June 17, 2021
Mothers will soon have greater access to critical support as they welcome a new child, with Maryland set to join a handful of states in providing Medicaid reimbursement for doula care. The anticipation of a baby can make pregnancy a joyful time. But the stresses of racism and doctors’ disregard for Black women’s health concerns can lead to serious pregnancy complications and even death during or shortly after childbirth for many mothers. During this time, community-based, culturally-competent doulas can be important advocates for women. A doula is a non-medical support person who provides information, advocacy, and emotional and social support during pregnancy, birth, and the postpartum period. Community-based doula care provides intensive 24/7 support designed to address social determinants of health for pregnant and postpartum women. Research shows that community-based doula care can improve health outcomes for both women and their infants, including shorter labors and lower cesarean rates. The PJC’s Access to Health and Public Benefits Project, led by attorney Ashley Black, began working with other maternal health allies on securing pregnancy doula Medicaid reimbursement in 2019, and we are excited to see how expanded access to doula care will benefit Maryland families.
From the beginning, we have been committed to building an inclusive coalition to drive the advocacy. We co-founded the Reproductive Health Equity Alliance of Maryland, a cohort of birth workers, women with lived experience with pregnancy complications, clinicians, researchers, and reproductive health advocates working to expand access to evidence-based maternal health interventions, primarily doula care. RHEAM conducted a survey of doulas across Maryland to learn about their practice, certification and training, barriers to providing care, and interest in Medicaid reimbursement. By summer 2020, the survey had reached 100 responses with an overwhelming interest in Medicaid reimbursement.
During the 2020 legislative session, PJC attorney Ashley Black took the lead for RHEAM in drafting legislation with feedback from doulas and other birth workers on creating a Doula Technical Assistance Advisory Group. This stakeholder group would study barriers to doula Medicaid reimbursement and make recommendations on reimbursement and a statewide certification program. RHEAM secured support for the bill from the Maryland Hospital Association and many other maternal health professionals and advocates. Although the bill was unopposed, it did not pass due to the shift in the legislature’s focus toward the pandemic. But we worked with the House Health and Government Operations and Senate Finance Committees to ask the Maryland Department of Health (MDH) to convene the Advisory Group without legislation. MDH agreed to convene the group as described in the bill, and we had our first official Advisory Group meeting in 2021. We continued to build momentum by educating state agencies, lawmakers, and community members on the importance of doula care.
In May 2021, the Maryland Health Services Cost Review Commission authorized $8 million in funding to be directed to Medicaid to work on maternal and child health initiatives, including reimbursement of doula care. The funding will cover four years of reimbursement. Medicaid will seek matching funds from the federal government to bring the total funding to $16 million, although it is unclear how much of this funding will go to doula care. With our allies, we are now advocating administratively to ensure that doulas and women who have experienced pregnancy complications have authentic and meaningful involvement in Medicaid’s program design and rollout so that it is inclusive of community-based doula care and provides a fair reimbursement rate. We hope that Medicaid will work with the Doula Technical Assistance Advisory Group in determining scope of services that will be reimbursed, eligibility and certification, and outcome measures. We also need Medicaid to build this funding into its budget to cover doula care permanently.
Doula reimbursement is a huge victory for advocates and Medicaid beneficiaries, but there remains significant work to be done to ensure that the program is inclusive of community-based doulas and meets the needs of Maryland moms. We look forward to working with our allies and Medicaid to build an inclusive reimbursement program and can’t wait to see how health outcomes of pregnant and postpartum Medicaid beneficiaries will be improved with doulas by their side.