Centering Community Doula Voices: New Report Highlights Barriers that Limit Participation in Maryland’s Medicaid Program for Community-Based Doulas

February 24, 2026
For immediate release

Contact:
Ana Rodney, Doula Alliance of Maryland: arodney@doulaalllianceofmd.org
Ashley Woolard, Public Justice Center: woolarda@publicjustice.org

BALTIMORE, MD – The Doula Alliance of Maryland (DAM), Public Justice Center (PJC), and Maryland Family Network (MFN) co-authored and released in December 2025 a new report, Centering Community Doula Voices: A Path Toward Equity in Maryland’s Medicaid Doula Program. The report sheds light on the shared experiences of 24 community-based doulas in Maryland who navigated the complex enrollment process to join Maryland’s Medicaid program as service providers but encountered significant barriers along the way. The report also makes recommendations to remove barriers to participation in the program.

In 2022, Maryland joined several states, like Oregon, California, Rhode Island, and New Jersey, by expanding its Medicaid program to cover doula services for pregnant and postpartum beneficiaries. Doulas provide information, advocacy, and support for birthing people during pregnancy, birth, and after delivery, including to birthing people who have experienced miscarriages and abortions. DAM, PJC, and MFN convened listening sessions with 24 community-based doulas during summer 2023 to learn about their experiences with provider enrollment in Maryland’s Medicaid program and recommendations to improve the process.

As the report finds, more than three years into the program, only 33 doulas were enrolled in the Medicaid program and only 281 Medicaid beneficiaries had received doula support as of December 2024. The report cites six key barriers to participation of community-based doulas in the Medicaid program:

1. Insufficient reimbursement rates for doulas that do not reflect the scope, time, and emotional labor required for comprehensive perinatal support.
2. Delayed and unreliable payment timelines, with reimbursements taking six months to a year—an untenable model for doulas and small organizations.
3. Frequent uncompensated labor, including training requirements, administrative work, and extensive social support for clients.
4. Complex and burdensome administrative and billing processes that require specialized knowledge and are largely unsupported.
5. A lack of formal networks, mentorship, and professional support, despite doulas relying heavily on one another for sustainability and wellbeing.
6. Costly and restrictive certification requirements that exclude many culturally congruent doulas and narrow the pipeline of providers eligible to serve Medicaid clients.

Community-based doulas provide time-intensive, life-saving support and care to birthing people, but Medicaid reimbursement rates do not reflect this. At the time of the listening sessions, the maximum reimbursement rate for a package of doula services, including 8 prenatal or postpartum visits as well as the labor and delivery, was low at approximately $977. In comparison, Rhode Island’s maximum reimbursement rate for a smaller package of services, including six total prenatal and postpartum visits as well as labor and delivery support, was $1500.

“The Doula Alliance of Maryland is dedicated to making sure the Maternal Health Landscape is equitable and sustainable for birth workers,” stated Ana Rodney, Director of Advocacy and Public Policy for the Doula Alliance of Maryland. “We know that doula voice is what has brought us to the moment we are seeing in Maternal Health in Maryland and we will continue to uplift that voice as we move the work forward.”

Centered in the voices of community-based doula participants, the report makes four recommendations to remove barriers to participating in the program:

1. A sustainable funding model to provide adequate and timely reimbursement. Maryland Medicaid should increase the reimbursement rate to reflect the scope and value of a doula’s work.
2. Maryland Medicaid should provide doulas more financial support to complete the certification process.
3. The certification process should better reflect the work and value of doulas.
4. MDH should establish a Doula Hub that should connect doulas to guidance and supports for administrative work, professional development, and structural determinants of health that impact both doulas and their clients.

“Doulas know best what barriers are preventing them from doing the work they’re so passionate about, and their insights are key to resolving them,” said David Reische, Paralegal for the PJC’s Health and Benefits Equity Project and report co-author. “This report provides a guide for the state to better support these incredible advocates by reducing administrative barriers, making it easier for these needed professionals to enter the field and build a career, and prompt and fair compensation for their work in supporting Maryland’s mothers and children.”

The report is available on the Doula Alliance of Maryland’s website: https://bit.ly/doula-voices.