Medi-Cal will cover the doulas at more than double the initial California rate

California will cover doula services for low-income residents at more than double the state’s proposed starting rate under a spending plan that lawmakers approved last week.

Some advocates welcomed the new benefit in Medi-Cal, the state’s Medicaid health insurance program, as a step toward professionalizing this group of non-medical childbirth workers. They say better pay can encourage more people to become doules. Other advocates, however, have called it a partial win, saying the rate is still too low for the amount of time and work it takes to ensure healthy deliveries.

Doulas initially criticized the state for offering one of the lowest rates in the nation, $ 450 at birth, so low that many said it wouldn’t be worth accepting Medi-Cal patients. In response, Governor Gavin Newsom raised his bid to $ 1,154 last month, much higher than most other states.

For some, this will still not be enough in a state of high cost of living with workloads limited by the unpredictability and time-consuming nature of doula work. Many doulas may only serve two or three clients per month as the work often requires them to be available.

“I’m absolutely not impressed,” said Samsarah Morgan, an Oakland doula who has been in the field for over 40 years. “It’s not a living wage for someone doing this job.”

The rate in other states that offer doula services through Medicaid typically ranges between $ 770 and $ 900. Oregon joined Rhode Island this month by offering the highest rate, at $ 1,500 per birth.

California lawmakers approved a budget on June 13. Once the governor signs the new spending plan, Medi-Cal coverage for doula services will take effect in January 2023 and will cost $ 10.8 million annually. California would pay about $ 4.2 million and the rest would be covered by the federal government.

“We recognize the value of the work that doulas provide to mothers and babies, in particular, the intensity of services and the length of time the doulas spend,” wrote the state’s Department of Health Services, which administers Medi-Cal. in a May 13 email to a group of doules and researchers to advise the department on the new benefit.

Doulas acts as a coach, guiding families during pregnancy and supporting them in the hospital during labor and delivery, as well as during the postpartum period. Doula’s services have been associated with better birth outcomes, such as lower rates of caesarean sections, more breastfeeding, and fewer babies born underweight.

Doulas also serve women who experience miscarriages or have miscarriages, something the doula advisory group hopes the state will agree to cover in the future.

Yet it is difficult to know how many doules work in California because the field is not regulated. Most of their work is for patients who pay out of their own pocket, up to $ 3,500 depending on the location and experience of the doula.

Advocates hope that adding doules to Medi-Cal’s covered services will help reduce maternal mortality rates, particularly for black mothers, who die from childbirth at nearly three times that of white mothers.

During the negotiations, Doulas asked for up to $ 3,600 for each pregnancy and for maternal support for up to one year after birth. They wanted $ 1,000 for witnessing labor and delivery and $ 100 each for up to six sessions before birth and 20 sessions after delivery.

Under the governor’s latest proposal, the state would pay $ 126.31 for an initial visit and $ 60.48 for up to eight subsequent and shorter visits. Labor and delivery would be reimbursed at $ 544.28. State or Medi-Cal insurers may approve additional visits.

The Newsom administration has set pay for labor and doula childbirth at the same rate as doctors and midwives. “This proposal recognizes that while doulas have less formal training than that of a licensed practitioner, doula services are different and typically last significantly longer than a visit or birth event with a licensed practitioner,” he said. written the status in the email of May 13, the authenticity of which has been confirmed by KHN.

Doulas could have negotiated a flat rate with the administration, but he believed that billing for each visit would be fairer for workers, said Anu Manchikanti Gómez, an associate professor at the University of California-Berkeley School of Social Welfare. study doula programs in California. The downside, however, is that some doulas may not earn full rate if their customers don’t use all of the visits assigned before or after birth.

“Because the perinatal visit rate is so low, it doesn’t make a huge difference in terms of government spending,” Gómez said. “But $ 900 versus $ 1,100 could be hugely important to a doula.”

Although the repayment rate is lower than doulas’ demand, some said it was still progress. Khefri Riley, a Los Angeles doula who helped negotiate the new rates, said introducing doula services in Medi-Cal could create a path for new birth workers to enter the profession. “The needle has been moved slightly,” Riley said.

Others have said the new rate is more acceptable but the numbers are still tight for doulas. Chantel Runnels serves customers in the Inland Empire and can drive more than 100 miles round trip for patients. With gasoline prices over $ 6 a gallon, Runnels said, “everyone feels the squeeze.”

Some doulas point to local government and private insurance programs which pay even more. A pilot doula program in Los Angeles paid up to $ 2,300 per birth and one in Riverside paid up to $ 1,250.

“We live in one of the more expensive states and I think there are a lot of big wins in the review that reflect the fact that they’re listening to the nature of the doula work,” Runnels said. “There is still a lot of room for improvement.”

State governments will often understand what is reasonable by checking rates in other states. California looked to Oregon, which was offering $ 350 for birth. But that rate was so low that few doulas were willing to accept Medicaid patients.

Then, on June 8, Oregon announced it would start paying $ 1,500 doules at birth. Raeben Nolan, vice president of the Oregon Doula Association, said the increase was the product of seven or eight years of lobbying.

Nolan said California was initially bringing Oregon down with its first proposal. Now, she applauds the California breakthrough.

“I love that they have so many paid visits,” Nolan said. “I think it’s really good.”

This story was produced by KHN, which publishes California Healthline, an independent editorial service of the California Health Care Foundation.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorial independent news service, is a program of the Kaiser Family Foundation, a non-partisan health policy research organization not affiliated with Kaiser Permanente.