A recent study conducted by the public policy division of Elevance Health, an insurance company operating Medicaid managed care plans, reveals promising outcomes for pregnant women who utilize doula services. The study, published last week, indicates that Medicaid beneficiaries who engage with doulas are less likely to undergo cesarean sections and experience postpartum anxiety or depression. While Elevance Health does not administer a Medicaid managed care plan in North Carolina, its findings align with existing research on doulas and maternal health. The report draws upon data from nine associated Medicaid plans.
The release of this report coincides with North Carolina’s ongoing discussions regarding the potential inclusion of doula services as a reimbursable benefit under Medicaid. Doulas, who provide support to women throughout pregnancy, labor, and postpartum, have gained attention as a potential solution to address concerning maternal health statistics in the United States. Notably, the U.S. has the highest maternal mortality rate among wealthy nations, with Black women facing a disproportionate risk compared to white women, as reported by the CDC. In North Carolina specifically, maternal mortality rates have doubled between 2019 and 2021, with a significant number of deaths occurring among Black women.
Recognizing the potential impact of doula care, the U.S. Department of Health and Human Services advocated for its expansion, particularly targeting populations at higher risk of pregnancy-related complications, such as Black, American Indian, and Alaska Native women. North Carolina’s Department of Health and Human Services has been exploring the integration of doula services into Medicaid benefits since 2019, with several pilot projects funded through grant initiatives. Last week, DHHS announced collaboration with the Institute of Medicine to establish recommendations for implementing a reimbursement program for doula services under Medicaid and other insurance plans.
According to the Elevance report, twelve states and Washington, D.C. currently reimburse doula services through Medicaid, with an additional twelve states beginning to offer this benefit. Despite efforts to introduce bills allowing Medicaid reimbursement for doula services in North Carolina since 2021, legislative progress has been limited.
In recent years, various groups within North Carolina have advocated for improved maternal health, with recommendations urging private insurers and Medicaid managed care companies to cover doula support. The state hosted a doula summit in October 2022, where representatives from states with existing Medicaid reimbursement for doula services shared insights and best practices. Concerns were raised regarding payment rates, referral processes, and insurance billing, highlighting the need for clarity and support for doulas within the healthcare system.
Doulas emphasized the importance of Medicaid reimbursement to ensure accessibility to services for all pregnant individuals, particularly those with low incomes. They underscored the role of doulas in addressing maternal health disparities and advocated for fair compensation to support their essential work in improving birth outcomes.
