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This chart was created and is maintained by the National Health Law Program's Doula Medicaid Project.
You can also view this information in our Doula Medicaid Interactive Map.
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.
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StateImplementation StatusTimelineSummary of EffortsPrivate Insurance Coverage Bills Introduced or Signed Into LawState Specific Reports and/or SurveysAvailable ResourcesStatewide Standing RecommendationReimbursement RateBilling / Payment StructureWho is Allowed to Bill (i.e. Individuals, Groups, Other Entities)Physical Setting(s) in which Doula Services are CoveredCoverage for Abortion Doula CareTelehealthTraining, Credentialing, and/or Certification RequirementsCredentialing Requirements (i.e. List of Organizations or Core Competencies)Experience or Legacy PathwayRequirement for Continuing EducationFingerprint Background Check RequirementLiability Insurance RequirementFunded Outreach EffortsApplication FeeRequired Ethics/Professional StandardsBills Relating to People in Carceral Settings Introduced or Signed Into Law
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Last updated May 2026BLUE: Actively Reimbursing
PURPLE: Implementation in Process
GREEN: Adjacent Action
GREY: Action Proposed or No Current Action		NOTE: Information in these sections correspond to the Current Coverage Landscape on our interacitve map, and is primarily for states that have implemented or are in the process of implementing Medicaid coverage for doula care.
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AKAdjacent Action2023-2024 - State funded a pilot community doula programFrom 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 were experiencing housing instability, had no other labor support, had a history of trauma or previous traumatic birth experience, had a high-risk medical condition or mental health diagnosis; and/or were BIPOC. While the state funded pilot sunset in 2024, Due North continues to provide some level of free community-supported doula services based on doula volunteer availability. NoN/A• Due North Support Services Community Doula ProgramN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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ALAdjacent Action2023 - Statewide committee forms to advance doula efforts
3/10/2026 - HB 598 introduced (Rural Maternal and Infant Health Equity Act)		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 hopes to introduce legislation in the future.

In March 2026, HB 598, the Rural Maternal and Infant Health Equity Act, was introduced, which would require Medicaid and private insurance to cover midwife and doula services, establish a grant program to support midwifery and doula services and rural birth centers, and create the Rural Maternal and Infant Health Equity Program Fund.		Yes. HB 598, the Rural Maternal and Infant Health Equity Act, introduced in March 2026, would require coverage of midwife and doula services in both Medicaid and all private state health plans.N/AAdvocacy
• BirthWell Partners Community Doula Project

2026 Legislative Session
• HB 598 - Rural Maternal and Infant Health Equity Act)		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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ARImplementation in ProcessJan 2024 - Statewide health policy organization endorses expanded access to doula care
Aug 2024 - Doula Alliance of Arkansas starts
4/21/2025 - HB1252 signed into law (mechanism for state certified doulas, plan for Medicaid coverage for doula care)
2/20/2025 - HB1427 signed into law (home visiting reimbursement for doulas and CHWs)
Early 2026 - Anticipated start date of Medicaid doula benefit		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, the state's 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 champions improved maternal health outcomes in the state and works to expand 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 requires that certified community-based doulas receive compensation from Medicaid as well as health benefit plans. It also 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 requirement for private insurance coverage of doula care technically went into effect in August 2025. While there has been some delay in implementation, in early 2026 the AR Division of Medicaid Services had laid out guidelines for the state's Community-Based Doula Certification and stated their intention to submit a SPA to CMS requesting retroactive approval to 3/1/2026.		Yes, HB1252 allows state certified community-based doulas to receive compensation from private health benefit plans. The law went into effect in August 2025.N/AState Agency Resources
• AR Dept of Health Community-Based Doula Certification

Advocacy
• ACHI position on doula care
• Doula Alliance of Arkansas

Prior Legislation
• HB1252 (2025) - mechanism for state certified doulas, plan for Medicaid coverage for doula care
• HB1427 (2025) - home visiting reimbursement for doulas and CHWs		No.Up to $712.15 to $855.25 depending on vaginal or cesarean delivery.The Proposed Provider Manual Rules (Feb 2026) state that doula services will be limited to up to four visits during the prenatal period, support during labor/delivery, and up to two visits during the postpartum period. The minimum visit length for doula services is one hour. A request for extension of benefits can be submitted for those who require additional visits beyond the allocated four prenatal visits and two postpartum visits.

Doula services are available up to 16 weeks postpartum.

The proposed fee schedule states that each prenatal and postpartum visit will be reimbursed at $64.45, labor/support at a vaginal delivery will be reimbursed at $468.55, and labor/support at a cesarean delivery will be $325.45. Total maximum possible reimbursement would be $712.15 t0 $855.25 depending on a vaginal or cesarean delivery.		N/AThe Proposed Provider Manual Rules (Feb 2026) state that at least one doula visit must take place in the client's home. Otherwise, acceptable service locations for the prenatal and postpartum visits including the client's home, doula office, physician's office, hospital, homeless shelter, group home, temporary lodging, outreach site, and public health clinic. Labor/delivery services cannot be provided at the client's home.N/AThe Proposed Provider Manual Rules (Feb 2026) state that the initial doual visit must be in person, as do doula services during labor/delivery. After the initial visit, subsequent prenatal and postpartum visits may be conducted via telehealth. To be eligible for certification as an AR Dept of Health Certified Community-Based Doula, which allows community-based doulas to receive compensation from Medicaid as well as private health benefit plans, you must:
• be at least 18 years old
• maintain certification from a doula certification organization designated by the department (current list available here) OR hold a certificate as a doula by the Doula Alliance of Arkansas
• submit $50 application fee

There is also a mechanism for doulas to apply for reciprocal certification for doulas who can provide documentation of equivalent certification/licensure and documentation that they are already certified in another state/district.

Certification is valid for two years from the date of issuance.

The Proposed Rules Pertaining to Doula Certification (Feb 2026), includes a mechanism for automatic certification of uniformed service members, veterans, and their spouses.		List of approved doula certification organizations.The Proposed Rules Pertaining to Doula Certification (Feb 2026), specify that certification shall include both formal training and experiential pathways. Doulas must complete 10 hours of professional development requirement and training every two years. (See
AR State Legislature Act 965)		N/AN/AN/AThere is an application fee of $50.N/AN/A
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AZActively Reimbursing4/26/2021 - SB 1181 signed into law (state certification for doulas)
8/2023 - Start date for voluntary doula licensing program
9/23/2024 - SPA for doula Medicaid benefit approved
10/1/2024 - Start date for doula Medicaid benefit		In April 2021, SB 1181 was signed into law, which outlined a multi-step process of state certification for doulas, and also established a Doula Community Advisory Committee to consult with the Dept of Health Services on implementing the state certification. The Committee formed in 2022 and met from 2022 to 2023. Alongside the work of the committee, organizations such as the Cihuapactli Collective and Arizona Birthworkers of Color advocated for the certification to be equitable and inclusive of all doulas in the state, including those trained in ancestral or non-Western practices.

State certification was not required to practice as a doula in the state, just as a mechanism for doulas to be come state certified as a stepping stone to eventual Medicaid reimbursement. The Dept of Health Serices launched its voluntary licensing program for doulas in August 2023. In Sep 2024, Arizona's SPA was approved by CMS, with an effective start date of 10/1/2024.		NoN/AState Agency Resources
• AZ Dept of Health Services Doula page
• Approved SPA

Advocacy
• Cihuapactli Collective
• Arizona Birthworkers of Color

Prior Legislation
• SB 1181 (2021) - state certification for doulas		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 certain individuals)
• 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 and a renewal fee of $200.Yes. Doula application requires issuance of a valid fingerprint clearance card and signed Doula Code of Ethics.No. See Doula FAQ: "State-certified doulas are not required to carry liability insurance when becoming an AHCCCS registered provider."No.The application fee is $100 and the certification fee is $200. This is the same for either initial applications or reciprocity applications. (See Doula Fee Table.)Yes, thre is a Doula Code of Ethics that doulas must sign as part of their application.N/A
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CAActively Reimbursing6/28/2021 - Doula services included in state budget
10/4/2021 - SB 65 signed into law (CA Momnibus)
1/1/2023 - Start date of doula benefit
1/26/2023 - SPA for doula Medicaid benefit approved
10/7/2023 - AB 904 signed into law (encourages private insurance coverage of doula care)
12/19/2023 - SPA to increase reimbursement rates approved		Doula services were included in Governor Gavin Newsom's 2021-2022 state budget in June 2021. Additional details on implementation of doula Medicaid care were also included in SB 65, the California Momnibus, which was signed by 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 ultimately began on 1/1/2023. In Nov 2023, DHCS Medical Director Dr. Karen Mark, issued a statewide standing recommendation for doula services. 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.

In Feb 2023, AB 904 was introduced, which 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 was signed into law in Oct 2023. In March 2025, the CA Dept of Managed Health Care released APL 26-005 pertaining to health plan compliance with AB 904. 		AB 2199 (2022) and AB 583 (2023) 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)		State Agency Resources
• Approved SPA for doula services
• DHCS Doula Services webpage
• Statewide standing recommendation
• Approved SPA for increased reimbursement rates

Advocacy
• CA Medi-Cal Doula Benefit Feedback Form for Community Doulas (Providers) and Pregnant People (Beneficiaries)

Prior Legislation
• SB 65 (2021) - CA Momnibus
• AB 904 (2023) - encouraging private insurance coverage of doula care		Yes, as of 11/1/2023$3152.65 for a vaginal delivery, $3263.31 for a cesarean birth (see DHCS Doula FAQ)Doula services are reimbursed as follows:
• 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.

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.

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.		Under the training pathway, CA requires that doulas complete at least 16 hours of training in core competenciesYes. 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 LA County Doula Hub launched in 2025. No.No.N/A
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COActively Reimbursing7/6/2021 - SB21-193 signed by Governor (Birth Equity bill)
5/30/2023 - SB23-288 signed by Governor (exploring doula Medicaid benefit)
6/5/2024 - SB24-175 signed by Governor (private coverage of doula care)
7/1/2024 - Start date of benefit
8/19/2024 - SPA approved		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, required private health plans in the state to cover doula care. The requirement went into effect on May 30, 2025.• Advocating for Birthworkers in Colorado (2022)
• Doula Benefit: Results from Year 1 of Implementation (2026)		State Agency Resources
• HCPF Doula Benefit page
• Approved SPA

Prior Legislation
• SB 21-193 (2021) - birth equity bill
• SB23-228 (2023) - exploring doula Medicaid benefit
• SB24-175 (2024) - private coverage of doula care		No.Up to $1500Doulas 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 Codes of Conduct and Standards of Practice for Colorado Medicaid Doulas.

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 Codes of Conduct and Standards of Practice for Colorado Medicaid Doulas 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 enrolleesNo.To become a Medicaid provider, doulas must agree to follow the Codes of Conduct and Standards of Practice for Colorado Medicaid Doulas.N/A
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CTActively Reimbursing6/14/21 - Public Act No. 21-35 signed by Governor (scope of practice review)
5/23/2022 - HB 5500 signed by Governor (Doula Advisory Committee)
6/26/2023 - SB 986 signed by Governor (doula certification)
1/1/7/2025 - SPA approved, doula benefit begins
6/10/2025 - HB 7214 signed by Governor (doula friendly practices)
3/12/2026 - HB 5561 introduced (increasing Medicaid reimbursement rates)		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 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.

There are a number of bills that have been signed into law in recent years:
• In March 2022, HB 5500 was introduced, which established a Doula Advisory Committee to develop recommendations for certification, training, continuing education, and doula training curricula. 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 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. The provision pertaining to increasing Medicaid reimbursement of doulas was later amended out of the bill. The bill was signed by the governor in June 2025.
• 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 bill was signed by the governor in June 2025.

The SPA for doula services was approved on 1/17/2025 with an effective date of 1/1/2025.

In March 2026, HB 5561 was introduced, which would increase Medicaid reimbursement rates for a number of providers, including doulas.		No.Scope of Practice Review Committee Report on Doula Certification (2021)State Agency Resources
• HUSKY Health Doula Services Policies and Procedures
• Approved SPA

Advocacy
• Doulas4CT
• Connecticut Doula Integration Toolkit

Prior Legislation
• Public Act No. 21-35 (2021) - scope of practice review
• HB 5500 (2022) - Doula Advisory Committee
• HB 986 (2023) - doula certification
• HB 7214 (2025) - doula friendly practices

2026 Legislature
• HB 5561 (2026) - increasing Medicaid reimbursement rates		No.Up to $1200.Doula coverage can be provided up to nine months prior to the birth, throughout pregnancy, during labor/delivery, and through 12 months following delivery. Coverage includes four perinatal (prenatal or postpartum) visits, and labor/delivery. Reimbursement for each perinatal visit is $100 and reimbursement for labor/delivery is a flat fee of $800. Maximum reimbursement is $1200. (See Connecticut Medical Assistance Program Provider Bulletin 2025-14)

Up to four additional perinatal visits beyond the four can be provided with prior authorization from the recommending licensed Medicaid. (See HUSKY Health Connecticut Provider Policies & Procedures for Doula Services.)		Doulas can enroll and bill as individuals or groups.Regulations do not contain specific limitations.Unclear.Most doula services are permissible in person or via synchronized telemedicine (audio and video system with real-time communication). No more than half the perinatal visits may be performed via telemedicine. Also telemedicine is not permitted for labor/delivery -- doulas. must be present in person for labor/delivery. (See Connecticut Medical Assistance Program Provider Bulletin 2025-14)Doulas must be certified by the Department of Public Health before they enroll with the Connecticut Medical Assistance Program (HUSKY Health). There are two routes for certification by the Dept of Public Health.

For the first route, doulas must provide:
• two reference letters from families or pofessionals with direct knowledge of the applicant's experience as a doula, verifying the applicant's training or experience; and
• documentation of completion of an approved doula training program or combination of such programs

For the second route, doulas can
• notarized attestation that the applicant has provided doula services to at least three families and training in at least four of the core competencies identified by the Doula Training Program Review Committee during the five years preceding the date of the application.

There is an application fee of $100.		Both. The first pathway requires that doulas receive training from one or more approved doula training programs. The second pathway requires training in at least four of a list of core competencies.No.Doulas and doula groups must re-enroll every five years. (See Connecticut Department of Social Services Provider Bulletin 2025-05.) It is unclear whether there are CE requirements as well.No.No.No.There is an application fee of $100.No.N/A
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DCActively Reimbursing1/15/2021 - Bill 24-26, the Maternal Health Resources and Access Act, introduced (pilot program for doula Medicaid care)
7/20/2021 - 2022 Budget Support Act (made doula Medicaid permanent)
9/28/2022 - SPA for doula Medicaid benefit approved
10/1/2022 - Start date of doula benefit		In Jan 2021, Bill 24-26, the Maternal Health Resources and Access Act, was introduced, which included a pilot for Medicaid reimbursement of doula care. The 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 Dept 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.		Some federal employee health plans do include coverage for doula care, including Government Employees Health Association (GEHA) and Foreign Service Benefit Plan (FSBP). N/ADistrict Agency Resources
• Dept of Health Care Finance Maternal Health Projects page
• Approved SPA

Prior Legislation
• Bill 24-26 (2021), the Maternal Health Resources and Access Act - pilot program for doula Medicaid care
• 2022 Budget Support Act - made doula Medicaid permanent		No.Up to $3882.24 (not inclusive of $100 incentive payment).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 maximum possible reimbursement is up to $3882.24. Up to six perinatal visits can be reimbursed at $107.89 per visit. These visits can take place during the prenatal period or up to six weeks postpartum. Reimbursement for labor/delivery is $762.98. Reimbursement for postpartum services is billed and reimbursed at a per-unit rate and billed in 15-minute increments of $13.48/15 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.Doula services may be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth, when appropriate. (See Chapter 112 Doula Services EP Rulemaking 9 26 22.)Unclear.Doula services may be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth, when appropriate. (See Chapter 112 Doula Services EP Rulemaking 9 26 22.)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 can be found in Transmittal # 22-34 and Transmittal # 24-32.

To serve clients in managed care, doulas must enroll both as DHCF providers as well as with the managed care organization.		List of approved doula organizations. (See Transmittal # 22-34 and Transmittal # 24-32.)No.No.No.No.No.No.No.N/A
12
DEActively Reimbursing7/25/2022 - HB 343 signed by Governor (plan for doula Medicaid coverage)
8/9/2023 - HB 80 signed by Governor (doula Medicaid coverage)
1/1/2024 - Start date of benefit
6/18/2024 - SPA approved
6/30/2024 - HB 345 signed by Governor (postpartum visits)
9/24/2024 - HB 362 signed by Governor (private insurance coverage)		Delaware passed a number of bills pertaining to 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. 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 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, requires 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)		State Agency Resources
• Delaware First Health Doula Services page
• Delaware Certification Board - Certified Doula for Medicaid Reimbursement
• Approved SPA

Advocacy
• Doula Ad Hoc Committee

Prior Legislation
• HB 343 (2022) - plan for doula Medicaid coverage
• HB 80 (2023) - doula Medicaid coverage
• HB 345 (2024) - postpartum visits
• HB 362 (2024) - private insurance coverage		No. However, Delware First Health guidance specifies that the initial standard set of doula services (i.e. outside of the five additional postpartum visits) do not require authorization or referral.Total reimbursement is up to $1621.78.Doula coverage for Medicaid enrollees include:
• Maximum of three prenatal visits, up to 90 min/visit
• Maximum of three postpartum visits, up to 90 min/visit, within 90 days of delivery
• Attendance at labor and birth.
• An additional five postpartum visits. up to 90 min/visit, within 180 days of delivery, are permissible with an Additional Postpartum Doula Visit Form signed by a licensed provider (2025 DE REG TEXT 690599)

Prenatal and postpartum visits are paid at $15.83 per 15 min ($94.98/90 min visit), while attendance at labor and delivery is paid at a flat fee of $477. There is an additional $100 incentive payment for doulas who attend all six standard visits and delivery. Total possible maximum reimbursement rate is $1621.78.

Note that state guidance requires that at least one prenatal doula visit must have taken place in order to qualify for postpartum doula visits		Doulas can enroll and bill as individuals or through employers or organizations.Regulations do not contain specific limitations.Unclear.Regulations do not contain specific limitations.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 ReimbursementYes, 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.$75 certification feeYes, there is a Code of Ethical Conduct that doulas must confirm on their application they have read, understood, and commited themselves to.N/A
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FLActively Reimbursing2018 - 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
11/17/2025 - SB 514 introduced (Doula Support for Healthy Births pilot)
1/6/2026 - HB 1043 introduced (doula workforce development support fund)
1/8/2026 - SB 1508 introduced (The Motherhood Initiative)		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. For example, 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.

There are a number of pending bills in the 2026 legislature:
• On 11/17/2025, SB 514 (companion bill HB 515). 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
• On 1/6/2026, HB 1043 (companion bill SB 1456) was introduced, which would create a doula workforce development support program to fund, strengthen, and expand doula training programs, doula organizations, and community-based birthing services providers.
• On 1/8/2026, SB 1508, "The Motherhood Initiative" was introduced, which includes a number of maternal health related provisions, including authorizing a doula or midwife to be present with their client during childbirth at a hospital.		No.N/AState Agency Resources
• AHCA Managed Care Updates (2018)

Advocacy
• G.R.O.W. Doula Program

2026 Legislature
• SB 514 (2025) - Doula Support for Healthy Births pilot
• HB 1043 (2026) - doula workforce development support fund
• SB 1508 (2026) - The Motherhood Initiative		N/AVaries 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.Varies by plan.Varies by plan.N/A
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GAAdjacent Action2022-2023: HMHBGA doula pilot with Medicaid managed care plans
April 2025 - launch of HMHBGA/HealthConnect One doula pilot
2025 - launch of Georgia Community Doula Coalition
2/10/2026 - HB 1264 introduced (doula Medicaid pilot)		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 it would be launching a new community-based doula program in partnership with HealthConnect One. As of 2025, the 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.

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.

In Feb 2026, HB 1264 was introduced, which would create a pilot program for Medicaid coverage of doula care.		No.Georgia Doula Study (2022-2023)Advocacy
• HMHBGA - Doula Access Working Group
• GA Doula Medicaid Reimbursement Pilot
• Georgia Doula Study (2022-2023)
• Georgia Community Doula Coalition

2025-2026 Legislature
• HB 1264 (2026)		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
15
HIAdjacent Action1/17/2025 - SB 945 introduced (doula certification)
3/7/2025 - SCR71 introduced (sunrise review on doulas)		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. HMHB-Hawaii is also considering facilitating the creation of a statewide HI Doula Care Coalition.

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 and carried over to the 2026 legislative session.

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.N/AAdvocacy
• HMHB Community Based Doula Program

2025-2026 Legislature
• SB 945 (2025) - doula certification
• SCR71 (2025) - sunrise review on doulas		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
16
IAAdjacent Action2021-2022 - Maternal Health Doula Project
1/23/2025 - SF 132 introduced (doula Medicaid coverage)		From 2021-2022, the Iowa Dept of Health and Human Services piloted 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 was aimed at providing culturally congruent, community-based care to address disparities in Black maternal and infant health outcomes.

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 Jan 2025, SF 132 was introduced, which requires that the Dept of Health and Human Services provide for Medicaid coverage for doula care, create a process for doula certification, and establish a reimbursement rate "that supports a livable income for a full-time practicing doula."		No.N/AAgency Resources
• Dept Health & Human Services Maternal Health Doula Project

Advocacy
• Iowa Total Care doula program

2025-2026 Legislature
• SF 132 (2025) - doula Medicaid coverage		N/ADoulas 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/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/ANo.N/AN/AN/A
17
IDWe were not able to find any current efforts in this state.
18
ILActively Reimbursing4/27/2021 - HB 158 signed by Governor (doula Medicaid services)
7/29/2024 - HB 5142 signed by Governor (private coverage of doula care)
6/10/2024 - SPA approved
12/19/2024 - Start date of doula Medicaid coverage
6/16/2025 - SB 2437 signed by Governor (doula hospital access, permitting statewide standing recommendation)		In April 2021, HB 158 was signed into law, which included coverage of perinatal doula services and home visiting services. Some advocates were unhappy that the two services had been lumped together. The benefit was originally supposed to begin on July 1, 2022, but implementation was delayed. The Illinois Department of Healthcare and Family Services (HFS) contracted with SIU (Southern Illinois University) School of Medicine 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. The state's doula Medicaid benefit began on 12/19/2024, and on the same day a statewide standing recommendation was issued by the Director of the Illinois Dept of Public Health.

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.

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.N/AState Agency Resources
• Approved SPA
• SIU School of Medicine Illinois Medicaid-Certified Doula Program

Advocacy
• Chicago Illinois Doula Coalition Network (CIDCN)

Prior Legislation
• HB 158 (2021) - doula Medicaid services
• HB 5142 (2024) - private coverage of doula care

2025-2026 Legislature
• SB 2437 (2025) - doula hospital access, permitting statewide standing recommendation		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 University (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.No.No.No.No.No.N/A
19
INAdjacent Action4/18/2019 - SB 416 passed (doula Medicaid coverage, never implemented)
8/5/2022 - SB 2 signed by Governor (Doula Reimbursement Advisory Board)
12/5/2025 - HB 1049 introduced (doula coverage in Medicaid and private insurance)
1/6/2026 - SB 198 introduced (doula coverage in Medicaid and private insurance, other perinatal policies)
1/5/2026 - SB 155 introduced (doula Medicaid coverage)		In 2019, Indiana passed SB 416 which allowed doulas to be reimbursed under Medicaid. However, funds for the bill were stripped from the budget so the benefit was never implemented. In August 2022, the Governor signed into law SB 2, which among other things established a Doula Reimbursement Advisory Board.

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.

In the 2025-2026 legislature, a number of bills have been introduced relating to doula care:
• In Dec 2025, HB 1049 was introduced, which would require coverage for doula services in Medicaid and private plans
• In Jan 2026, SB 198 was introduced, which addresses various perinatal policies, and includes the same requirement of coverage of doula services in Medicaid and private plans, as in HB 1049.
• Also in Jan 2026, SB 155 was introduced, which would require the Office of the Secretary of Family and Social Services to develop and implement a doula program.		HB 1049 was introduced in Dec 2025, which would require coverage for doula services in state employe ehealth plans, policies of accident and sickness insurance, and individual or group health maintenance organization contracts (in addition to Medicaid). SB 198 includes the same requirements as in HB 1049.N/AAdvocacy
• Indiana 4 Doulas

Prior Legislation
• SB 416 (2019) - doula Medicaid coverage, never implemented
• SB 298 (2021) - Doula Reimbursement Advisory Board

2025-2026 Legislature
• HB 1049 (2025) - doula coverage in Medicaid and private insurance
• SB 198 (2026) - doula coverage in Medicaid and private insurance, other perinatal policies
• SB 155 (2026) - doula Medicaid coverage		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
20
KSActively Reimbursing11/2023 - Kansas Doula Alliance formed
6/6/2024 - SPA approved
7/1/2024 - Start date of benefit		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, which 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.

In 2023, Kansas Medicaid began exploring how to include doula care as a benefit. The SPA to add doula services was approved by CMS in June 2024 and the benefit began on 7/1/2024.		No.Coverage of Community Based Doula Care: A Summary of Initial Stakeholder Convenings with Kansas Doulas (2023)State Agency Resources
• Approved SPA
• Kansas DHE Doula Toolkit
• Doula Enrollment and Coverage Bulletin

Advocacy
• Kansas Birth Justice Society		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)Unclear. 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.No.No.No.
21
KYAdjacent Action4/18/2024 - SB 74 signed by governor (study on doula care)
1/22/2026 - HB 471 introduced (doula Medicaid coverage)		Kentucky has introduced legislation for several years in a row requiring doula Medicaid coverage: HB 286 in 2021, HB 39 in 2022, HB 275 in 2023, HB 307 in 2024, and HB 814 in 2025. On 1/22/2026, the bill was re-introduced as HB 471. Consistent with previous years, the bill would require the Dept for Medicaid Services and any Medicaid MCO, to provide coverage for doula services, establish a Doula Advisory Council, and to seek federal approval if necessary.

On 1/5/2024, SB 74 was 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.

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.Doula Services and Maternal Care in the Commonwealth of Kentucky: Report to the Legislative Research Commission (2024)Prior Legislation
• SB 74 (2024) - study on doula care

Advocacy
• Humana pilot
• Anthem pilot
• UnitedHealthcare pilot

2026 Legislature
• HB 471 (2026) - doula Medicaid coverage		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/ANo.
22
LAActively Reimbursing6/11/2021 - HB 190 signed into law (doula registry board)
6/7/2023 - HB 272 signed into law (private coverage of doula care)
5/28/2024 - SB 190 signed into (doula rates)
1/1/2025 - Date by which private health plans were required to provide doula coverage
6/10/2025 - HB 454 signed into law (Medicaid coverage of doula care)
6/11/2025 - HB 514 signed into law (changes to doula registry board)
2/2/2026 - SPA approved with benefit start date of 1/20/2026		A number of bills were signed into law in Louisiana leading up to its implementation of Medicaid coverage for doula care:
• In April 2021, HB 190 was introduced, which would create a state Doula Registry Board within the Dept of Health, charged with developing criteria for doula registration, as well as reviewing and approving applications. The bill was signed into law by the Governor in June 2021.
• In March 2023, HB 272 was introduced, which would require 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 were charged with complying with the law as of 1/1/2025.
• In March 2024, 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 454 was introduced, which would provide Medicaid coverage for doula care. The bill was signed by the Governor on 6/9/2025.
• Also in April 2025, 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.

The SPA to add doula services was approved by CMS on 2/2/2026 with a benefit start date of 1/20/2026. 		Yes. HB272 passed in 2023, requiring private health plans to cover doula care by 1/1/2025.N/AState Agency Resources
• Louisiana Doula Registry
• Approved SPA

Prior Legislation
• HB 190 (2021) - doula registry board
• HB 272 (2023) - private coverage of doula care
• SB 190 (2024) - doula rates
• HB 454 (2025) - Medicaid coverage of doula care
• HB 514 (2025) - changes to doula registry board
No.Maximum possible reimbursement rate is up to $1383.72.Doula services include five prenatal visits for up to 90 min each (reimbursed at $69.69/visit), three postpartum visits for up to 90 min each (reimbursed at $69.69/visit), and support at labor and delivery (reimbursed at $459). Doulas can also bill for up to three birthing classes, up to three lactation classes, and up to three parenting classes, at $40.80/class. The total possible maximum reimbursement rate is $1016.52.

The number of allocated prenatal and postpartum visits can be exceeded when deemed medically necessary. (See SPA.) 		Doulas can bill as individuals or as part of a doula group.N/AN/AN/ATo be eligible as registered doulas for the purposes of Medicaid reimbursement, the proposed rules state that doulas must be
• trained to provide physical, emotional, and educational support to pregnant and birthing women and their families;
• have approved registration with the Doula Registry Board; and
• be enrolled as a Louisiana Medicaid provider.

The Louisiana Doula Registry Board requires that doulas 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 OR 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.No.No.No.
23
MAActively Reimbursing12/8/2023 - Start date of doula Medicaid benefit
2/6/2024 - SPA approved
8/23/2024 - H.4999 signed by Governor (doula services for parents of adopted infants)
3/12/2025 - SPA approved to add doula services to adoptive parents of infants
2/25/2025 - H.4344 introduced (private coverage of doula care, doula hospital access)
2/5/2026 - H.5021 introduced (doula scholarship fund)		Doulas and stakeholders in the state began organizing and advocating for Medicaid coverage for doula care in the state beginning with the introduction of H.1182 in 2019. While that bill did not pass, it did help to galvanize advocacy in the state and inspire additional work and research on the topic. The Massachusetts Doula Coalition formed during this period. By 2023, MassHealth began exploring implementation of Medicaid coverage for doula care.

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 with a start date of 12/8/2023. 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. 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.

In Feb 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. In Feb 2026, H.1333 was replaced by H.5021.		Yes. H.4344, introduced in Feb 2025, 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)		State Agency Resources
• MassHealth Doula Services Program: Information for Doulas
• MassHealth Doula Services Program: Information for Members
• Approved SPA for doula services
• Approved SPA for adoptive parents of infants

Advocacy
• MA Doula Coalition

Prior Legislation
• H.4999 (2024) - doula services for parents of adopted infants

2025-2026 Legislature
• H.4344 (2025) - private coverage of doula care, doula hospital access
• H.5021 (2025) - doula scholarship fund		Yes, as of 12/8/2023.Reimbursement rate is 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.

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 care is also available to adoptive parents of infants under the age of 1.		Individual doulas and 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 hours old, obtain an NPI number, complete a free online MassHealth Doula Provider Training, and demonstrate that they possess specified rquired competencies.

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.No.No.No.
24
MDActively Reimbursing7/6/2021 - Maternal and Child Health Care Initiative announced
1/1/2022 - Effective start date of doula Medicaid benefit
5/29/2022 - SB 166 signed into law (made doula care permanent)
6/15/2022 - SPA approved
5/20/2025 - HB 1251 signed into law (doula hospital access)		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. The SPA was approved by CMS on 6/15/2022 with an effective start date of benefits of 1/1/2022. In May 2022, SB 166 was signed by the Governor, which codified the regulations put in place by the Dept 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 2025, the Alliance published Centering Community Doula Voices: A Path Toward Equity in Maryland's Medicaid Doula Program, a report that synthesized the history and background of the state's Medicaid doula benefit and the Doula Alliance of Maryland, and also shared findings from a 2023 statewide doula survey and listening sessions, including ongoing barriers to access and recommendations to make the benefit more inclusive and equitable for community-based doulas.

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.Centering Community Doula Voices: A Path Toward Equity in Maryland's Medicaid Doula Program (2025)State Agency Resources
• Dept of Health Medicaid Doula Program
• Dept of Health Doula Provider Information
• Approved SPA

Advocacy
• Doula Alliance of Maryland

Prior Legislation
• SB 166 (2022) - made doula care permanent
• HB 1251 (2025) - doula hospital access		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.No.No.No.
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MEImplementation in Process2022 - Maine Doula Coalition launched
6/24/2025 - LD 1523 passed unsigned (various doula services provisions)		In 2022, the Maine Doula Coalition was launched, with the aim of working towards expanding access to doula care in the state, achieving equitable reimbursement for doulas, and improving birth experiences and perinatal outcomes in Maine. The Coalition has helped to create a number of resources, including the Maine Doula Workforce Assessment and the Maine Doula Directory.

In April 2025, LD 1523 (HP 1008) was introduced, which requires that the Dept of Health and Human Services: by 1/1/2026 initiate a rate determination process for doula services with a planned start date of 1/1/2028; establish a statewide doula council to provide advice and make recommendations regarding doula services; and submit a report to the legislature no later than 2/1/2027 on their progress. The bill was passed unsigned on 6/24/2025.		No.Maine Doula Workforce Assesment (2024)Advocacy
• Maine Doula Coalition

2025-2026 Legislature
• LD 1523 (2025) - various doula services provisions		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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MIActively Reimbursing4/2022 - Dept of Health and Human Services announced they would include doula care as a new benefit for Medicaid enrollees
6/21/2022 - SPA approved
1/1/2023 - Start date of doula benefit
12/31/2024 - HB 5826 signed into law (doula scholarship fund)		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 did 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 and created a Michigan Doula Advisory Council. CMS approved Michigan's SPA in June 2022, and the benefit formally launched on 1/1/2023. The same month, Michigan's Chief Medical Executive, Dr. Natasha Bagdasarian, issued a standing recommendation for doula services, making Michigan the first state to issue a statewide standing recommendation of this type to meet 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 June 2024, HB 5826 was introduced, to establish a doula scholarship fund to support the training and certification of new doulas. This bill was signed by the Governor in December 2024.

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.N/AState Agency Resources
• Michigan Dept of Health & Human Services Doula Initiative
• Approved SPA

Advocacy
• Michigan Doula Medicaid Provider Toolkit

Prior Legislation
• HB 5826 (2024) - doula scholarship fund		Yes, as of 1/13/2023. Michigan was the first state to issue a statewide standing recommendation for doula services.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. The 2023 state budget allocated funding to create the Doula Initiative, whose mission is to expand the doula workforce and promote access to doula care by providing technical assistance and support, facilitating the Doula Advisory Council, and managing the Doula Registry.

In 2024, 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. 		No.No.No.
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MNActively Reimbursing2013 - SF 699 passed (Medicaid coverage of doula care)
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 (addressing barriers to accessing doula care)
12/11/2024 - SPA approved increasing reimbursement rates
1/12/2024 - elimination of supervision requirement
2/19/2026 - SF 3768 introduced (private coverage of doula care)		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. As a result, 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 Dec 2023, Minnesota's SPA increasing the doula reimbursement rate 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.

In Feb 2026, SF 3768 (companion bill HF 3779) was introduced, which would require private health plans in the state to cover doula services. The bill specifies that the services are to be provided without cost-sharing, without review and referral limitations, and without quantity limitations.		SF 3768, introduced in Feb 2026, would require private health plans to offer doula care.Medicaid Coverage of Doula Services in Minnesota: Preliminary findings from the first year (2015)State Agency Resources
• MN Dept of Human Services Doula Services
• Approved SPA (for doula services
• Approved SPA (to increase reimbursement rates)

Prior Legislation
• SF 699 (2013) - Medicaid coverage of doula care
• HF 33 (2021) - addressing barriers to accessing doula care

2025-2026 Legislature
• SF 3768 (2026) - private coverage of doula care		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.No.No.No.
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MOActively Reimbursing6/30/2022 - HB 3010 signed in part, vetoed in part (doula training program)
10/1/2024 - SPA approved
10/1/2024 - Start date for doula Medicaid benefit
12/1/2025 - HB 1820 introduced (doula registration), HB 1949 introduced (statewide standing rec), SB 841 (statewide standing rec)
12/11/2025 - HB 2372 introduced (statewide standing rec)
1/7/2026 - SB 1229 introduced (private coverage of doula care)
2/3/2026 - HB 3168, HB 3169 introduced (various revisions to doula Medicaid coverage, private coverage of doula care)		Since 2021, the Missouri Community Doula Council has worked to advocate for access and coverage to community-based doula services, as well as sustainable pay for community doulas. The Council is also currently handling enrollment of doulas as MO HealthNet providers.

In March 2024, the State Medicaid Agency shared its proposed rule 13 CSR 70-25.160 on Doula Services, which established guidelines for Medicaid coverage and reimburseemnt for community doula services. 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 a permanent basis, on 10/1/2024.

There have been several bills introduced pertaining to expanding access to doula care:
• 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 Dec 2025, HB 1820 was introduced, which creates a process for doulas to register with the Dept of Health and Senior Services for purposes of insurance reimbursement.
• Also in Dec 2025 - Jan 2026, multiple bills were introduced that would allow medical officers in the state to issue standing orders including a nonspecific recommendation of doula services: HB 1949, HB 2372, and SB 841.
• In Jan 2026, SB 1229 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 Feb 2026, HB 3168 and HB 3169 were introduced, identical bills which expand the MO HealthNet doula program to include doula attendance at cesarean births, and increase the number of allocated support sessions for those who need more than six to an additional allocation of ten. The bill language also requires private health plans to cover doula care effective 1/1/2027.		Yes. SB 1229, HB 3168, HB 3169, all introduced in the 2025-2026 legislature, require private insurance coverage for doula care.Medicaid Reimbursement for Doula Services:
Definitions and Policy Considerations (2022)		State Agency Resources
• Missouri Dept of Social Services Doula Program
• Approved SPA

Advocacy
• Missouri Community Doula Council

Prior Legislation
• HB 3010 (2022) - doula training program

2025-2026 Legislature
• HB 1820 (2025) - doula registration
• HB 1949 (2025) - statewide standing rec
• SB 841 (2025) - statewide standing rec
• HB 2372 (2025) - statewide standing rec
• SB 1229 (2026) - private coverage of doula care
• HB 3168 (2026) - various revisions to doula Medicaid coverage, private coverage of doula care
• HB 3169 (2026) - various revisions to doula Medicaid coverage, private coverage of doula care		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.No.No.No.
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MSAction ProposedFall 2025 - MS Division of Medicaid begins exploring doula coverage
1/7/2026 - HB 78 introduced (state certification of doulas)
1/19/2026 - HB 1493 introduced (Momnibus Act)		The Mississippi Division of Medicaid is exploring avenues to provide funding for doula coverage, though a definitive course of action has not yet been established.

In Jan 2026, two bills were introduced pertaining to expanding access to doulas:
• HB 78 would require the State Dept of Health to create a mechanism for state certification of doulas, including administrative and disciplinary procedures, continuing education, etc. The legislation specifies that state certification does not prohibit others from practicing as birth doulas, so long as they do not hold themselves as "state-certified birth doulas" if they are not state certified.
• HB 1493, the Mississippi Maternal Health Momnibus Act would advance a number of maternal health related services, among them creating a one-year pilot program for Medicaid coverage for doula care, and creating a study on doula certification.		NoN/A2026 Legislature
• HB 78 (2026) - state certification of doulas
• HB 1493 (2026) - Momnibus Act		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
30
MTImplementation in Process11/2023 - Montana Doula Collaborative formed
5/12/2025 - SB 319 signed by governor (process for doula licensing)
1/1/2027 - Deadline for doulas in the state to become licensed
End of 2026 - Anticipated start date of doula Medicaid benefit		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. In Dec 2025, the state issued its licensing rules for doulas (Montana Administrative Rules Chapter 24.139). Doulas in the state have until 1/1/2027 to become licensed.

The Montana Department of Public Health and Human Services is moving forward with implementation of Medicaid coverage for doula care, and advocates hope the benefit will roll out by the end of 2026.		NoN/AState Agency Resources
• Doula licensing rules

Advocacy
• Montana Doula Collaborative

Prior Legislation
• SB 319 (2025) - process for doula licensing		N/AN/AN/AN/AN/AN/AN/AAccording to Montana Administrative Rules Chapter 24.139.501, doula applicants must submit:
• completed department application;
• current CPR certication;
• required fees;
• veritification from all states where the applicant holds/has held a doula license/certificate; and
• have completed one of the licensing pathways described below.

There are three main licensing pathways:
• Successful completion of 40 hours of supervised training with a licensed doula that includes at least two unique perinatal experiences (note that individuals who are seeking supervised training must obtain a "limited license," which requires submitting an application with additional proof the applicant will be supervised in doula activities by a licensed doula who has been practicing for at least five years with no legal or disciplinary action taken against the doula); or
• Successful completion of at least 20 hours of doula training, provided by one or more entities approved by the department; or
• Doulas who have practiced for at least two years as of 1/1/2026 can submit a completed application, and a list of at least five and up to ten clients served within the previous two years.

Additionally, doulas currently licensed to practice as a doula in another state may be licensed by endorsement. Applicants must provide proof of their active licensure in good standing, and the other licensing state must have substantially equivalent standards to Montana.		Both options are available. Yes. There is a pathway for doulas who have practiced for at least two years, and who can provide a list of at least five and up to ten client served.N/AN/AN/AN/A$180 for application for initial license, $175 for license renewal, which is required annually (Montana Administrative Rules Chapter 24.139.403)Montana Administrative Rules Chapter 24.139.2301 pertains to Unprofessional Conduct.N/A
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NCAdjacent ActionFall 2022 - NC Dept of Health and Human Services holds Doula Summit
3/24/2025 - S463 introduced (doula Medicaid coverage)
3/26/2025 - S483 introduced (doula Medicaid coverage)
4/29/2026 - S908 introduced (supporting doula workforce)
4/30/2026 - S964 introduced (doula Medicaid coverage)		There were a number of bills introduced in the 2025-2026 Legislative Session pertaining to Medicaid coverage of doula care:
• In March 2025, S463 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.
• In April 2026, S908 was introduced, which is a broad maternal health bill that includes a section calling on the state to establish fair reimbursement and prompt payment for doulas, fund doua suport hubs and mentorship, provide grants to maternal health CBOs, and conduct regional workforce assessments.
• Also in April 2026, S964 was introduced, which would require Medicaid coverage of doula care as well as the allocation of $550,000 in recurring funds beginning with the 2026-2027 fiscal year to provide support services and technical assistance for the doula workforce. The bill would also create the certified professional midwives licensing act and establish a licensing process for birth centers.

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)State Agency Resources
• NC Dept of Health and Human Services Doula Summit Report

Advocacy
• NC Doula Organization
• Healthy Blue doula program

2025-2026 Legislature
• S463 (2025) - doula Medicaid coverage
• S483 (2025) - doula Medicaid coverage
• S908 (2026) - supporting doula workforce
• S964 (2026) - doula Medicaid coverage		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
32
NDAction Proposed2020-2023 - Don't Quit the Quit doula program
1/16/2025 - HB1464 introduced (certification and coverage of postpartum doulas)		From 2020-2023, 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.

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. The bill did not pass.		NoN/AAdvocacy
• Don't Quit the Quit

2025-2027 Legislature
• HB1464 (2025) - certification and coverage of postpartum doulas		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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NEImplementation in Process2023 - Launch of Rooted Doula Care and Support Program
4/17/2026 - LB 958 signed into law (various Medicaid provisions including Medicaid reimbursement for doula care)
1/1/2029 - anticipated start date of benefit		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.

In Jan 2026, LB 958 was introduced, which includes various Medicaid provisions, including requiring Medicaid reimbursement for doula care no later than 1/1/2029, as well as creation of a work group to develop and submit an implementation plan to the Dept of Health and Human Services no later than 1/1/2027. The bill was signed into law on 4/17/2026.		No.Doula Care to Improve Outcomes and Reduce Disparities in Nebraska (2024)Advocacy
• Rooted Doula Care and Support Program

2025-2026 Legislature
• LB 958 - various Medicaid provisions including Medicaid reimbursement for doula care		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AIn Jan 2023, LB 581 was introduced, which would have created a pilot programs for doula services at the Youth Rehabilitation and Treatment Center and the Nebraska Correctional Center for Women. The bill was indefinitely postponed in April 2024.
34
NHImplementation in Process6/20/2023 - Governor signs budget which included funding for provisions of SB 175, Momnibus
7/26/2024 - SB 337 signed by Governor (voluntary doula certification)
1/16/2025 - State begins program for voluntary doula certification		In January 2023, SB 175 was introduced, the state's Momnibus, which included a number of maternal health related supports, including coverage of doula care for Medicaid enrollees. The bill did not pass, but in June of that year, the Governor signed a bipartisan budget which included funding for parts of 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. The voluntary doula certification program rolled out on January 16, 2026. 		No.N/APrior Legislation
• SB 337 (2024) - voluntary doula certification		N/AN/AN/AN/AN/AYes. See Plc 1900 on Voluntary Certification of Doulas and Lactation Service Providers, defining the perinatal period as "the period that extends from conception through 12 months after the end of pregnancy, inclusive of all birth outcomes."N/ADoulas who wish to be certified by the New Hampshire Office of Professional Licensure and Certification for Medicaid reimbursement must complete both a Universal Application for Initial Licensure as well as a Doula Supplement Form.

Acocrding to Plc 1900 on Voluntary Certification of Doulas and Lactation Service Providers, doulas must demonstrate training and experience in a listed set of core competencies by either:
• certification within the last 5 years from any certifying organization meeting the standards established by the National Doula Certification Board (NDCB); or
• other training and experience as documented by a transcript from a school/program providing at least 10 hours of training in the listed core competencies AND evidence of attendance at 3 or more births within the past 5 years and evidence of at least one visit during the perinatal period per year in each year after completion of training		Core competencies.No.Unclear, but renewal fee is $160 and doulas must have attended at least one birth during the term being renewed, and have made one visit during the perinatal period in each year of the term being renewed. (See Plc 1900.)No.No.No.Initial application fee is $160. No fee required for applicants who are active military or a military spouse.Plc 1900 lays out Ethical and Professional Standards for doulas.No.
35
NJActively Reimbursing5/8/2019 - S1784 signed by governor (doula Medicaid coverage)
1/1/2021 - Start date of doula benefit
2/19/2021 - SPA approved
10/24/2022 - SPA to increase reimbursement rates approved
1/16/2024 - S4119 signed into law (doula hospital access)
1/7/2026 - S3091 signed into law (doula public awareness campaign)
1/20/2026 - S3530 signed into law (Incarcerated Women's Protection Act)
1/13/2026 - S2672 (home birth), A2238 (employment protections), A3439 (Female Inmates' Rights Protection Act) introduced
5/4/2026 - A4843 introduced (Community-led Birthing Justice and Equity Resource Initiative Program Act)		In 2019, New Jersey passed S1784, which added doula care to its list of covered Medicaid maternity care services. The SPA was approved in Feb 2021 with an effective start date of 1/1/2021. In 2022, CMS approved NJ's SPA to increase reimbursement rates for maternity services clinicians and community doulas.

A number of additional bills pertaining to doula coverage were subsequently introduced and passed in the state:
• 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 April 2024, S3091 (companion bill A4222, combined with A4944) was introduced, which requires the Dept of Health Services to establish a public awareness campaign on doulas. The bill was approved on 1/7/2026.
• In June 2024, S3530, the Incarcerated Women’s Protection Act, was introduced, which includes a number of provisions for women who are incarcerated, including the provision of doula services to incarcerated females who are pregnant. The bill was signed into law in Jan 2026.

In early 2026 a number of bills were introduced:
• S2672 (companion bill A4335) would require both private health insurance plans and Medicaid to provide coverage for planned home childbirth, including services provided by a doula
• A2238 (companion bill S4185) would provide certain employment protections for doulas who fail to report to work due to their duty as a certified doula needing to attend a birth for a client in active labor
• A3439, called the Female Inmates' Rights Protection Act, would create a number of protections and expanded services for women who are incarcerated, including providing doula services to pregnant people who are incarcerated, and allowing the doula to attend their client during labor and childbirth.
• A4843 (companion bill S4170) would establish the Community-led Birth and Wellness Resource Initiative Program to address racial disparities in maternal and infant health, and allocate $12 million to support five community-led birthing and wellness resource initiatives across the state. The bill would in part support access to and training for more diverse midwfiery and doula workforce.
A4335, introduced in 2026, would require private health plans to cover planned home childbirth, including services provided by a doula (at the planned home childbirth).NJ Doula Roll Call Survey 2024 (2024)State Agency Resources
• NJ Dept of Human Services Doula Care Page
• Approved SPA (2021)
• Approved SPA increasing reimbursement rates (2022)

Advocacy
• NJ Doula Learning Collaborative

Prior Legislation
• SB 1784 (2019) - doula Medicaid coverage
• S4119 (2023) - doula hospital access
• S3091 (2024) - doula public awareness campaign
• S3530 (2024) - Incarcerated Women's Protection Act

(see summary for list of current legislation)		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.From 2022 to 2024, the NJ Dept of Health provided funding support for the statewide New Jersey Doula Learning Collaborative. In July 2024, the Collaborative transitioned to a regional hub model.

In Jan 2026, S3091 was signed into law, which requires the NJ Maternal and Infant Health Innovation Authority to establish a public awareness campaign on the benefits of doula and midwife services.		No.No.S3530, the Incarcerated Women’s Protection Act, was signed into law in Jan 2026. The Act includes a number of provisions for females who are incarcerated, including the provision of doula services to incarcerated females who are pregnant.

Also, A3439, introduced in Jan 2026, would create a number of protections and expanded services for women who are incarcerated, including providing doula services to pregnant people who are incarcerated, and allowing the doula to attend their client during labor and childbirth.
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NMActively Reimbursing4/7/2020 - 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 (Doua Credentialing & Access Act)		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, the Doula Credentialing & Access Act, 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.		No.• Expanding Access to Doula Care: Birth Equity and Economic Justice in New Mexico (2020)
• New Mexico Doula Association Lookback & Path Forward: Grounding the Work, Strengthening the System (2026)		State Agency Resources
• NM Health Doula Program page
• Approved SPA
• NM Dept of Health Doula Certification Toolkit

Advocacy
• NM Doula Association
• Doula and Lactation Provider Managed Care Reference Guide

Prior Legislation
• HB 214 (2025) - Doua Credentialing & Access Act		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.No.No.No.
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NVActively Reimbursing6/9/2021 - AB 256 signed by governor (doula Medicaid coverage)
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 (increase in reimbursement rates)
4/10/2024 - SPA increasing reimbursement rate approved		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. 		Yes. SB 192, introduced in Feb 2025, would have required private insurance coverage of doula care. N/AState Agency Resources
• NV Certification Board Doula Certification
• Approved SPA
• Approved SPA increasing reimbursement rate
Advocacy
• The DOULA CO-OP

Prior Legislation
• AB 256 (2021) - doula Medicaid coverage
• AB 283 (2023) - increase in reimbursement rates		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. Renewal fee is $50.No.No.No.$100 application fee.No.No.
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NYActively Reimbursing3/2019 - Start date for NY State Doula Pilot Program
3/2022 - Start date for NYC Citywide Doula Initiatve
11/6/2023 - S1867A signed by Governor (community doula directory)
1/26/2024 - S8080 signed by Governor (community doula directory)
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 (patient access to doulas)
12/21/2024 - S5991A signed by Governor (doulas in operating room)
2/14/2025 - S809, A1019, S758, A1026 signed into law (repealing parts of S5992A and S5991A )

(see summary for list of current legislation)		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 in NY have been signed into law pertaining to doula care:
• In Nov 2023, S1867A was signed into law, which created the NY state community doula directory.
• In Jan 2024, S8080 was signed into law, which directs the Dept of Social Services to establish and maintain the community doula directory.
• In Dec 2024, both S5992A and S5991A were into law, which require maternal health care facilities to allow pregnant/postpartum people access to their doulas, and allow doulas access to the operating room when a cesarean birth is being performed.
• In Feb 2025, S758 and A1019 were signed into law; these bills relate to S5992A and S5991A, and clarified 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 same month, S809 and A1026 were also signed into law, which repealed the section of S5991A which allows doulas to be present in the operating room while a cesarean birth is being performed.

There are a number of pending bills from the 2025-2026 legislative session:
• A3508 (companion bill S8622) 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.
• A5140 (companion bill S6494) would require private insurance coverage for doula care.
• 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 (companion bill S9868) 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. 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)		State Agency Resources
• NY State Doula Pilot Program
• NYC Citywide Doula Initiative
• NY State Medicaid Doula Services Benefit
• Approved SPA
• Statewide standing order

Advocacy
• NY Coalition for Doula Access
• NYCDA Medicaid Reimbursement Guide for the Doula Services Benefit

Prior Legislation
• S1867A (2023) - community doula directory
• S8080 (2024) - community doula directory
• S5992A (2024) - patient access to doulas
• S5991A (2024) - doulas in operating room
• S809, A1019, S758, A1026 (2025) - repealing parts of S5992A and S5991A

(see summary for list of current legislation)		Yes, as of 6/10/2024. It was only good for one year and was reissued for a year on 6/10/2025.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.

The doula benefit was 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 began being covered by the managed care plans beginning on 4/1/2025. 		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 competencies 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.N/AN/AA4073, introduced in Jan 2025, would require all correctional institutions and facilities to provide a specified scope of doula services.
39
OHActively Reimbursing6/23/2021 - Ohio Dept of Medicaid announced doula care would be part of Maternal and Infant Support Program
7/2023 - Doula Medicaid benefit included in state budget
10/3/2024 - Start date of benefit
12/9/2024 - SPA approved		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.

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, and on the same day the Medicaid Medical Director issued a statewide standing recommendation for doula services.		No.N/AState Agency Resources
• Approved SPA
• OH Dept of Medicaid Doula Initiative
• Ohio Board of Nursing page on doula certification
• Ohio Medicaid Managed Care Organizations (MCOs) Consolidated Doula Resource Guide		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. In Ohio, doulas are regulated by the Board of Nursing.

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.Initial application fee is $35, renewal fee is also $35Ohio Administrative Code Section 4723-24 includes the Standards of Doula Practice.No.
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OKActively Reimbursing2021 - 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		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. The SPA was subsequently approved on 6/26/2023 with an effective start date of 7/1/2023.No.N/AState Agency Resources
• OK Health Care Authority Doula Services page
• 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.No.No.No.
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ORActively Reimbursing6/17/2011 - HB 3311 signed by Governor (doula Medicaid coverage)
8/1/2012 - SPA approved (non-traditional healthcare workers)
2014 - Start date of doula benefit
5/1/2017 - SPA approved (doula care as preventive service, 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 (doula program for incarcerated individuals)
11/4/2024 - SPA approved (increasing reimbursement to $2365)
7/17/2025 - SB 692 signed into law (private coverage of doula care)
3/31/2026 - SB 1568 signed into law (coverage levels for doula services in Medicaid)		In June 2011, Oregon passed HB 3311, which required the Oregon Health Authority to explore doula Medicaid benefits. The Health Authority subsequently submitted a SPA to add doula Medicaid coverage, which 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 increase reimbursement rates to $350. This SPA was approved effective 5/1/2017. Even with the increased reimbursement rates, enrollment and uptake of the benefit were low. The Oregon Doula Association formed early on, and continues to provide support, resources, education, and advocacy. Doula hubs also formed to assist doulas with administrative tasks such as billing and contracting.

In Jan 2022, the Doula Services Rule was amended to remove barriers to accessing doula services, including eliminating the need for a referral from a licensed provider. In June 2022, the Health Authority announced it would increase the reimbursement rate rom $350 to $1500. The SPA 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.

Additional legislation pertaining to doula care has passed in recent years:
• In Jan 2023, HB 2535 was introduced, which requires the Dept of Corrections to create a doula program for pregnant and postpartum people at Coffee Creek Correctional Facility, the only women's prison in the state. The bill also prevents shackling during labor, childbirth, and postpartum recovery; and prohibits other restrictions that interfere with postpartum recovery and lactation needs. The bill was signed by the Governor on 7/18/2023.
• In Jan 2025, SB 692 was introduced, which proposed to expand coverage of doula care in Medicaid and private insurance, and require 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, private insurance coverage of doula care remained, and a reimbursement rate of at least $3,760 was specified. The bill also created more robust Medicaid postpartum care and created a grant to expand access to more culturally specific and diverse doulas in the state.
• In Feb 2026, SB 1568 was introduced, which requires Medicaid and private plans to cover doula costs up to minimum coverage levels, if they otherwise cover pregnancy and childbirth. The bill also requires that upon passage, an emergeny is declared to exist, and so the Act becomes effectively immediately. The bill was signed into law on 3/31/2026.		Yes. SB 692, signed into law in July 2025, will 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)		State Agency Resources
• OR Health Authority page on Birth Doulas
• Approved SPA (2012) - non-traditional healthcare workers
• Approved SPA (2017) - doula care as preventive service, increasing reimbursement to $350
• Approved SPA (2022) - increasing reimbursement to $1500
• Approved SPA (2024) - increasing reimbursement to $2365

Advocacy
• Oregon Doula Association

Prior Legislation
• HB 3311 (2011) - doula Medicaid coverage
• HB 2535 (2023) - doula program for incarcerated individuals

2025-2026 Legislature
• SB 692 (2025) - private coverage of doula care
• SB 5182 (2025) - doula and midwifery access for incarcerated individuals
• SB 1568 (2026) - coverage levels for doula services in Medicaid		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.No.No.HB 2535 was signed into law in July 2023, which requires the Dept of Corrections to create a doula program for pregnant and postpartum people at Coffee Creek Correctional Facility, the only women's prison in the state. The bill also prevents shackling during labor, childbirth, and postpartum recovery; and prohibits other restrictions that interfere with postpartum recovery and lactation needs.
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PAActively Reimbursing2021 - PA Doula Commission formed
2023 - Certified Perinatal Doula pathway launched
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 (doula Medicaid coverage)
1/1/2025 - Start date of benefit
4/2/2024 - SPA approved		In 2021, 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 initially offered 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.

In August 2023, HB 1608 was introduced, which 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 was signed into law by the Governor on 10/29/2024.

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 have required private insurance coverage of doula care.N/AState Agency Resources
• Certified Perinatal Doula application
• Approved SPA

Advocacy
• PA Doula Commission

Prior Legislation
• HB 1608 (2024) - doula Medicaid coverage		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 areasYes, there is an experience pathwayRecertification is required every three years. Doulas must complete 15 hours of training relevant to doula practice, and the fee to recertify is $75. No.No.No.$50 application fee.The PA Certification Board maintains a Doula Code of Ethics.No.
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RIActively Reimbursing7/9/2021 - H5929A signed by Governor (Medicaid and private insurance coverage of doula care)
1/2022 - Rhode Island Birthworker Co-op launched
5/23/2022 - SPA approved
7/1/2022 - Start date for doula benefit		In July 2021, Rhode Island passed H5929A (companion bill S0484A), requiring coverage of doula services in Medicaid and private health plans. 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 was the first state in the country 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).N/AState Agency Resources
• RI Health and Human Services Doula Services Page
• Approved SPA
• Rhode Island Certification Board
• Doula Services Manual

Advocacy
• Rhode Island Birthworker Co-op
• Rhode Island Perinatal Resource Directory

Prior Legislation
• H5929A (2021) - Medicaid and private insurance coverage of doula care		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 domainsNo.Recertification is required every two years. No.Yes, managed care organizations in the state require all doulas contracting with them to have professional liability insurance. No.$50 application fee.The RI Certification Board maintains a Code of Ethical Conduct for Perinatal Doulas.No.
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SCAdjacent Action11/2022 - SC Doula Steering Committee formed
1/14/2025 - S0042, H3108 introduced (both doula coverage in Medicaid and private insurance)		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.

BirthMatters, a state-based doula group, provides community doula services to birthing people age 25 and under at no charge.

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.Expanding Access to Doulas in South Carolina (2024)Advocacy
• South Carolina Doula Steering Committee
• BirthMatters Doula Care Services

2025-2026 Legislature
• S0042 (2025) - doula coverage in Medicaid and private insurance
• H3108 (2025) - doula coverage in Medicaid and private insurance		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/ANo.
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SDActively Reimbursing2023 - South Dakota Doulas begins organizing
1/25/2024 - DSS announced it would include Medicaid coverage for doula care as part of Pregnancy Health Home
1/10/2025 - SPA approved		In 2023, a statewide nonprofit called South Dakota Doulas began organizing around legislation for Medicaid coverage for doula care, and advocacy to improve maternal and infant health and to support the doula workforce.

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.N/AState Agency Resources
• Approved SPA
• SD Medicaid Doula Training Powerpoint
• SD Medicaid Billing & Policy Manual for Doula Services

Advocacy
• South Dakota Doulas
• 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.No.No.No.
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TNImplementation in Process6/1/2022 - SB 2150 signed by Governor (study doula certification programs)
5/11/2023 - SB 394 signed by Governor (doula services advisory committee)
9/27/2023 - TN Doula Advisory Committee begins meeting
2/5/2025 - HB 295 introduced (state certification of doulas)
1/16/2026 - SR 263 introduced (resolution for doula Medicaid coverage)		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 Jan 2023, SB 394 was introduced. The bill 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 Dept of Health set up said TN Doula Services Advisory Committee, which began meeting in Sep 2023.

On 1/21/2025, HB 295 (companion bill SB 44) was introduced, which would require Medicaid coverage for doula care and require the state to create a process for state certification of doulas. However, in March 2025, SB 44 was amended to only create a certification process for doula providers, but would not require Medicaid reimbursement. On 1/15/2026, SR 263 was introduced, which is a resolution urging TennCare to provide Medicaid coverage for doula care.		No.• Tennessee Doulas: Practical and Policy Recommendations (2022)
• Doula Services for Tennessee: A Report of the Doula Services Advisory Committee to the Tennessee Department of Health (2025)		State Agency Resources
• TN Doula Services Advisory Committee

Advocacy
• Tennessee Doula Association

Prior Legislation
• SB 2150 (2022) - stuy doula certification programs
• SB 394 (2023) - doula services advisory committee

2025-2026 Legislature
• HB 295 (2025) - state certification of doulas
• SR 263 (2026) - resolution for doula Medicaid coverage		N/AN/AThere is no current billing/payment structure, as Tennessee has not yet implemented Medicaid coverage for doula care. However, the Doula Services Advisory Committee Report from March 2025 included two proposals:
• The first proposal would reimburse up to $1715, including $100 for an initial visit, $75/visit for up to three prenatal visits, $900 for support during labor and delivery, and $85/visit for up to four postpartum visit. This proposal including incentive payments for client attendance at a pediatric newborn care visit and a postpartum follow up visit.
• The second proposal would look at rates in geographically similar states and make adjustments based on cost of living.

The Committee report recommended incentive payments to encourage best practices, such as for the doula accompanying the client to a prenatal clnical appt and meeting the clinician, for the client adhering to postpartum care visits and newborn care visits, for the client receiving dental care. Alternatively, enhanced rates could be provided in certain scenarios, such as for provding services to clients in rural areas, and/or providing services to first-time clients or certain high-risk populations. 		There is no current Medicaid doula billing, as Tennessee has not yet implemented Medicaid coverage for doula care. However, the Doula Services Advisory Committee Report recommended that doulas enrolled as Medicaid providers should be able to practice and bill both independently and as part of a group, and to contract with managed care plans. N/AN/AN/AThere is no training, credentialing, and/or certification requirement in place, as Tennessee has not yet implemented Medicaid coverage for doula care. However, the Doula Services Advisory Committee Report from March 2025 included recommended core competencies and standards for the provision of doula services in the state.N/AThere is no current pathway in place, as Tennessee has not yet implemented Medicaid coverage for doula care. However, the Doula Services Advisory Committee Report from March 2025 recommened the state put in place both a training and lived experience pathway.There is no continuing education requirement in place, as Tennessee has not yet implemented Medicaid coverage for doula care. However, the Doula Services Advisory Committee Report from March 2025 recommened that doulas be required to renew their verification every three years, for which they provide documentation or sign an attestation of having completed ten hours of continuing education every three years, and maintained adult and infant CPR certification. N/AN/AN/AN/AN/ANo.
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TXAdjacent Action6/2/2023 - HB 1575 signed by Governor (case management)
2023 - Texas Doula Association formed
11/12/2024 - HB 514 introduced (growing doula workforce)
11/21/2024 - HB 1201 introduced (doula pilot program)
2/5/2025 - HB 2477 introduced (doula services for group benefit plans)
2/7/2025 - HB 2573 introduced (doula Medicaid coverage)
3/14/2025 - HB 5583 introduced (doula Medicaid coverage)		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.

A number of bills relating to Medicaid coverage for doula care were. introduced for the 2025-2026 Legislature:
• In Nov 2024, HB 514 was introduced, which is aimed at growing the doula workforce.
• 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.
• 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.

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, 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, introduced in Feb 2025, would cover doula services under certain group benefit plans for governmental employees and retirees. Understanding the Texas Doula Workforce: 2025 Doula Workforce Findings Report (2025)Advocacy
• Texas Doula Association

Prior Legislation
• HB 1575 (2023) - case management

2025-2026 Legislature
• HB 514 (2024) - growing doula workforce
• HB 1201 (2024) - doula pilot program
• HB 2477 (2025) - doula servcies for group benefit plans
• HB 2573 (2025) - doula Medicaid coverage
• HB 5583 (2025) - doula Medicaid coverage		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/ANo.
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UTActively Reimbursing3/15/2023 - HB 415 signed by governor (PEHP doula coverage)
3/19/2025 - SB 284 signed by governor (doula Medicaid coverage)
12/19/2025 - SPA approved
4/1/2026 - Start date of benefit		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.

In Feb 2025, SB 284 was introduced, which required Medicaid coverage for doula care. The bill was signed into law in March 2025. The SPA for doula services was approved on 12/19/2025 with a start date of 4/1/2026.		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.N/AState Agency Resources
• PEHP Doula Covered Services
• Approved SPA
• UT Dept of Health and Human Services, Women's Services & Family Planning page
• UT Doula Provider Attestation Form

Prior Legislation
• HB 415 (2023)
• SB 284 (2025)		No.N/AThe SPA states that prenatal and postpartum services are billed at 15 min per unit, with a limit of 32 units across non-labor support services (i.e. prenatal and postpartum support services). Labor/delivery support is reimbursed on a per diem basis and limited to one unit per pregnancy. Travel time and mileage are not covered.N/ARegulations do not contain specific limitations.Unclear.Regulations do not contain specific limitations.Doulas must be enrolled with the UT Division of Integrated Health Care, within the UT Dept of Health and Human Services, through either the Certification or Experience Pathway. (See SPA.)

The Certification Pathway will require that a doula:
• complete a Division of Integrated Health Care approved doula training program;
• has attended at least three births within the last five years;
• be CPR certified; and
• sign the doula provider attestation.

The Experience Pathway will require that a doula:
• has attended at least ten births as a doula, with at least five of those births in the past two years;
• submit four letters of recommendation, of which two letters are from a clinical member of a birth team for a previously attended birth, such as a nurse, nurse practitioner, midwife, or obstetrician;
• attest to having knowledge and competency in prenatal, labor and delivery, postpartum, lactation, newborn support, guidance, and education;
• be CPR certified; and
• sign the doula provider attestation.		List of approved doula training programs for Certification Pathway.Yes, there is an Experience Pathway.No.No.No.No.No.Yes, there is a Utah Doula Medicaid Code of Conduct.No.
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VAActively Reimbursing4/6/2020 - HB 687 signed by Governor (state certification of doulas)
4/7/2020 - HB 826 signed by Governor (work group)
4/7/2021- HB 1800 budget bill signed by Governor (doula Medicaid coverage)
10/28/2021 - SPA approved
4/1/2022 - Start date for doula benefit
4/4/2024 - SB 118 signed by governor (private coverage of doula care)
3/24/2025 - SB 1384 signed by governor (doula hospital access)
5/2/2025 - HB 1614 signed by governor (doula postpartum coverage)
4/8/2026 - HB 425 signed by governor (doula postpartum coverage)
4/11/2026 - HB 328 enrolled into law (doula EHB)
4/13/2026 - HB 838 signed by governor (doula postpartum coverage)		A number of bills have been signed into law in VA pertaining to expanding access to doula care:
• April 2020: HB 687 creates a process for state certification of doulas
• April 2020: HB 826 requires 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.
• April 2021: The state's 2021 budget bill, HB 1800, calls on the Dept of Medical Assistance Services to implement Medicaid coverage for doula care.
• April 2024: SB 118 (companion bill HB 935) required private health coverage of doula care. 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.
• March 2025: SB 1384 requires doula hospital access, in addition to a partner/spouse.
• May 2025: HB 1614 (companion bill SB 1418) increased the allowance of postpartum visits from four to six, and also increased the amount of time postpartum that doula services could be utilized by Medicaid enrollees from 12 weeks to 12 months.
• April 2026: HB 425 is similar to HB 1614 (which was signed into law in March 2025).
• April 2026: HB 328 requires the VA Bureau of Insurance to select a new essential health benefits (EHB) benchmark plan for the 2029 plan year that includes, among other things, coverage for doula care services.
• April 2026: HB 838 is similar to HB 1614 (which was signed into law in March 2025), but also includes language about up to two linkage-to-care incentive payments for postpartum and newborn care.

Virginia's SPA was approved in Oct 2021 with an effective date of 1/1/2022. The doula benefit began on 4/1/2022.		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.

HB 328 was enrolled into law on 4/11/2026. This bill requires the VA Bureau of Insurance to select a new essential health benefits (EHB) benchmark plan for the 2029 plan year that includes, among other things, coverage for doula care services.		Report of the VA Medicaid Benefit for Community Doula Services Work Group (2020)State Agency Resources
• VA Medicaid Community Doula Program
• Approved SPA
• VA Certification Board State-Certified Doula page

Advocacy
• Doula Association of Virginia

Prior Legislation
• HB 687 (2020) - state certification of doulas
• HB 826 (2020) - work group
• HB 1800 (2021) - doula Medicaid coverage
• SB 118 (2024) - private coverage of doula care
• SB 1384 (2025) - doula hospital access
• HB 1614 (2025) - doula postpartum coverage
• HB 425 (2026) - doula postpartum coverage
• HB 328 (2026) - doula EHB
• HB 838 (2026) - doula postpartum coverage		No.Up to $1078.92. See Dept of Medical Assistance Services Community Doulas for Medicaid Members.Doulas are reimbursed $859 for four prenatal and four 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, for a total of ten prenatal and postpartum visits combined.

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.No.No.No.
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VTImplementation in Process5/6/2024 - S.109 signed by Governor (sunrise review)
6/9/2025 - S.53 signed by Governor (doula Medicaid coverage)
July 1, 2027 - anticipated start date of benefit		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 serve as a model for elsewhere in the state.

In 2017, the Vermont Legislative Joint Fiscal Office issued a brief about Medicaid Coverage for Doula Services in Vermont.

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. In Jan 2025, the VT Office of Professional Regulation issued the sunrise review required by S.109.

On 2/6/2025, S.53 was introduced, which creates a voluntary certification for community-based perinatal doulas, mandates Medicaid coverage of doula care regardless of the outcome of the pregnancy, requires the state to create a registry of certified community-based doulas, requires the state to appoint two certified community-based doulas to serve as advisors, and put in place reimbursement that 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.

The Doula Association of Vermont and other stakeholders are currently working with the Office of Professional Regulation. This process must be complete by 7/1/2026, which is the same date the state expects to submit a SPA. Doula Medicaid coverage is tentatively anticipated to begin 7/1/2027.		No.• Medicaid Coverage for Doula Services in Vermont (2017)
• Doula Sunrise Report (2025)		State Agency Resources
• VT Legislative Joint Fiscal Office Issue Brief
• Doula Sunrise Report

Advocacy
• The Doula Project of WCMHS
• Doula Association of VT

Prior Legislation
• S.109 (2024) - sunrise review
• S.53 (2025) - doula Medicaid coverage

N/AS.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/AN/AN/AS.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/AN/AN/AN/AS.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/AN/AN/AN/ANo.
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WAActively Reimbursing4/3/2020 - SB 6168 budget bill signed in part by Governor
3/30/2022 - HB 1881 signed by Governor (state-certified birth doula)
10/1/2023 - Start date for new health profession of state-certified birth doulas
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 (midwifery/doula services for people who are incarcerated)		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.

In March 2024, Medicaid coverage for doula care was included in the state budget at a reimbursement rate of $3500 with an additional $200k allocation for a doula hub and referral system. 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. The doula benefit began on 1/1/2025.

In Jan 2025, SB 5182 was introduced, which requires the Dept of Corrections to allow midwifery or doula services for 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.

In June 2025, the Doulas4All Coalition, Surge Reproductive Justice, and Washington State Health Care Authority published the WA State Doula Hub & Referral System Legislative Report. Also in 2025, the Doulas4All Coalition and Surge Reproductive Justice published the WA State Doula Hub & Referral System Community Report.
No.• Washington state Medicaid reimbursement: Survey of birth doulas (2020)
• Methods to secure doula reimbursement approval from CMS (2020)
• WA State Doula Hub & Referral System Legislative Report (2025)
• WA State Doula Hub & Referral System Community Report (2025)		State Agency Resources
• Approved SPA
• WA Health Care Authority Doulas page
• WA Dept of Health Birth Doulas page
• Birth Doula Services Billing Guide

Advocacy
• Doulas4All Coalition
• WA Doula Directory

Prior Legislation
• SB 6168 (2020) - budget bill
• HB 1881 (2022) - state-certified birth doula
• SB 5182 (2025) - midwifery/doula services for people who are incarcerated		Yes. As of 10/2024.Up to $3500.Doula services covered by Medicaid are (also 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. 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.

Birth doula application fees are being waived through 6/30/2026.		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 doula's 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)Yes, fingerprint background check is required.No.Yes, the 2024 state budget included a $200k allocation for a doula hub and referral systemBirth doula application fees are being waived through 6/30/2026.N/ASB 5182, signed into law in April 2025, requires the Dept of Corrections to allow midwifery or doula services for incarcerated individuals who are pregnant or who have given birth within the last six weeks.
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WIAdjacent Action2019 - State-funded doula pilot programs launch in Madison and Milwaukee
2021 - Doula care included in Governor's budget but stripped by Republicans
2023 - Doula care included in Governor's budget but stripped by Republicans
12/12/2025 - SB 755 introduced (doula care for people who are incarcerated)
2/26/2026 - AB 1058 introduced (Medicaid doula coverage); AB 1088 introduced (postpartum visit)		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, such as the Wisconsin Doulas Association, continue to advocate for access to doula care.

In Dec 2025, SB 755 (companion bill AB 773) was introduced, which would limit physical restraints on pregnant and certain postpartum people in the custody of a correctional facility. Additionally, the bill requires access to a doula or to lactation support services for those in the custody of a correctional facility who are pregnant or who have given birth in the past six weeks. In Feb 2026, AB 1085 (companion bill SB 1108) was introduced, which would require Medicaid coverage of doula care, as well as require hospitals to provide doulas access to their clients who are Medicaid enrollees. Also in Feb 2026, AB 1088 (compansion bill SB 1101) was introduced, which requires hospitals to provide a postpartum home visit within 14 days if requested by the patient within 14 days of giving birth; the visit may be provided by a variety of care providers, including a doula.		No.N/AAdvocacy
• Wisconsin Doulas Association

2025-2026 Legislature
• SB 755 (2025) - doula care for people who are incarcerated
• AB 1085 (2026) - Medicaid doula coverage
• AB 1088 (2026) - postpartum home visit		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/ASB 755 (companion bill AB 773) would limit physical restraints on pregnant and certain postpartum people in the custody of a correctional facility. Additionally, the bill requires access to a doula or to lactation support services for those in the custody of a correctional facility who are pregnant or who have given birth in the past six weeks.
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WVAdjacent Action2022 - WV Perinatal Partnership doula pilot launches
1/16/2026 - SB 470 introduced (Medicaid doula coverage)		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.

State Senator Laura Chapman has regularly introduced legislation to extend coverage for doula care in Medicaid (SB 313 in 2024, SB 292 and SB 40 in 2025, and SB 470 in 2026). The bills in 2024 and 2025 also included coverage for state employees (under the WV Public Employees Insurance Act). 		Yes. 2025 proposed legislation SB 292 and SB 40 would have provided coverage for doula care for state employees, but the bills did not pass.N/AAdvocacy
• WV Perinatal Partnership

2026 Legislature
• SB 470 (2026) - Medicaid doula coverage		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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WYNo actionMay 2025 - Legislative Services Office produces report on maternal health strategies for Labor CommitteeIn May 2025, the Wyoming Legislative Service Office prepared a Review of Strategies to Improve Maternal Health Care Access for the Wyoming Labor Committee. The report included Medicaid coverage of doula care as a strategy.NoReview of Strategies to Improve Maternal Health Care Access (2025)N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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ASWe were not able to find any current efforts in this territory.
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GUAction Proposed2023 - Start of Guåhan Doula Project
6/26/2024 - Bill 318-37 introduced		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 -- aims to reduce Guam's high maternal and infant mortality rate through doula support, advocacy, education, resources, and referrals for pregnant and postpartum people and their families.NoN/AAdvocacy
• Guåhan Doula Project

Prior Legislation
• Bill 318-37 (2024) - funding for Guåhan Doula Project.		N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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MPWe were not able to find any current efforts in this territory.
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PRWe were not able to find any current efforts in this territory.
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VIWe were not able to find any current efforts in this territory.
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TRICAREAdjacent Action Taken1/1/2022 - Start date for doula pilot
1/1/2025 - Doula pilot expands overseas		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 began expanding overseas, also only for those using TRICARE at civilian facilities overseas and not at military treatment facilities.

In April 2026, the Dept of Defense decided to extend the Demonstration by another five years, through 12/31/2031.

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/AN/ADept of Defense Resources
• TRICARE Childbirth and Breastfeeding Support Demonstration
• Demonstration Extention to 12/31/2030

Advocacy
• Military Birth Resource Network and Postpartum Coalition		N/AUp 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/AN/AN/AN/ATo 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/AYes. Doulas who are network providers must have professional liability insurance. See Requirements for Provider Participation. N/AN/A
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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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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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