ENGAGED SCHOLARSHIP

Engaged scholarship creates a framework in which scholars can participate in building research and projects in collaboration with community partners that is both equitable and sustainable for the community. Engaged scholars develop programs with community stakeholders in a way that is hopefully less extractive and more value added to the community as a whole. Engaged scholarship thinks critically about the ways in which academia and community members can work together to create important social change. My engaged scholarship project is centered at the intersection of gender, race, and health. My community partner, MOMCares, and I aim to correct the Black maternal mortality disparity crisis through access to culturally congruent doulas funded by Medicaid.

Overview

There is a strong, well-documented link between income, race, and health disparities, especially for Black women. In Maryland, Black women are 2.75 times more likely to die of pregnancy-related causes than their White counterparts (MMHIP, 2021). Low income Black mothers who are Medicaid eligible are at an ever higher risk for negative birth and postpartum outcomes (Kozhimannil, et al., 2013). Doula services have been shown to improve birth outcomes and maternal health broadly (Ellman, 2020) and for low income women specifically (Kozhimannil, et al., 2013). Medicaid covers nearly 65% of Black births (TCF, 2021). On February 21, 2022, Maryland Medicaid declared that it would provide coverage for doula/birth worker services to Medicaid beneficiaries (MHD, 2022). Medicaid reimburses $350 per birth and up to $627 for eight prenatal/postpartum services visits. Although the allowed reimbursement rates are low, it is a step in the right direction and a way to supplement doula income. This Medicaid benefit will also allow more low income mothers to access doula care more effectively. 

The primary objective of the project is to assist MOMCares doulas with enrolling as a Medicaid biller and successfully receive payment from Medicaid. In the future, MOMCares could pilot this program to other doulas, thereby increasing the number of Medicaid eligible doulas; increasing the number of Medicaid insured birth people who use doulas; and shrinking the maternal health disparity gap for low income birth people of color in Baltimore. As more doulas register and momentum is built, there is an opportunity to advocate for higher reimbursement rates as well. 

Process

The process for accomplishing this project is first to research how doulas register for Medicaid. Once all the resources are gathered, I will document in easy, concise language and visuals how to enroll. I will work with MOMCares on enrolling and then provide feedback from the doulas that will hopefully improve the process. This process will continue hopefully until Medicaid is more attainable for all doulas and Medicaid eligible birthing people have access to doulas.

Goals

1. Assist  MOMCares doulas enrolling with Medicaid: I plan to help enroll MOMCares doula(s) with Medicaid from start to finish. The doulas will then be able to bill Medicaid for eligible births and perinatal service visits. I will also collect data on the doulas who have registered with Medicaid.

2. Improve the Medicaid enrollment process: A main part of this project is to document the process of enrolling including the “pain points” and barriers to enrolling. This information will then be shared with the Maryland Health Department and Senate with the goal of improving and streamlining the process for doulas. The long-term work with MDH will continue throughout the summer through the Baltimore Field School fellowship program. 

Milestones and Deliverables

1. Pre-Registration Process

2. Registration Process

3. Documentation of the process

4. Report Findings and Recommendations

Implementation

I will work as a “paperwork doula” for MOMCares. I cannot do the process for them, but I will come alongside them to offer knowledge and support as MOMCares enrolls with Medicaid. I will have standing bi-weekly virtual and in-person meetings with MOMCares to develop our relationship and move the project forward. I will document the process of enrolling in order to provide an end of project summary as well as recommendations of improvement to the Maryland Department of Health. MOMCares could implement enrollment with Medicaid as part of their doula training process in the future. This project could be a model for other doula groups endeavoring to enroll with Medicaid. Ideally, doulas would be paid for their time and effort to enroll with Medicaid or the Medicaid reimbursement rates would increase to make enrollment with Medicaid sustainable and equitable for doulas who serve low-income Black birthing people. As a Baltimore Fields School 2.0 Fellow, I will continue to implement this project and work with MDH to create a better process for enrolling in Medicaid.