for doula care, in addition to increasing certain Medicaid rates for maternity and prenatal care • Also in March 2023, H421 was introduced, which would have required Medicaid coverage for doula care, in addition to requiring the Dept of Health and Human Services to conduct a statewide analysis of doula support services. In March 2025, SB463 was introduced, which would require Medicaid coverage of doula care. The same month, the Children First Act, S483 (companion bill H507) was introduced, which include a number of provisoins around expanding access to child care and support for caregivers, including a provision on Medicaid coverage for doula care. The Dept of Health and Human Services has been independently exploring Medicaid coverage for doula care. In 2021, the Dept conducted a survey to learn more about doulas practicing in the state, and then in the fall 2022 hosted a doula summit (read the report summarizing the findings from the survey and summit). Also in 2022, the Dept began providing funds to help hire and train doulas in Edgecombe, Halifax, Nash, and Pitt counties. The Dept is currently working with the NC Institute of Medicine Task Force on Maternal Health to develop recommendations for expanding access to doula care in Medicaid and other insurance. There is also a group called the North Carolina Doula Organization which is working to organize doulas in the state, as well as promote educational development and financial support for doulas. In June 2024, Blue Cross and Blue Shield of North Carolina's Medicaid managed care plan, Healthy Blue, announced they would begin covering doula services for their Medicaid enrollees in specific counties. | No. | Doulas in North Carolina: A Landscape Analysis and Summit Report (2023) | • S732 (2020) • S393 (2021) • S845 (2022) • H321 (2022) • H421 (2023) • NCDHHS report • NC Doula Organization • Healthy Blue doula pilot • SB463 (2025) • S483 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | ||||||||||||||||||||
32 | ND | Action Proposed | 1/16/2025 - HB1464 introduced | Bill introduced to certify postpartum doulas, and require Medicaid coverage of postpartum doula services. | In January 2025, HB1464 was introduced, which would create a mechanism for certification of doulas providing postpartum doulas, and would require Medicaid coverage of postpartum doula services. Also, there was a University of North Dakota based group called Don't Quit the Quit, which supported pregnant, postpartum, and breastfeeding people experiencing opioid use disorder by providing postpartum doula support. The program, which was grant funded, completed its work in 2023. | No | No | • HB1464 • Don't Quit the Quit | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
33 | NE | Adjacent Action Taken | 1/14/2021 - LB 416 introduced (did not pass) 1/17/2023 - LB 581 introduced (did not pass) 2023 - Launch of Rooted Doula Care and Support Program 1/16/2024 - LB 1278 introduced 1/22/2025 - LB 701 introduced | Doula pilot program launched in 2023; legislation around Medicaid coverage for doula care has been proposed but has not yet passed | In Jan 2021, LB 416 was introduced, which included Medicaid reimbursement for doula services, among other provisions aimed at addressing maternal health disparities. The legislation did not pass. In Jan 2023, LB 581 was introduced, which would create a pilot programs for doula services at the Youth Rehabilitation and Treatment Center and the Nebraska Correctional Center for Women. The bill did not pass. In Jan 2024, LB 1278 was introduced, which would require the Dept for Health and Human Services to create a program for Medicaid coverage for doula care by 1/1/2026, and to establish a stakeholder and expert workgroup to implement such program, including reimbursement for doula and full spectrum doula services. The bill was indefinitely postponed in April 2024, and then in Jan 2025 was reintroduced as LB 701. In 2023, I Be Black Girl, A Mother's Love, Nebraska Perinatal Quality Improvement Collaborative (NPQIC), United Healthcare, and Nebraska Medicine came together to launch a Rooted Doula Care and Support Program, a pilot program to provide doulas for high-risk Black, Indigenous, and other people of color (BIPOC) birthing people. The pilot will run for five years and will launch first in Douglas and Sarpy Counties, which are home to over 50% of Nebraska's non-white residents. In April 2024, the NPQIC released a white paper on Doula Care to Improve Outcomes and Reduce Disparities in Nebraska. | No. | Doula Care to Improve Outcomes and Reduce Disparities in Nebraska (2024) | • LB 416 (2021) • LB 581 (2023) • Rooted Doula Care and Support Program • LB 1278 (2024) • LB 701 (2025) | N/A | N/A | N/A | N/A | N/A | N/A (Of note, LB 1278, introduced in Jan 2024, does specifically reference full spectrum doula services.) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
34 | NH | Implementation in Progress | 1/19/2023 - SB 175 introduced (did not pass) 6/20/2023 - Governor signs bipartisan state budget which included funding for provisions of SB 175 7/26/2024 - SB 337 signed by Governor | Bipartisan state budget included funding for doula Medicaid coverage as part of state Momnibus bill package | In January 2023, SB 175 was introduced, the state's Momnibus, which includes a number of maternal health related supports, including coverage of doula care for Medicaid enrollees. In June 2023, the Governor signed a bipartisan budget which included funding for the Momnibus. In January 2024, SB 337 was introduced, which created a voluntary doula certification process. The bill also created a lactation service certification process to ensure credentialing by the International Board of Lactation Examiners. The bill was signed by the Governor in July 2024. | No. | No. | • SB 175 • SB 337 | N/A | N/A | Language in SB 175 requires that the Dept assess reimbursement rates and adjust rates accordingly every two years. | N/A | N/A | N/A | N/A | Language in SB 175 requires that the Dept "address the requirements and expertise of practicing doulas, doula training providers, and home visiting experts" in implementation of the doula Medicaid benefit. | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
35 | NJ | Actively Reimbursing | 5/8/2019 - S1784 signed by governor 1/1/2021 - Start date of doula benefit 2/19/2021 - SPA approved 10/24/2022 - SPA to increase reimbursement rates approved 12/7/2023 - S4214 introduced 1/16/2024 - S4119 signed into law 4/11/2024 - S3091 introduced 6/28/2024 - S3530 introduced 10/21/2024 - A4944 introduced | Legislation passed followed by approval of SPA | In 2019, New Jersey passed S1784, which added doula care to its list of covered Medicaid comprehensive maternity care services. The SPA was approved in Feb 2021 with an effective start date of benefits of Jan 1, 2021. From 2022-2024, the NJ Dept of Health convened the New Jersey Doula Learning Collaborative, which provided training, workforce development, supervision support, mentoring, technical assistance, billing support, and sustainability planning for community doulas and doula organizations throughout the state. Starting in July 2024, the Collaborative transitioned to a regional hub modle, with three hubs across the state, in North Jersey, Central Jersey, and South Jersey. In 2022, CMS approved NJ's SPA to increase the reimbursement rate for maternity service clinicians and community doulas. In Nov 2023, S4119 (companion bill A5739) was introduced, which requires hospitals and birthing centers to allow patients access to their doulas for support before, during, and after labor and childbirth. The bill was signed into law in Jan 2024. In Dec 2023, S4214 (companion bill A1356) was introduced, which establishes a number of rights and protections for female inmates, among them the requirement to provide doula care to support inmates who are pregnant during their labor and delivery. In April 2024, S3091 (companion bill A4222) was introduced, which would require the Dept of Health Services to establish a public awareness campaign on doulas. In June 2024, S3530 (companion bill A4694) was introduced, which is similar to S4214 from 2023. On Oct 2024, A4944 was introduced, which requires the Dept of Human Services to conduct a public awareness campaign on the benefits of doula and midwifery services. | No. | NJ Doula Roll Call Survey 2024 (2024) | • SB 1784 (2019) • Approved SPA (2021) • NJ Dept of Human Services Doula Care Page • NJ Doula Learning Collaborative • Approved SPA increasing reimbursement rates (2022) • S4119 (2023) • S4214 (2023) • S3091 (2024) • S4694 (2025) • A4944 (2025) | No. | Up to $1065 for standard care of eight visits and labor/delivery. Up to $1331 for enhanced care (patients 19 or younger). Additional $100 incentive payment for attendance at a postpartum follow-up visit. (See SPA 22-0020.) | Standard care includes reimbursement up to $1065 for 8 visits and attendance during labor and delivery. Enhanced care is available for patients 19 or younger, and includes reimbursement up to $1,331 for 12 visits and attendance during labor and delivery. There is a $100 incentive for a postpartum follow-up visit for both levels of care. Each visit is billed for and reimbursed separately, and at 15-min increments at $16.61/unit rate. The initial prenatal visit can be a maximum of six units and the others have a maximum of four units. Reimbursement at delivery is a flat rate of $500. | Doulas can enroll and bill as individuals, as part of an agency, or as part of a health care provider such as an FQHC. | Doulas services can be provided in the community (including client homes), clinician offices, or hospitals. | Unclear. | Yes. Doula services by telehealth are also reimburseable. See A5757. | Doulas must be at least 18 and must complete doula training, which includes core competencies (perinatal counseling, infant care, labor support) and community-based/cultural competency training, HIPAA training, and adult/infant CPR certification. Doulas must also pass a fingerprint-based criminal background check and have liability insurance. (See Steps for Individual Doulas to Enroll as a NJ FamilyCare Provider.) Doula trainings must be approved by the NJ Dept of Human Services. The full list of approved doula training programs is available here. | List of approved doula organizations. | No. | No. | Yes, as part of enrollment, doulas must complete a fingerprint background check. | Yes, as part of enrollment, doulas must secure active indiviaul professional liability insurance. | The state provides some funding support for the New Jersey Doula Learning Collaborative. | |||||||||||||||||||
36 | NM | Actively Reimbursing | 4/7/2020 - Tewa Women United report published 7/2023 - NM Doula Association scholarships funded 12/5/2024 - SPA approved 2/2/2025 - Start date of benefit 3/21/2025 - HB 214 signed by governor | State Medicaid Agency implemented Medicaid coverage for doula care | In April 2020, Tewa Women United published a report on Expanding Access to Doula Care: Birth Equity and Economic Justice in New Mexico. The report uplifts a community-based doula model, shares details about doula care from the organization's Doula Project, and offers recommendations to promote birth equity and economic justice in New Mexico and beyond. In July 2023, UnitedHealthcare announced that it was donating $150,000 to the New Mexico Doula Association to help fund 22 scholarships for a doula certification and training program. The SPA was approved on 12/5/2024 with a retroactive start date of 10/1/2024. The Medicaid doula benefit went live on Feb 2, 2025. In Jan 2025, HB 214 was introduced, which creates a Medicaid credentialing process for doulas who want to serve Medicaid enrollees, creates a doula credentialing advisory council, require annual reporting on doula care in the state, require doula access in hospitals and freestanding birth centers, and create a doula fund. The bill, which codified the SPA which was approved in 2024, was signed by the Governor on 3/21/2025. The New Mexico Doula Association created and maintains a New Mexico Doula Directory to help potential clients in the state find prenatal, birth, postpartum, abortion, loss, or full-spectrum doula support. The Association has also created a 2025 Doula and Lactation Provider Managed Care Reference Guide to explain Medicaid managed care in New Mexico and provide advice on certification, credentialing, and contracting. | No. | Expanding Access to Doula Care: Birth Equity and Economic Justice in New Mexico (2020) | • Tewa Women United report • NM Doula Association • Approved SPA • NM Health Doula Program page • HB 214 (2025) • NM Dept of Health Doula Certification Toolkit • Doula and Lactation Provider Managed Care Reference Guide • New Mexico Doula Directory | No. | Maximum possible reimbursement is $3300. | Doula services covered will be: • nine prenatal and postpartum visits, per calendar year, of up to two hours each, billed at $100/hour • support during labor and delivery billed at a flat rate of $1500 Maximum possible reimbursement is $3300. | Doulas can bill as individuals or groups. | Regulations do not contain specific limitations. | Yes. Coverage includes care before, during, and after a pregnancy or childbirth. | Regulations do not contain specific limitations. | There are three steps for doulas to become Medicaid providers. First, they must be certified as a credentialed doula with the NM Dept of Health. Next, they must enroll with NM Medicaid. Third, they must credential with each Medicaid managed care plan that they will be working with. To credential with the NM Dept of Health, doulas must (see SPA): • be at least 18 years old • provide federal employer identification number • provide local business license, tax certificate, and permit • maintain current adult and infant CPR certification from American Red Cross or American Heart Association • complete HIPAA training There are three pathways for certification with NM Medicaid (see Doula Certification Toolkit): • Pathway 1 - Certified Doula Pathway: Doulas must complete and certify in one from a list of specific doula trainings • Pathway 2 - Core Competencies Pathway: Doulas must provide a certificate of completion for a doula training with at least 15 total hours demonstrating completion of each among a list of core competencies; also must provide attestation that they have provided support at three births • Pathway 3 - Experience Pathway: Doulas must provide three written testimonial or professional letters of recommendation, at least one of which must be from a licensed provider or certified doula; also must provide attestation that they have provided doula serices for at least two years and that those two years have taken place within the last five years from the date of application Also, note that you do not have to be a NM resident to become a state-certified doula in NM. Doulas living within 100 miles of a NM border are also eligible. (See Doula FAQs.) | Both. Pathway 1 requires certification from one among a list of recognized doula groups. Pathway 2 requires meeting a set of core competencies. | Yes. Pathway 3 is an experience pathway. | Yes. Doulas must complete 24 hours of continuing education in maternal perinatal, and/or infant care every two years. See SPA. | There will be no background check required from 2/2/2025 to 6/30/2025. Background checks will be implemented starting 7/1/2025 for new applications and for renewals. (See Doula FAQs.) | No. | No. | |||||||||||||||||||
37 | NV | Actively Reimbursing | 6/9/2021 - AB 256 signed by governor 4/1/2022 - Start date for doula benefit July 2022 - DOULA CO-OP formed 7/7/2022 - SPA approved 6/27/2023 - AB 283 signed by governor 4/10/2024 - SPA increasing reimbursement rate approved 2/7/2025 - SB 192 introduced | Legislation passed including doula services as a covered Medicaid benefit, followed by approval of SPA | In June 2021, AB 256 was signed by the Governor, directing the state to include doula services in their Medicaid State Plan. The Nevada Certification Board took over responsibility for certifying NV doulas as Medicaid providers, with input from the Doula Certification Advisory Committee. The doula Medicaid benefit began on 4/1/2022. CMS approved the SPA on July 7, 2022. In July 2022, a group of doulas formed the DOULA CO-OP, a nonprofit organization with the goal of cultivating a thriving and diverse community for birthworkers and parents in Nevada, with a specific focus on underserved birthing families, including Medicaid enrollees. In March 2023, AB 283 was introduced, which proposed an increase in the state's Medicaid reimbursement rate for doula care, including an incentive payment for doulas providing services in rural areas. The bill, which was community doula led, was signed by the governor on June 27, 2023. Consistent with AB 283, in Sep 2023, the Nevada Dept of Health and Human Services Division of Health Care Financing and Policy (DHCFP) submitted a SPA to CMS to increase the urban and rural birth doula Medicaid provider reimbursement from a maximum of $450 for three prenatals, attendance at birth, and three postpartums, to $1500 in urban counties and $1650 in rural counties. The SPA was approved by CMS in April 2024. In Feb 2025, SB 192 was introduced, which requires hospitals to allow doulas access to their clients during the birthing process, and also would require private insurance coverage of doula care. | Yes. SB 192 would require private insurance coverage of doula care. | No. | • AB 256 (2021) • NV Certification Board Doula Certification page • Approved SPA • The DOULA CO-OP • AB 283 (2023) • Approved SPA increasing reimbursement rate • SB 192 (2025) | No. | Reimbursement rate is $1300 in urban counties and $1430 in rural counties. | Original reimbursement rate was $350 total for a maximum of four visits at $50 each during prenatal/postpartum period, and $150 for presence at labor/delivery. The postpartum visits can take place up to 90 days postpartum. In April 2024, CMS appoved a SPA raising the reimbursement rate to $100 for each prenatal/postpartum visit, and $900 for presence at labor/delivery, for a total of $1300 if all visits are utilized. There is an additional 10% incentive for doulas providing services in rural areas (recipients outside of urban Washoe and urban Clark counties), which brings the total for doula care in rural areas to $1430. | Doulas can enroll and bill as individuals or groups. | Doulas may provide services within the home, office, hospital, or freestanding birthing center settings. (See Medicaid Services Manual 603.4E) | Unclear. | Unclear but there are no specific exclusions in the regulations and Nevada Medicaid does otherwise cover some telehealth services. | Doulas must be certified by the Nevada Certification Board to be eligible for Medicaid reimbursement. The full list of certification requirements is available here. Board certification requirements include: • completion of a Board-approved doula training or doula certification that includes required core competencies (core competencies include perinatal counseling and support services, labor support, infant care, trauma-informed care, cultural competency/humility, and HIPAA compliance) • adult and infant CPR certification • attendance at at least one birth in the past five years, with a recommendation submitted to the Board by the client • agreement to the NCB Certified Doula Ethical Principles and Code of Conduct • residency requirement (live or work in Nevada at least 50% time) • payment of $100 application fee Medicaid enrollment also requires: • current Nevada NPI number • current Nevada State Business Licence (sole proprietor if enrolling as an individual or LLC if enrolling as a group) • taxpayer identification number (SS-4 or CP575 or W-9) • completion and approval of the NV Dept. of Health and Human Services Provider Enrollment Application Recertification requires a $50 renewal fee, 10 hours of NCB-approved continuing education, and proof of current adult and infant CPR certification | Must have Nevada Certification Board approved foundational birth doula training. | No. | Yes. Recertification requires 20 hours of continuing education in the Nevada Birth Doula Competencies every two years, and proof of current adult and infant CPR certification. | No. | No. | No. | |||||||||||||||||||
38 | NY | Actively Reimbursing | 3/2019 - Start date for NY State Doula Pilot Program 3/2022 - Start date for NYC Citywide Doula Initiatve 11/6/2023 - S1867A signed by Governor 1/26/2024 - S8080 signed by Governor 3/1/2024 - Start date of benefit 3/25/2024 - SPA approved 6/10/2024 - Statewide standing order issued 12/11/2024 - S5992A signed by Governor 12/21/2024 - S5991A signed by Governor 1/28/2025 - A3508 introduced 1/31/2025 - A4073 introduced 2/12/2025 - A5140 introduced 2/13/2025 - A5309 introduced 2/14/2025 - S809, A1026, S758 signed into law 2/20/2025 - A5709 introduced 2/26/2025 - A6140, S5665 introduced (see summary for complete list of legislation) | Doula pilots took place across the state, doula services subsequently included in the Governor's 2024 state budget | From 2019 to 2024, the state funded a New York State Doula Pilot Program to cover doula services for pregnant people enrolled in Medicaid in Erie and Kings Counties. New York City ran a similar pilot program from 2022 to 2024, the Citywide Doula Initiative, which aimed to provide free doula services to Medicaid enrollees to specific populations. A number of bills were signed into law by the Governor in 2023 and 2024: • In Nov 2023, S1867A was signed by the Governor, which requires the creation of the NY state community doula directory for doulas serving Medicaid patients. • In Jan 2024, S8080 was signed by the Governor, which, similarly, directs the Dept of Social Services to establish and maintain a community doula directory. • In Dec 2024, both S5992A and S5991A were signed by the Governor, which require maternal health care facilities to allow pregnant and postpartum mothers access to their doulas, and allow doulas access to the operating room when a cesarean birth is being performed, respectively. In 2025 a number of bills were introduced: • S758 and A1019 relates to the bills signed in Dec 2024, by clarifying that maternal health care facilities are not required to grant doula access during emergency situations or when such could compromise the safety of the patient or health care team. The bill was signed into law on 2/14/2025. • A3508 would require the state to conduct a study to evaluate integration of doula care, services, and support. • A4073 would require all correctional institutions and facilities to provide a specified scope of doula services. • S809 and A1026 were introduced, which would repeal the section of S5991A which allows doulas to be present in the operating room while a cesarean birth is being performed. Both these bills were signed into law on 2/14/2025. • A5140 (companion bill S6494) would require private insurance coverage for doula care. It is similar to A8329 from 2023-2024. • A5309 would allow the Commissioner of Health to issue a statewide standing order (the previous standing order issued in June 2024 is only valid for one year). • A5709 would create a doula Medicaid reimbursement work group to set reimbursement rate and address other criteria related to doula practice • A6140 would include doulas as medical services providers for Medicaid recipients • S5665 (companion bill A7332) would require the Dept of Health to conduct a public awareness and education program on doulas and their benefit to pregnancies The New York Coalition for Doula Access and other advocates have been working since 2011 to advocate for Medicaid reimbursement. In Feb 2024, the Coalition released its Medicaid Reimbursement Guide for the Doula Services Benefit which includes resources, information, and an FAQ. New York rolled out Medicaid coverage for doula care on 3/1/2024. The SPA was approved on 3/25/2024. The doula benefit will be carved out of the Medicaid managed care benefit package from 3/1/2024 to 3/31/2025 (i.e. doula providers will bill Medicaid fee-for-service for all doula services, including those provided to Medicaid enrollees in managed care plans). Doula services will begin being covered by the managed care plans starting on 4/1/2025. In April 2024, the enacted state budget allocated $250,000 to establish a grant program to help recruit, train, support, and mentor community-based doulas. On 6/10/2024, the State Health Commissioner issued a statewide standing order for doula services that was good for one year. The statewide standing order was reissued for a year on 6/10/2025. | Yes. A5140 would require private insurance coverage for doula care. Similar bills were introduced in 2018, 2019, and 2021, and 2023. | • Advancing Birth Justice: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities (2019) • The State of Doula Care in NYC in 2023 (2023) • Next Steps for Doula Services in New York State: Medicaid Benefit Design and Reimbursement (2023) | • NY State Doula Pilot Program • NYC Citywide Doula Initiative • S1867A (2023) • NY Coalition for Doula Access • NY State Medicaid Doula Services Benefit • NYCDA Medicaid Reimbursement Guide for the Doula Services Benefit • Approved SPA • Statewide standing order • S5992A (2024) • S758 (2025) • A3508 (2025) • A4073 (2025) • S809 (2025) • A1026 (2025) • A5140 (2025) • A5309 (2025) • A5709 (2025) • A6140 (2025) • S5665 (2025) (see summary for complete list of legislation) | Yes, as of 6/10/2024, but it is only good for one year. | Reimbursement is up to $1500 in New York City and up to $1350 for the rest of the state. | New York's doula Medicaid benefit includes eight total prenatal or postpartum visits, reimbursed at $93.75 per visit for New York City and $84.37 per visit for the rest of the state. In person doula support during labor & delivery is reimbursed at $750 for New York City and $675 for the rest of the state. The total reimbursement would be up to $1500 in New York City and up to $1350 for the rest of the state. | As of January 2025, doulas can bill as individuals or groups. Doula-only groups can enroll and bill for doula services. Individual doula providers can also affiliate with a multi-professional group, which can bill for services. As always, individual doulas can also enroll and bill. | Regulations do not contain specific limitations. | Yes. (2023-S8080 Sponsor Memo) | Regulations do not contain specific limitations. | The New York State Dept of Health offers two pathways for NYS Medicaid Doula Enrollment: The "Training Pathway" requires: • 24-hour minimum training in all required competencies (required competenceis are to be determined) • Doula support provided at a minimum of three births The "Work Experience Pathway" would require: • 30 births or 1000 hours of doula experience within the last five years • Testimonials of doula skills in prenatal, labor and postpartum care BOTH pathways also require: • Basic HIPAA training • Adult/Infant CPR • Liability insurance • Doula must be age 18 or older | Training pathway utilizes core competencies to meet enrollment criteria. | Yes. There is a work experience pathway. | Yes. All doulas revalidate as NYS Medicaid providers every five years, at which time they must demonstrate completion of continuing education in doula competencies. | No. | Yes. Doulas must maintain current liability insurance. | Yes. State 2024-2025 budget includes $250,000 in grant to community-based organizations to help increase the number of doulas. | |||||||||||||||||||
39 | OH | Actively Reimbursing | 2/23/2021 - HB 142 introduced (did not pass) 6/23/2021 - Ohio Dept of Medicaid announced doula care would be part of Maternal and Infant Support Program 2/22/2023 - SB 69 introduced (did not pass) 3/23/2023 - SB 93 introduced (did not pass) 7/2023 - Doula Medicaid benefit included in state budget 10/3/2024 - Start date of benefit 12/9/2024 - SPA approved | State Medicaid Agency working to implement doula Medicaid coverage as part of broader maternal and infant health efforts; doula Medicaid benefit also included in state budget | In February 2021, HB 142 was introduced, which would have estabished Medicaid coverage for doula care. The bill passed the House but did not advance further. In June 2021, Ohio's Department of Medicaid announced that it would implement doula care as part of a broader Maternal and Infant Support Program aimed at improving infant and maternal outcomes, with a focus on reducing racial disparities. The Program is being implemented in phases over 2-3 years, with the doula program to roll out as part of the fourth and final phase. In February 2023, SB 69 was introduced, which would have designated the calendar week including March 22 as Ohio Doula Awareness Week. In March 2023, SB 93 was introduced, which would have created a category of "certified doulas" regulated by the Ohio Board of Nursing. The bill also would have created a Doula Advisory Board to provide input and recommendations to the Board of Nursing and the Dept of Medicaid. Neither of these bills passed. In July 2023, the Ohio legislature passed the state budget with language that included several million dollars designated for Medicaid coverage for doula care. There were some elements of the original budget bill language that were vetoed by the governor, while still leaving the doula Medicaid benefit and doula certification piece intact. The state decided that the Board of Nursing would regulate doulas and created a Doula Advisory Group to provide input on state regulations. The Doula Advisory Group was appointed in Nov 2023 and began to meet in Jan 2024. The SPA was approved on 12/9/2024 with a retroactive start date of 10/1/2024. The doula benefit began on 10/3/2024. | No. | No. | • HB 142 (2021) • OH Dept of Medicaid Doula Initiative • SB 69 (2023) • SB 93 (2023) • Ohio Board of Nursing page on doula certification • Approved SPA | Yes. As of 10/3/2024. | Up to $1200. | The doula Medicaid benefit includes up to 48 15-min units (or 12 hours) between the time of the first prenatal visit up to 12 months postpartum. Reimbursement is at $12.50 per unit for a total of $600. There is a flat reimbursement rate of $600 for support during labor and delivery. The total reimbursement rate is up to $1200. Additional services in excess of these limits are permitted with prior authorization. Medicaid managed care plans are not permitted to pay less than the stated FFS rate for two years. | Doulas can bill as individuals. Ambulatory health clinics, FQHCs, freestanding birth centers, hospitals, professional medical groups, and rural health clinics can also submit claims and bill on behalf of either independent or non-independent doulas. (See Ohio Administrative Code Section 5160-8-43) | There are no place-of-service restrictions for doula services. (See Ohio Administrative Code Section 5160-8-43) | Unclear. | Telehealth is permitted for prenatal and postpartum visits. | According to the Ohio Administrative Code 4723-24-02, to be eligible for Medicaid reimbursement, doulas must: • submit a completed application including $35 application fee • be at least 18 years of age • meet requirements of certification pathway OR experience pathway • submit to criminal records check Certification Pathway • have certification from a doula organization recognized at international, national, state, or local level for training and certifying doulas • complete four hours of training in racial bias, health disparities, or cultural competency Experience Pathway • ten hours of doula continuing education • at least four of the ten hours of doula continuing education must be related to racial bias, health disparities, or cultural competency • remaining six hours should relate to the doula's practice • must have been actively practicing as a doula for previous three years Doulas can also obtain reciprocal certification by endorsement by confirming they already have an existing substantially similar certification to practice as a doula from another state or government entity. This pathway still requires four hours of training in racial bias, health disparities, or cultural competency. | Both. There is an option for certification from a recognized doula group or meeting a set of core competencies. | No. The rules have an "experience" pathway, but it still requires a specific number of hours of training. | Yes. Renewal of the certificate to practice as Board-certified doula requires ten hours of continuing education, including four hours related to racial bias, health disparities, or cultural competency; and the remaining six hours related to the doula's practice.Up to five excess hours of continuing education can be applied to satisfy future continuing education requirements.The continuing education requirement may be waived one time. | Yes. Criminal background check required. | No. | No. | |||||||||||||||||||
40 | OK | Actively Reimbursing | 2021 - OK Health Care Authority began internal discussions on including doula care in Medicaid 6/26/2023 - SPA approved 7/1/2023 - Start date for doula benefits | State Medicaid Agency decided to include doula care as covered Medicaid benefit, benefit included in the state buget, SPA approved | In 2021, the Oklahoma Health Care Authority began internal discussions on including doula services in the SoonerCare, the state's Medicaid program. In early 2023, the Health Care Authority requested funding in the state budget to cover doula services. SoonerCare hosted a training on the new doula benefit in June 2023. The SPA was subsequently approved on 6/26/2023 with an effective start date of 7/1/2023. | No. | No. | • OK Health Care Authority Doula Services page • Training on doula benefit, contracting, and enrollment • Approved SPA • List of SoonerCare doula providers | No. | Up to $1044.45. See SPA 23-0014. | The doula benefit covers a total of eight prenatal and postpartum visits at $64.45/visit, as well as support during labor and delivery ($528.85 for vaginal delivery). Prior authorization is not required for the standard doula benefit package, but would be required for additional visits beyond the eight allowed. Doula services are available for 12 months postpartum. Total reimbursement is $1044.45. The prenatal and postpartum visits must be at least 60 min long and face-to-face. Prenatal and postpartum visits can be conducted by telehealth, but not the labor and delivery visit. The prenatal and postpartum visits can take place in the beneficiary's residence, physician's office, doula's office, a hospital, or in the community. However, there is no coverage for home birth, so the labor and delivery care visit cannot take place in the beneficiary's residence. | Doulas can enroll and bill as individuals or groups. | Doulas will coordinate with the Medicaid enrollee to determine the most appropriate service location for prenatal/postpartum visits. Locations may include the Medicaid enrollee's home, physician's office, doula's office, hospital, or in the community. The labor/delivery visit cannot take place in the Medicaid enrollee's home. See SPA 23-0014. | Unclear. | Prenatal/postpartum visits can be conducted via telehealth. Labor/delivery visit cannot be conducted via telehealth. See SPA 23-0014. | Doulas must be at least 18 years of age and obtain an NPI. Doulas must have at least one certification as a birth doula, postpartum doula, full-spectrum doula, and/or community-based doula. Doulas must be certified by one of the state's recognized certifying organizations, the full list of which can be found here. | List of approved doula organizations. | No. | No. | No. | No. | No. | |||||||||||||||||||
41 | OR | Actively Reimbursing | 6/17/2011 - HB 3311 signed by Governor 8/1/2012 - SPA approved (non-traditional healthcare workers) 2014 - Start date of doula benefit 5/1/2017 - SPA approved (doula as preventive services, increasing reimbursement to $350) 1/1/2022 - Doula Services Rule amended to remove barriers to accessing care 7/1/2022 - SPA approved (increasing reimbursement to $1500) 7/18/2023 - HB 2535 signed by Governor 11/4/2024 - SPA approved (increasing reimbursement rate to $2365) 7/17/2025 - SB 692 signed into law | Legislation passed in 2011 followed by approval of SPA ; ongoing improvements to benefit over the years through legislation | In June 2011, Oregon passed HB 3311, which required the Oregon Health Authority to explore doula Medicaid benefits. The OR Health Authority subsequently submitted a SPA to add (Non-)Traditional Healthcare Workers, including doulas, as Medicaid reimbursement eligible providers. The SPA was approved by CMS with an effective date of 8/1/2012. The state began covering doula benefits in 2014. Initially the state was reimbursing $75 for labor and delivery. In 2017, the state submitted a SPA to move doulas to the preventive services category and to increase reimbursement rates to $350. The SPA was approved effective 5/1/2017. Even with the increased reimbursement rates, enrollment and uptake of the benefit were low. From Jan 2016 to Dec 2020, the OR Health Authority reimbursed for roughly 204 births (for comparison, roughly 19,000 Medicaid enrollees in the state give birth each year). Doulas expressed frustration at the low reimbursement rate and difficult billing process. Despite these challenges, doulas worked to organize and support one another. The Oregon Doula Association, a statewide professional organization for all doulas, formed early on, and continues to provide support, resources, education, and advocacy. Doula hubs also formed to assist doulas with administratively burdensome tasks such as billing and contracting. In Jan 2022, the Doula Services Rule was amended to remove barriers to accessing doula services, including removing the requirement for a referral from another licensed provider. In June 2022, the OR Health Authority announced it would be increasing its reimbursement rate from $350 to $1500. The SPA to increase the reimbursement rate was approved in Nov 2022 with an effective date of July 2022. In Nov 2024, another SPA was approved increasing the reimbursement rate to $2365 starting 1/1/2025. In January 2023, HB 2535 was introduced, which requires the Dept of Corrections to create a doula program for pregnant and postpartum adults in custody at Coffee Creek Correctional Facility, which is the only women's prison in the state. The bill also prevents shackling during labor, childbirth, and postpartum recovery, as well as prohibiting other restrictions that would interfere with a person's postpartum recovery and lactation needs. The bill was signed by the Governor on 7/18/2023. On 1/13/2025, SB 692 was introduced, which expands coverage of doula care in both Medicaid and private insurance, and requires that the Medicaid reimbursement rate for doula services "be not less than the rate paid in the State of Washington." The bill, which was signed into law on 7/17/2025, was later amended to eliminate the Medicaid reimbursement rate piece. However, the legislative language that passed maintained the requirement for private insurance coverage of doula care and requires a reimbursement rate of at least $3,760 for the package of services. It also expanded Oregon's Medicaid doula coverage to include more robust postpartum doula care, and created a grant program to support expanding access to more culturally specific and diverse doulas in the state. | Yes. SB 692, signed into law in July 2025, wil require doula care in private insurance | • Advancing Health Equity for Childbearing Families in Oregon: Results of a Statewide Doula Workforce Needs Assessment (2018) • Birthing a Sustainable Model: Oregon Doula Survey Findings (2025) | • HB 3311 (2011) • Approved SPA (2012) • Approved SPA (2017) • OR Health Authority page on Birth Doulas • Oregon Doula Association • Doula Services Rule Amendment (2022) • Approved SPA (2022) • HB 2535 (2023) • SB 692 (2025) | No. | Up to $1505. See OHA Birth Doula FFS Billing Guide. Starting on 1/1/2025, reimbursement rate will be up to $2365. See Oregon SPA 24-0021. | The doula benefit includes up to two prenatal visits reimbursed at $215/visit, up to two postpartum visits reimbursed at $215/visit, and birth/delivery support reimbursed at $645. The total reimbursement rate is $1505. Starting 1/1/2025, the doula benefit will cover two prenatal visits, delivery support, and two postpartum visits at $1505. The benefit will also cover an additional four visits which can be provided in any combination of prenatal and postpartum visits, reimbursed at $215 per visit. Total reimbursement if all visits are utilized will be $2365. Postpartum visits are available up to one year after the end of the pregnancy. Doula services can be billed once per pregnancy. Multiple births are not eligible for additional reimbursement. | Doulas can enroll and bill as individuals or groups. | Regulations do not contain specific limitations. | Unclear. | Unclear. | To become an Oregon State Certified Traditional Health Worker Birth Doulas, doulas must either: • complete at least 28 hours of in-person training hours from a list of programs provided by the OR Health Authority; or • exercise the Legacy Clause by providing evidence of attendance at ten live births and 500 hours of community work as a birth doula In addition, all doulas must also complete: • at least six contact hours of cultural competency • at least one contact hour of inter-professional collaboration • at least one contact hour on HIPAA • at least four hours of trauma-informed care • an OR Health Authority approved Oral Health Training • CPR certification for adults and infants/children • generally follow Standards of Professional Conduct | List of approved doula organizations. | Yes. the Legacy Clause allows doulas to forgo the 28 hours of in-person training hours, by instead providing evidence of attendance at ten live births and providing 500 hours of community work as a birth doula. | Yes. To maintain certification, doulas must complete at least 20 hours of continuing education every three years. Continuing education can be on any topic relevant to the work of a doula. | Yes. Background check is required. | No. | No. | |||||||||||||||||||
42 | PA | Actively Reimbursing | 4/14/2021 - HB 1175 introduced (did not pass) 2021 - PA Doula Commission formed 2023 - Certified Perinatal Doula pathway launched 1/31/2023 - SB 335 introduced (did not pass) 8/15/2023 - HB 1618 introduced 1/10/2024 - Doulas began enrolling w/ the PA Certification Board 2/1/2024 - Doulas began enrolling w/ Medicaid managed care plans 10/29/2024 - HB 1608 signed into law 1/1/2025 - Start date of benefit 4/2/2024 - SPA approved | State launched a Certified Perinatal Doula pathway; State Medicaid Agency in ongoing discussions with statewide doula group on doula Medicaid efforts; also ongoing legislative efforts | In April 2021, HB 1175 was introduced, which would have provided for Medicaid coverage of doula care, created a state-maintained doula registry, and set up a Doula Advisory Board to determine relevant doula education requirements. The bill did not pass. In Jan 2023, the bill was reintroduced as SB 335, which also did not pass. In Aug 2023, the bill was reintroduced as HB 1608. The bill was signed into law by the Governor on 10/29/2024. Also in Aug 2023, HB 1618 was introduced, which would require private insurance coverage of doula care. The same year, doulas and other stakeholders came together to start the Pennsylvania Doula Commission. The Commission's goal is to promote equitable access to doula care through workforce development, while also facilitating childbirth with dignity, improving perinatal health outcomes, and reducing health disparities. In 2023, the Pennsylvania Certification Board launched a pathway to become a Certified Perinatal Doula. The Board also maintains a list of approved Certified Perinatal Doulas.The PA Doula Commission offers a financial hardship application for the cost of the application fee ($50), based on circumstances and need. Doulas became eligible to enroll as providers with the PA Certification Board in Jan 2024, and with the Medicaid managed care plans in Feb 2024. Some doulas and doula agencies have successfully enrolled with and are being reimbursed by Medicaid managed care plans. On 4/2/2025, the SPA for doula services was approved, with an effective date of January 1, 2025. | Yes, HB 1618, introduced in Aug 2023, would require private insurance coverage of doula care. | No. | • HB 1175 (2021) • Dept of Human Services Perinatal and Parenting Support • PA Doula Commission • Certified Perinatal Doula application • List of approved Certified Perinatal Doulas • SB 335 (2023) • HB 1608 (2023-2024) • HB 1618 (2023-2024) • Approved SPA | No. | Up to $2550. | Doula services covered by Medicaid are: • Labor and Delivery at a flat rate of $1000.00 • Doula Services (Postpartum visit) $100.00 • Doula Services (Prenatal visit) $100.00 • Other Doula Services (two per calendar year) including fertility and pre-conception counseling, pregnancy loss, infant loss, or termination of pregnancy at a flat rate of $175.00 per service There is a combined limit of 12 prenatal and/or postpartum visits per calendar year. The total reimbursement rate is up to $2550. MCOs are permitted to exceed these rates but cannot pay less than these rates. Services are provided during pregnancy and through the 12-month postpartum period that begins when the pregnancy ends, and extends through the last day of the 12th month in which the postpartum period ends. See Medical Assistance Bulletin on Doula Services. | Doulas can enroll and bill as individuals or groups. This includes agencies as well as entities such as hospitals. | Permissible places of services include office, home, hospitals, and other community locations. See Medical Assistance Bulletin on Doula Services. | Yes. See Medical Assistance Bulletin on Doula Services including billing codes for termination of pregnancy. | The initial prenatal visit, the first postpartum visit, and doula services during labor and delivery, must be provided in person. Telehealth is permitted for other visits. See Medical Assistance Bulletin on Doula Services. | There are two pathways to become a Certified Perinatal Doula. For the training pathway, you must: • complete application • submit proof of 24 hours of relevant education/training in the Certified Perinatal Doula knowledge areas; at least one hour must be in HPAA/client confidentiality • submit documentation of current CPR certification for adults and infants • submit three client evaluations from families served within the prior 12 months For the experience pathway, applicants who did not obtain education through an approved doula training organization or certifying body, must submit proof of one year of experience, acquired within two years prior to submission of the application. For more information, see this announcement from the PA Doula Commisision. More details also available on the Certified Perinatal Doula application form. | Core competencies in Certified Perinatal Doula knowledge areas | Yes, there is an experience pathway | Recertification is required every three years, unclear what education requirements are entailed. | No. | No. | No. | |||||||||||||||||||
43 | RI | Actively Reimbursing | 7/9/2021 - H5929A signed by Governor 1/2022 - Rhode Island Birthworker Co-op launched 5/23/2022 - SPA approved 7/1/2022 - Start date for doula benefit | Legislation passed requiring doula coverage in Medicaid and private health plans, followed by SPA approval | In July 2021, Rhode Island passed H5929A (companion bill S0484A), requiring coverage of doula services in Medicaid and private health plans. (Note that the private insurance requirement applies only to fully insured health plans offered by a RI licensed insurer, meaning this does not apply to self-insured plans or plans licensed by other states, even when used in the state.) Rhode Island is the first state to require coverage for doula services in private insurance as well as in Medicaid. A group called Rhode Island Families Deserve Doulas engaged in advocacy efforts early on and helped organize doulas and other stakeholders to push for passage of H5929A. In January 2022, community-based doulas in the state launched the member-owned and operated Rhode Island Birthworker Co-op, which offers doulas support with the billing, record-keeping, and administrative requirements related to insurance reimbursement in the state. The benefit started on 7/1/2022. The SPA was approved by CMS in May 2022 with an effective start date of 7/1/2022. | Yes. H5929A passed in July 2021, requiring coverage of doula care in private insurance (as well as in Medicaid). | No. | • H5929A (2021) • Approved SPA • Rhode Island Health and Human Services Doula Services Page • Rhode Island Certification Board • Rhode Island Birthworker Co-op • Doula Services Manual | No. | Up to $1500. See SPA 21-0013. | Reimbursement is provided up to a maximum of $1,500, and includes three prenatal and three postpartum visits at $100 each, and labor and delivery services at $900, with no prior authorization requirement. If a patient does not use all three prenatal visits, those can be allocated as postpartum visits. If there is not a live birth, the remaining alotted benefit amount from prenatal and labor/delivery can be used towards postpartum/bereavement supports. | Doulas can enroll and bill as individuals or groups. | There is no reimbursement for doulas for home births/deliveries. However, prenatal and postpartum visits are permitted in the client's home. (See Doula Services Manual.) | Yes. (See Rhode Island Certification Board Certified Perinatal Doula Application, which includes pregnancy "loss, bereavement, and termination" as a required training domain.) | Regulations do not contain specific limitations. | Doulas interested in being eligible for reimbursement by Medicaid and/or private insurance must certify as a Perinatal Doula through the Rhode Island Certification Board. The cost to apply with the Board is $50. Additional requirements include: • completion of 20 hours of relevant education/training; • documentation of a current CPR certification with competencies for both adults and infants; and • documentation of a current SafeServ certification for meal prep. | Core competencies of relevant education/training to the Certified Perinatal Doula domains | No. | Recertification is required every two years. | No. | No. | No. | |||||||||||||||||||
44 | SC | Adjacent Action Taken | 11/2022 - SC Doula Steering Committee formed 1/14/2025 - S0042, H3108 introduced | Statewide collaborative has formed to advocate for policies around equitable compensation for doulas in SC | In Nov 2022, the South Carolina Doula Steering Committee launched. The Committee is leading a collaborative, statewide effort to advocate for policies that provide equitable compensation for doulas in the state, including studying how other states have built their doula reimbursement policies to make policy recommendations for South Carolina. In 2025 they embarked on a survey of doulas in the state, and also published a one-pager, South Carolinians Deserve Doulas. A SC-based organization, BirthMatters, provides community doula services to young birthing people (age 25 and under) at no charge. Their doulas provide education, emotional support, birth support, and continue following the families until the infant is one year old. In Jan 2025, S0042 was introduced, which requires Medicaid and private health plans to cover doula services. A similar bill, H3108, was also introduced the same month, but contains more details about the doula Medicaid implementation piece. | Yes, S0042 and H3108 would require coverage of doula care in both Medicaid and private insurance. | Yes. Expanding Access to Doulas in South Carolina (2024) | • South Carolina Doula Steering Committee • BirthMatters Doula Care Services • S0042 (2025) • H3108 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
45 | SD | Actively Reimbursing | 2023 - South Dakota Doulas begins organizing 1/12/2024 - HB 1081 introduced 1/25/2024 - DSS announced it would include Medicaid coverage for doula care as part of Pregnancy Health Home 1/10/2025 - SPA approved | State Medicaid Agency is implementing Medicaid coverage for doula care as part of effort to improve maternal health care/delivery for Medicaid enrollees | In 2023, a statewide nonprofit called South Dakota Doulas began organizing around legislation for Medicaid coverage for doula care. On 1/12/2024, HB 1081 was introduced, which would have required that the state implement Medicaid coverage for doula care. In Jan 2024, the South Dakota Dept of Social Services announced that it would be including Medicaid coverage for doula care as part of its Pregnancy Health Home effort, which aims to improve care and management of prenatal, postpartum and well-child care services for pregnant and parenting Medicaid enrollees. HB 1081 was tabled while the Dept proceeded with doula Medicaid implementation. The SPA to include doula services in Medicaid was approved in Jan 2025 and benefits began on 1/1/2025. | No. | No. | • South Dakota Doulas • HB 1081 • Approved SPA • SD Medicaid Doula Training Powerpoint • SD Medicaid Billing & Policy Manual for Doula Services • South Dakota Doulas - Doula Toolkit | No. | Up to $1800 per pregnancy, but this amount can be exceeded with prior authorization. See SD Medicaid Billing & Policy Manual for Doula Services. | Doula services are covered during the prenatal period, labor and delivery, and up to one year postpartum. Services are reimbursed at $16.87 per 15-min increment, with a flat fee of $600 for labor and delivery. The maximum possible reimbursement rate is $1800. However, this amount can be exceeded with prior authorization. See SD Medicaid Billing & Policy Manual for Doula Services. | To be determined. However, a July 2024 DSS Medicaid Doula Coverage presentation proposed that Medicaid would allow for individual doula enrollment. | Regulations do not contain specific limitations. | Unclear. | Doula services for care coordination, prenatal, and postpartum care can be provided in person or via telehealth. However, doula services for labor and delivery must be delivered in person. See SD Medicaid Billing & Policy Manual for Doula Services. | To be eligible as Medicaid providers, doulas must be (see SPA): • at least 18 years of age • maintain up-to-date certiication through a doula certification program approved by SD Medicaid The state is in the process of setting up an oversight body to provide credentialing and regulatory oversight of Medicaid approved doulas. In the interim, SD Medicaid is recognizing a list of approved doula credentialing organizations, which can be found on the SD Medicaid Doula Billing & Policy Manual for Doula Services. | Currently is a list of approved doula organizations. | No. | No. | No. | No. | No. | |||||||||||||||||||
46 | TN | Implementation in Progress | 6/1/2022 - SB 2150 signed by Governor 1/11/2023 - SB 128 introduced (did not pass) 1/17/2023 - SB 187 introduced (did not pass) 5/11/2023 - SB 394 signed by Governor 9/27/2023 - TN Doula Advisory Committee begins meeting 1/10/2024 - SB 1739 introduced (did not pass) 1/7/2025 - SB 44 introduced 2/5/2025 - SB 1093 introduced | Legislation passed to create a doula services advisory committee to establish core competencies and reimbursement rate for Medicaid coverage for doula care | In Jan 2022, SB 2150 was introduced. The bill originally required Medicaid coverage for doula care, but was later amended to instead require the Dept of Health to collaborate with TennCare, the state's Medicaid program, to study existing doula certification programs. SB 2150 was signed by the Governor on 6/1/2022. In Oct 2022, Healthy and Free Tennessee released Tennessee Doulas: Practical and Policy Recommendations, which collects the results of a survey of doulas across the state, as well as recommendations on what policies would best support doula work. There is also a Tennessee Doula Association that is working to educate about doulas and promote doula care in the state. In Jan 2023, a number of doula related bills were introduced: • SB 128 would have created a doula pilot program to run from 2024-2025 for pregnant women enrolled in TennCare with a higher likelihood of experiencing a higher-risk pregnancy, or with OB/GYN access issues. This bill did not pass. • SB 187 would have created a doula advisory committee to propose core competencies, methods for Medicaid reimbursement of doula services, reimbursement rates, incentives such as fee waivers, host town halls and a survey to establish needs and concerns with Medicaid coverage for doula services, and compile a report of their findings. This bill did not pass. • SB 394 originally would have required TennCare to cover doula care for Medicaid enrollees. The bill was later amended to create a five-member doula services advisory committee to advise the Dept of Health by establishing core competencies for doula care and recommending reimbursement rates for TennCare doula services. The bill was signed by the governor on 5/11/2023. The state is currently funding the Root to Rise Community Doula Pilot Program for pregnant TennCare enrollees who are Black and who live in specific zipcodes in Memphis. Following passage of SB 394, the Dept of Health set up the TN Doula Services Advisory Committee, which began meeting in Sep 2023. The Committee is tasked with creating core competencies and standards for doula services, propose reimbursement options and incentives such as fee waivers, provide analysis of existing doula pilot programs, and produce a report for the legislature by March 2025. On 1/10/2024, SB 1739 (companion bill HB 2225) was introduced, which would require Medicaid coverage for doula care and require the state to create a process for state certification of doulas. The bill was re-introduced on 1/7/2025 as SB 44 (companion bill HB 295). However, in March 2025, SB 44 was amended to only create a certification process for doula providers, but would not require Medicaid reimbursement. On 2/5/2025, SB 1093 was introduced, which extends the termination date for the doula services advisory committee from 7/1/2026 to 7/1/2027. | No. | Yes. Tennessee Doulas: Practical and Policy Recommendations (2022). | • SB 2150 (2022) • TN Doula Report • SB 128 (2023) • SB 187 (2023) • SB 394 (2023) • TN Doula Services Advisory Committee • SB 1739 (2024) • Roots to Rise Community Doula Pilot • Tennessee Doula Association • SB 44 (2025) • SB 1093 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
47 | TX | Adjacent Action Taken | 11/9/2020 - HB 158 introduced (did not pass) 11/14/2022 - HB 465 introduced (did not pass) 2/6/2023 - HB 1958 introduced (did not pass) 3/3/2023 - HB 3394 introduced (did not pass) 6/2/2023 - HB 1575 signed by Governor 2023 - Texas Doula Association formed 11/12/2024 - HB 514 introduced 11/21/2024 - HB 1201 introduced 2/5/2025 - HB 2477 introduced 2/7/2025 - HB 2573 introduced 2/20/2025 - HB 3121 introduced 3/14/2025 - HB 5583 introduced | A handful of Medicaid managed care plans in the state are piloting doula care; statewide doula advocacy coalition formed | Since 2020, a number of bills relating to Medicaid coverage for doula care have been introduced in the state: • In Nov 2020, HB 158 was introduced, which would have established a five-year pilot program for Medicaid coverage for doula care. The bill passed the House but did not pass the Senate • In Nov 2022, HB 465 was introduced, which had language similar to 2020's HB 158. The bill did not pass. • In Feb 2023, HB 1958 was introduced, which included a number of provisions aimed at addressing maternal mortality and morbidity in the state, and included the language in HB 465 creating the doula pilot.The bill did not pass. In Mar 2023, HB 3394 was introduced, which would have required Medicaid coverage for doula care, and included details around eligibility for reimbursement. The bill did not pass. Also in Mar 2023, HB 1575 was introduced, which aims to improve health outcomes for pregnant Medicaid enrollees and their children by providing case management for nonmedical needs. Those eligible to provide case management are licensed advanced practice nurses; licensed registered nurses; licensed social workers; state certified community health workers; and doulas certified by a recognized national certification program. The governor signed the bill on 6/2/2023 and and it was implemented by early 2025. • In Nov 2024, HB 1201 was introduced, which would create a doula pilot program in Medicaid, to be run in the most populous county in the state, as well as the county with the greatest maternal health support need. The same month, HB 514 was introduced, which appears to be aimed at growing the doula workforce. • In Jan 2025, HB 2477 was introduced, which would cover doula services under certain group benefit plans for governmental employees and retirees. In Feb 2025, HB 2573 was introduced, which would require Medicaid to cover doula care. A similar bill, HB 5583, was introduced in March 2025. The same month, HB 3121 was introduced, which lays out a number of requirements to address maternal mortality and morbidity in the state, including Medicaid coverage of doula care. In Sep 2022, Dell Children's Health Plan began offering doula support to its Medicaid enrollees. Services are provided by a group called Giving Austin Labor Support (GALS) Birthworkers and include two prenatal visits, two postpartum visits, and support during labor and delivery. In 2023, UnitedHealthcare also began offering doula services to its pregnant and postpartum Medicaid enrollees as part of a statewide pilot program. (UnitedHealthcare is also running similar doula pilots in Arizona, Kansas, Kentucky, and Washington.) Also in 2023, Blue Cross and Blue Shield of Texas began offering doula services to some of its enrollees through its Special Beginning program. In 2023, a group of doulas from across the state came together to form the Texas Doula Association. The group is working to ensure that doulas in Texas are centered in any work for doula reimbursement legislation, that their voices are heard in the process, and that doulas are able to regulate and govern themselves. | HB 2477 would cover doula services under certain group benefit plans for governmental employees and retirees. | No. | • HB 158 (2020) • HB 465 (2022) • HB 1958 (2023) • HB 3394 (2023) • HB 1575 (2023) • Texas Doula Association • HB 514 (2024) • HB 1201 (2024) • HB 2477 (2025) • HB 2573 (2025) • HB 3121 (2025) • HB 5583 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
48 | UT | Implementation in Progress | 2/7/2023 - SB 192 introduced (did not pass) 3/15/2023 - HB 415 signed by governor 1/16/2024 - SB 85 introduced (did not pass) 3/19/2025 - SB 284 signed by governor | Legislation passed to provide doula care to state employees | In Feb 2023, SB 192 was introduced, which would have required the Dept of Health and Human Services to submit a SPA, in consultation with stakeholders, requiring Medicaid coverage for doula care. The bill passed the Senate but not the House. The bill passed the Senate but failed in the House. It was reintroduced on 1/16/2024 as SB 85 (did not pass). It was reintroduced on 2/18/2025 as SB 284, and signed into law on 3/19/2025. Also in Feb 2023, HB 415 was introduced, which requires Utah's Public Employees Health Program (PEHP) -- which covers state employees -- to cover doula services and access to birth centers for three years. The bill was signed by the Governor on 3/15/2023. The doula benefit -- which covers only up to four months after delivery, and has a maximum benefit limit of $692.10 per pregnancy -- became effective for PEHP employees on 7/1/2023 and will continue through 6/30/2026. In 2024, the Utah Department of Health and Human Services Office of Substance Use and Mental Health began a pilot project to train Recovery Doulas. Their Recovery Doula program combines two types of health professionals -- doulas and peer support specialists -- who are trained to help pregnant patients and those dealing with mental health and addiction issues. As of Nov 2024, the Office of Substance Use and Mental Health is launching its second cohort, and is now looking forward to data tracking, sustainability program needs, and ongoing funding opportunities. | Yes. HB 415 was signed into law in March 2023. It will provide doula services for pregnant and postpartum members of Utah's Public Employees Health program from July 2023 to June 2026. | No. | • SB 192 (2023) • HB 415 (2023) • SB 85 (2024) • PEHP Doula Covered Services • SB 284 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
49 | VA | Actively Reimbursing | 4/6/2020 - HB 687 signed by Governor 4/7/2020 - HB 826 signed by Governor 12/1/2020 - Workgroup report published 4/7/2021- HB 1800 budget bill signed by Governor 10/28/2021 - SPA approved 4/1/2022 - Start date for doula benefit 1/5/2023 - HB 1538 introduced (did not pass) 4/4/2024 - SB 118 signed by governor 5/2/2025 - HB 1614 signed by governor 3/24/2025 - SB 1384 signed by governor | Doula coverage included in budget, followed by SPA approval | In April 2020, HB 687 was signed by the Governor. The bill created a process for state certification of doulas. Also in April 2020, HB 826 was signed by the Governor, which required the Dept of Medical Assistance Services to convene a work group to provide recommendations on Medicaid coverage for doula care. The Report of the Virginia Medicaid Benefit for Community Doula Services Work Group was published in Dec 2020. The following year, the state's 2021 budget bill, HB 1800, called on the Dept of Medical Assistance Services to implement Medicaid coverage for doula care, consistent with the workgroup recommendations. Virginia's SPA was approved in Oct 2021 with an effective date of 1/1/2022. The doula benefit began on 4/1/2022. On 1/5/2023, HB 1538 (companion bill SB 1273) was introduced, which would have required private health plans in the state to provide coverage for doula services. In late Jan 2023, HB 1538 was sent instead to the Senate Health Insurance Reform Commission, which will facilitate a study of the cost and benefits of private insurance coverage for doula care. On 1/4/2024, the bill was reintroduced as SB 118 (companion bill HB 935). This bill was signed by the Governor on 4/4/2024. In Jan 2025, HB 1614 was introduced, which would increase the allowance of postpartum visits from four to six, and would also increase the amount of time postpartum that doula services could be utilized by Medicaid enrollees from 12 weeks to 12 months. The bill was signed into law by the Governor on 5/2/2025. Also in Jan 2025, SB 1384 was introduced, which requires hospitals to allow a doula to be present in addition to a partner/spouse.The bill wa ssigned into law by the Governor on 3/24/2025. | Yes. SB 118 requires doula coverage in private insurance and was signed into law on 4/4/2024. However, the legislation required reenactment in the 2025 legislative session to become effective, which did not happen. As such, private insurance implementation in Virginia is on hold. | Yes. Report of the VA Medicaid Benefit for Community Doula Services Work Group (2020) | • HB 687 (2020) • HB 826 (2020) • Report of the VA Medicaid Benefit for Community Doula Services Work Group • HB 1800 (2021) • Approved SPA • VA Medicaid Community Doula Program • VA Certification Board State-Certified Doula page • VA State-Certified Doula Registry • HB 1538 (2023) • SB 118 (2024) • SB 1384 (2025) • HB 1614 (2025) • Doula Association of Virginia | No. | Up to $1078.92. See Dept of Medical Assistance Services Community Doulas for Medicaid Members. | Doulas are reimbursed $859 for eight prenatal and postpartum visits, and presence at labor/delivery. Services can provided up to 180 days (six months) after delivery. Authorization is required for more than eight visits or for services continuing past 180 days. In May 2025, the allowance for postpartum visits was increased from four to six. Doulas can also receive two $50 incentive payments (total of $100) for helping connect Medicaid enrollees to their postpartum medical appointment, and their newborns to pediatric care. The total reimbursement for a doula whose client utilizes all services is $1078.92. See SPA and Dept of Medical Assistance Services Community Doulas for Medicaid Members. | Doulas can enroll and bill as individuals or groups. | Regulations do not contain specific limitations. | Unclear. | Regulations do not contain specific limitations. | To be eligible for reimbursement as a Medicaid provider, doulas must be certified by the VA Certification Board as a state certified doula. The VA Certification Board requires that doulas must have completed 60 hours of training within the last three years, from a VA Certification Board accredited training provider. The full list of approved providers is here. | Doulas must have met a set of core competencies as provided by a specific list of doula training and certification organizations. See VA Certification Board. | No. | Doulas must complete at least 15 hours of continuing education every two years. See 12VAC5-403-60. | No. | Yes. In order to enroll as Medicaid providers, doulas must provide proof of liability insurance. See VA Dept of Medical Assistance page on Community Doula Program. | No. | |||||||||||||||||||
50 | VT | Implementation in Progress | 2/13/2019 - H.219 introduced (did not pass) 5/6/2024 - S.109 signed by Governor 1/24/2025 - H.79 introduced 6/9/2025 - S.53 signed by Governor July 2027 - anticipated start date of benefit | Legislation signed in spring 2024 to create sunrise review on doula regulation and proposal for doula Medicaid coverage, followed by legislation for Medicaid coverage for doula care signed in June 2025 | In 2017, the Vermont Legislative Joint Fiscal Office issued a brief about Medicaid Coverage for Doula Services in Vermont. On 2/13/2019, H.219 was introduced, which would have required Medicaid coverage for doula services. The bill also included details about training and certification requirements. The bill did not pass. On 2/28/2023, S.109 (companion bill H.154) was introduced, which would require a sunrise review on the regulation of doulas and require the Dept of Vermont Health Access to propose a plan for Medicaid coverage for doula care. The bill was signed into law in May 2024. On 1/24/2025, H.79 was introduced, which creates voluntary certification for community-based perinatal doulas. On 2/6/2025, S.53 was introduced, which is similar to H.79 except it includes a section also mandating Medicaid coverage of doula care, regardless of the outcome of the pregnancy. The bill requires the Vermont Office of Professional Regulation to, among other things, grant and renew such certifications, and create a registry of certified-community-based doulas. The bill also requires that the state seek the advice of community-based perinatal doula in implementing the bill, including appointing two certified community-based perinatal doulas to serve as advisors. The bill includes language stating that reimbursement will be “in amounts that are reasonable and adequate for the services provided and that are consistent with the reimbursement rates set by other states’ Medicaid programs.” The bill was signed by the Governor on 6/9/2025. Washington County Mental Health Services has a Doula Project that, since 2014, has provided free doula support to all women who receive or are eligible to receive services from the organization. The program is funded in part through a federal grant, and advocates hope the program can be a model for elsewhere in the state. As of Sep 2024, a newly formed nonprofit in Vermont, the Doula Association of Vermont, is working with the Vermont Office of Professional Regulation, the Department of Vermont Health Access, and the Vermont legislature, to advocate for Medicaid funding for doulas in Vermont. In Jan 2025, the VT Office of Professional Regulation issued the sunrise review required by S.109. | No. | • Medicaid Coverage for Doula Services in Vermont (2017) • Doula Sunrise Report (2025) | • VT Legislative Joint Fiscal Office Issue Brief • H.219 (2019) • S.109 (2023-2024) • The Doula Project of WCMHS • Doula Association of VT • H.79 (2025) • S.53 (2025) • Doula Sunrise Report | N/A | S.53, which was signed by the Governor in June 2025, specifes that "It is the intent of the General Assembly that the Department of Vermont Health Access reimburse qualified doulas in amounts that are reasonable and adequate for the services provided and that are consistent with the reimbursement rates set by other states’ Medicaid programs." | N/A | N/A | N/A | S.53, which was signed by the Governor in June 2025, specifes that doula care will be provided regardless of the outcome of the pregnancy. | N/A | N/A | N/A | N/A | S.53, which was signed by the Governor in June 2025, specfiies that state-certified community-based perinatal doula certification must be renewed every two years upon proof of compliance with any continuing education or competency requirements established by rule. | S.53, which was signed by the Governor in June 2025, does specify that a criminal history background or registry check may be required. | N/A | N/A | |||||||||||||||||||
51 | WA | Actively Reimbursing | 4/3/2020 - SB 6168 budget bill signed in part by Governor 3/30/2022 - HB 1881 signed by Governor 1/9/2023 - HB 1141 introduced (did not pass) 10/1/2023 - Start date for new health profession of state-certified birth doulas 1/11/2024 - SB 6172 introduced 2/6/2024 - Doula services included in state budget 8/1/2024 - Doula Apple Health provider enrollment opens 9/10/2024 - SPA approved 1/1/2025 - Start date of doula benefit 4/22/2025 - SB 5182 signed into law | State created voluntary process to become state-certified birth doula, doula services subsequently included in state budget | In April 2020, budget bill SB 6168 was signed in part by the Governor, which instructed the Dept of Health to make recommedations to the legislature on Medicaid reimbursement for doula care. The WA Health Care Authority and Dept of Health convened a Doula Services Stakeholder Workgroup, which in Dec 2020 published Methods to secure doula reimbursement approval from CMS. In March 2022, HB 1881, which created a new health profession for a state-certified birth doula, was signed by the Governor. State-certified birth doulas as a new health profession became effective on 10/1/2023. Alongside legislative action, there has also been consistent advocacy from doulas and other stakeholders, including a 2020 report on Washington State Medicaid Reimbursement: Survey of Birth Doulas and consistent work and advocacy from the Doulas For All Coalition. In Jan 2023, appropriations bill HB 1141 was introduced, which would have required development of an implementation plan for Medicaid reimbursement of doula services. The bill did not pass. On 1/11/2024, SB 6172 (companion bill HB 2350) was introduced, which would require the state to create competency-based requirements for a doula to obtain state certification. The bill specifically requires a waiver of any certification, examination, or renewal fees from for the first five years, from 2025-2030. Also in 2023, UnitedHealthcare began offering doula services to its pregnant and postpartum Medicaid enrollees as part of a statewide pilot program. (UnitedHealthcare is also running similar doula pilots in Arizona, Kansas, Kentucky, and Texas.) In March 2024, Medicaid coverage for doula care was included in the state budget at a reimbursement rate of $3500 with an additional $100k allocation for a doula hub and referral system. The Health Care Authority anticipates implementing the doula benefit by early 2025. The SPA to add doula services as a benefit in Medicaid was approved on 9/10/2024 with an effective start date of 1/1/2025. In Oct 2024, the Washington State Health Care Authority and Department of Health issued a joint statewide standing recommendation for doula services. In Jan 2025, SB 5182 was introduced, which requires the Dept of Corrections to allow midwifery or doula services to incarcerated individuals who are pregnant or who have given birth within the last six weeks. The bill was signed into law on 4/22/2025. | No. | • Washington state Medicaid reimbursement: Survey of birth doulas (2020) • Methods to secure doula reimbursement approval from CMS (2020) | • SB 6168 (2020) • Doula Services Stakeholder Workgroup Report • HB 1881 (2022) • WA State Medicaid Reimbursement: Survey of Birth Doulas • Doulas For All Coalition • HB 1141 (2023) • SB 6172 (2024) • Approved SPA • WA Health Care Authority Doulas page • Birth Doula Services Billing Guide • SB 5182 (2025) | Yes. As of 10/2024. | Up to $3500. | Doula services covered by Medicaid are (see Birth doula services fee schedule): • One initial 2-hour prenatal intake visit, must be in-person, reimbursed at $750 flat rate • Labor and delivery support, must be in-person, reimbursed at $750 flat rate • Prenatal and postpartum visits, limited to 20 hours total including one 1.5 hour comprehensive postpartum visit, reimbursed at $25 per 15-minute units up to a total of $2000 Maximum total reimbursement is up to $3500 per pregnancy. Services are covered up to 12 months after the end of the pregnancy. Also, note that these limitations may be exceeded based on medical necessity. | Doulas can enroll and bill as individuals or groups. | Regulations do not contain specific limitations. | Yes. (SPA specifies that services are "inclusive of all pregnancy outcomes.") | The initial 2-hour prenatal intake visit, labor and delivery support, and the first visit with a new doula if a client changes doulas, must be in person. All other prenatal and postpartum visits can be via telehealth. (See Birth Doula Services Billing Guide.) | There are three pathways to become a WA state-certified birth doula: • Training Program: Must complete Culturally Congruent Ancestral Practices, Training, and Education; in addition to completing a Birth Doula Education Program from an approved program • Ancestral: Must complete Culturally Congruent Ancestral Practices, Training, and Education; in addition to demonstrating Ancestral Pathway Competencies through self attestation or three written testimonial letters from profession-related leaders or peers • Out of State: Out of State Endorsement by submitting proof of current certification to practice as a birth doula in another state, DC, or a US territory View a detailed chart of the different pathways and required competencies. There are no fees required for initial birth doula state certification or for renewal, until 7/1/2025. | Both offered depending on certification pathway selected. | There is an ancestral pathway; however this pathway still requires at least an attestation of having completed culturally congruent ancestral practices, training, and education | Initial certification expires on your next birthday after the issuance of the initial certification. After that initial certification cycle, doulas must renew every two years on their birthday. Each renewal requires ten hours of continuing education. (See Birth Doulas FAQ) There are no fees required for initial birth doula state certification or for renewal, until 7/1/2025. | Yes, fingerprint background check is required. | No. | Yes, 2024 state budget included a $100k allocation for a doula hub and referral system | |||||||||||||||||||
52 | WI | Adjacent Action Taken | 2019 - State-funded doula pilot programs launch in Madison and Milwakee 2021 - Doula care included in Governor's budget but stripped by Republicans 2023 - Doula care included in Governor's budget but stripped by Republicans | Dept of Health Services running doula pilots; Governor has twice included doula care in proposed budget but both times funding was stripped from budget by Republicans | In 2019, the Wisconsin Dept of Health Services began running doula pilot programs in Madison and Milwaukee, with positive results. UnitedHealthcare Community Plan of Wisconsin, a Medicaid managed care plan, also supported the Milwaukee pilot with funding to help support training, care coordination, and data sharing. Medicaid coverage for doula care was included in Governor Tony Evers' proposed state budget for 2021-2023 and 2023-2025, but both times the benefit was stripped from the budget by the Republican controlled legislature. Meanwhile, doulas and stakeholders in the state continue to advocate for access to doula care. | No. | No. | • Madison doula pilot • Milwaukee doula pilot • 2021-2023 proposed state budget • 2023-2025 proposed state budget | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
53 | WV | Adjacent Action Taken | 2022 - WV Perinatal Partnership doula pilot launches 1/26/2023 - SB 479 introduced (did not pass) 1/12/2024 - SB 313 introduced (did not pass) 1/29/2024 - HB 5328 introduced (did not pass) 2/12/2025 - SB 292 and SB 40 introduced | Doula pilot taking place in state; legislation for doula Medicaid coverage has been introduced in multiple years | In 2022, the West Virginia Perinatal Partnership received a grant to train doulas and provide doula services to pregnant and postpartum women in underserved and vulnerable communities in the state. The group is also working with the WV Office of Maternal, Child and Family Health and the WV Rural Maternity and Obstetric Management Services to leverage the success of the pilot to find additional ways to expand access to doula care in the state. The Partnership currently works with a Doula Advisory Council and a Doula Network that meets on a regular basis to discuss statewide advocacy and strategy. In Jan 2023, SB 479 was introduced, which would have extended Medicaid coverage for doula services. The bill did not pass. In Jan 2024, two bills were introduced pertaining to expanding access to doula care. Neither bill passed. • SB 313 would provide coverage for doula care in both Medicaid and the WV Public Employees Insurance Act (for state employees) • HB 5328 (similar bill HB 5505) would require the state to submit a SPA for Medicaid coverage for doula care In Feb 2025, two similar bills were introduced that required coverage for doula care in Medicaid and the WV Public Employees Insurance Act (similar to SB 313 from 2024): SB 292 and SB 40. | Yes. SB 292 and SB 40 would provide coverage for doula care for state employees. | No. | • WV Perinatal Partnership • SB 479 (2023) • SB 313 (2024) • HB 5328 (2024) • SB 292 (2025) • SB 40 (2025) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
54 | WY | We were not able to find any current efforts in this state. | |||||||||||||||||||||||||||||||||||||||
55 | AS | We were not able to find any current efforts in this territory. | |||||||||||||||||||||||||||||||||||||||
56 | GU | Action Proposed | 6/26/2024 - Bill 318-37 introduced | Doula training project launched, bill introduced to fund training project | In June 2024, Bill 318-37 was introduced, which aims to improve maternal and infant health in Guam by allocating $400,000 from the General Fund to the Bureau of Women's Affairs Guåhan Doula Project. The Guåhan Doula Project -- which is a collaborative effort between the Bureau of Women's Affairs and the Birthworkers of Color Collective -- works to train individuals who want to become doulas. | No | No | • Bill 318-37 (2024) | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||||||||||||||
57 | MP | We were not able to find any current efforts in this territory. | |||||||||||||||||||||||||||||||||||||||
58 | PR | We were not able to find any current efforts in this territory. | |||||||||||||||||||||||||||||||||||||||
59 | VI | We were not able to find any current efforts in this territory. | |||||||||||||||||||||||||||||||||||||||
60 | TRICARE | Adjacent Action Taken | 1/1/2022 - Start date for doula pilot 1/1/2025 - Doula pilot will be expanded overseas | Five-year doula pilot program launched in Jan 2022 for civilian facilities in the United States, with plans to expand it overseas in 2025 | In Jan 2022, the Dept of Defense launched a five-year TRICARE Childbirth and Breastfeeding Support Demonstration, to pilot doula and lactation support for those who use the TRICARE health program at civilian facilities in the United States. In April 2024, the Department of Defense released its Report to the Committees on Armed Services of the Senate and the House of Representatives on the Demonstration Project, which summarizes the early findings from the demonstration project. In Jan 2025, the doula pilot will be expanded overseas, also only for those using TRICARE at civilian facilities overseas and not at military treatment facilities. The Military Birth Resource Network and Postpartum Coalition has been advocating for improvement and expansion of the doula and lactation support pilot for military families in the U.S. and abroad. | N/A | No. | • TRICARE Childbirth and Breastfeeding Support Demonstration • Military Birth Resource Network and Postpartum Coalition | N/A | Up to $966. See Rates for Childbirth Support Doula Services. | The program covers up to six prenatal and postpartum doula visits, as well as doula support at labor/delivery. Each of the prenatal or postpartum visits are reimbursed at $46. Support during labor/delivery is reimbursed $690. Total reimbursement for six prenatal and postpartum visits and support during labor/delivery is $966. See Rates for Childbirth Support Doula Services. | N/A | N/A | N/A | N/A | To become a TRICARE authorized certified labor doula, you must: • be at least 18 years old • obtain or maintain current adult, child, and infant CPR certification • obtain a National Provider Identification (NPI) number • have malpractice insurance • have certification from an approved doula certification organization • have attended at least 24 education hours in relevant subjects • have attended at least one breastfeeding course • have attended at least one childbirth course • sign an attestation of having attained required childbirth support experience The approved doula certification organizations are: • BirthWorks International • Doulas of North America International • Childbirth and Postpartum Professional Association • International Childbirth Education Association • toLabor | List of approved doula organizations. | No. | Unclear. | N/A | Yes. Doulas who are network providers must have professional liability insurance. See Requirements for Provider Participation. | N/A | |||||||||||||||||||
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63 | We would like to express our gratitude to all the doulas and advocates we spoke with in compiling this chart, including Dalia Abrams, Heather Allison, Lizet Ansaldo, Ebonie Bailey, Emily Barney, Caitlin Beasley, Andrea Berry, Ashley Black, Senait Brown, Jasmyne Bryant, Leah Castelaz, Gaby Cavins, Molly Chappell-McPhail, Gerria Coffee, Yuki Davis, Twylla Dillion, Amanda Dodson, Rebecca Elliott, Ashley Ezzio, Sara Finger, Ireta Gasner, Christina Gebel, Erika Geiss, Tony Gillespie, Kayla Goldfarb, Molly Gosselink, Nina Gurak, Karla Gutierrez, Ashley Hill Hamilton, Linda Herrick, Danita Jackson, Marcus Johnson-Miller, Thunwa Klaihathai, Katy Kozhimannil, Enjolie Lafaurie, Ariana Lazo, Samantha Lew, Kyesha Lindberg, Shauna Lively, Katharine London, Lisa Low, Michelle Ludwig, Jessica Lujan, Raquel Mazon Jeffers, Wendy McWeeny, Brian Merlos, Morgan Miles, Fatima Modaba, Elizabeth Mosley, Sabrina Movitz, Ashley Nguyen, Raeben Nolan, Maria Noyes, Quatia Osorio, Breechelle Parker, Melanie Phelps, Chanel Porchia-Albert, Laura Register, Jessica Roach, Anjali Salvador, Quentin Savwoir, Madison Scott, Elizabeth Simmons, Lauren Smith, Nan Strauss, Kenda Sutton-El, Kate Symmonds, Sarah Teel, Elizabeth Tinker, Kelsie Thomas, Kara Van de Grift, Jackie Vaughn, Kelly Vyzral, Steven Wagner, Gail Williams, Jazmin Williams, Sunny Lu Williams, Dorian Wingard, Elizabeth Wood, and Michelle Zambrano. | ||||||||||||||||||||||||||||||||||||||||
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65 | Thank you to the NHeLP interns who have helped with revisions of this chart over the years: Sarah Hart (NHeLP 2021-2022 intern and Georgetown law student), Mara Greenwald (NHeLP summer 2022 intern and Pepperdine law student), Katherine Rohde (NHeLP spring 2023 intern and University of Pennsylvania law student), and Katie Lee (NHeLP spring 2023 intern and George Washington University law student). | ||||||||||||||||||||||||||||||||||||||||
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