Advocacy 

Timeline of Doulas Integration into Medicaid

Based on the significant research that illustrated the benefits of doulas for improving maternal health outcomes, DC took steps to include doulas in the Medicaid system. DC Medicaid births make up a significant number of births in the District. From January 1, 2025, through October 31, 2025, the share of total District resident births funded by DHCF, including Medicaid/Alliance, was 43.4% (2,640 Medicaid births/6,076 Districtwide Births). Importantly, more than half of Medicaid managed care enrollee births are to residents in Wards 7 and 8, where some of the worse perinatal health outcomes are in the District. Between 2014-2028, the majority of District-Resident Pregnancy-Associated Deaths happened in Wards 7 and 8. Ensuring District residents, particularly those in Wards 7 and 8, is critical to building a continuum of maternal health care that prevents poor maternal health outcomes and maternal mortality. 

A brief timeline of bringing the doula Medicaid benefit is below. 

• 2021: a law passes that requires Department of Health Care Finance (DHCF) to submit a State Plan Amendment (SPA) to Centers for Medicare and Medicaid Services (CMS) to expand Medicaid to cover doula services for Medicaid beneficiaries. 

• 2021-2022: Maternal Health Advisory Group works with DHCF to draft and submit the SPA to CMS. 

• October 1, 2022: Doulas can now reimburse for services in the District. 

However, over the last three and half years, the positive impacts of the doula Medicaid benefit have not been fully realized in the District. DHCF reported in 2026, "utilization of doula services in both FFS and Managed Care has been lower than anticipated. The highest consumption of doulas services to-date has been for doulas participating in health centers and practice groups where revenue cycle management support exists and sources of referral are internal."

Gaps in Implementation

DC DLAC has identified several implementation barriers to the effective implementation of the doula Medicaid benefit. In particular, doulas experience significant administrative burden to enroll, credential and bill Medicaid as a Doula including:

• Complex paperwork: Enrolling as an Medicaid provider often requires navigating complex, multi-step bureaucratic systems.

• Multiple managed care organizations: Doulas frequently have to complete separate, repetitive credentialing processes for different Medicaid managed care plans rather than a single unified application.

• Cumbersome billing: Submitting claims and managing plan-specific billing rules demand time and technical resources that many independent or community-based doulas lack

Moreover, doulas experience financial and reimbursement obstacles to make operating within the Medicaid system sustainable for doulas. This includes:

• Low payment rates: Medicaid reimbursement rates are often significantly lower than what private clients pay, making it difficult for doulas to earn a living wage or cover basic travel and operating costs.

• Delayed payments: Slow or untimely processing of claims creates severe cash-flow problems for independent providers who rely steadily on their day-to-day income.

Beyond barriers, DLAC has also identified other areas that need further attention:

• Doula friendly hospital protocol and practices (e.g. development of all facilities letter requires additional steps for implementation)

• Proper oversight for doula practice (currently the Board of Medicine is developing oversight for doulas)

• Clear communication from government to doulas (e.g. the closure of a MCO was not clearly communicated and was not clear who was required to communicate)

• Public awareness campaign to ensure beneficiaries know about the benefit 

• Workforce development for doulas 

Recent News Articles (2026):

1. 1. Medicaid Now Covers Doula Support in More Than Half of States, and Finding One Is Still Hard

   2. Many States Cover Doula Care, but Access to a ‘Birthing Bestie’ Is Often Out of Reach - KFF Health News

   3. Medi-Cal Doula Benefit Plagued By Delayed Payments & Denials

DLACs Efforts to Inform Gaps in Implementation

1. Trainings with DHCF and MCO (see training page)

2. Report on the Creation of a Doula Hub (forthcoming)

3. Landscape of DC Doulas and the Gaps in Doula Medicaid Benefit Implementation (forthcoming)

Ultimately, doulas cannot function in the Medicaid space without adequate infrastructure support including: (1) crentralized credentialing and billing systems; (2) technical assistance and administrative support; (3) data and tracking systems; (4) professional and educational development; (5) partnership. We seek to develop appropriate infrastructure that will allow doulas to engage in Medicaid and serve beneficiaries with ease - where doulas feel empowered and capable to navigate these complex systems. 

Other Opportunities for Engagement 

Upcoming

• None

Previous

• Maternal Health Roundtable, December 2023

• Managed Care Organization Roundtable, September 2025

• Streamlining Credentialing Medicaid Reimbursement Act, March 2026

• DC DLAC Site Visit, May 2026

• Maternal Health Roundtable, July 2026