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Health Plans Should Consider Paying for Doula Services

There is a quiet revolution happening among health plans. Mothers and fathers who work for health insurance companies-and who had the support of a doula at the time of childbirth-are beginning to inquire about expanding benefits to include coverage for this evidence-based service.
Minnesota Experience: Recommendations from Managed Care Organizations

In September 2014, Minnesota’s state statute requiring Medicaid reimbursement for doula coverage went into effect. Minnesota is 1 of 2 states with legislation allowing Medicaid coverage of doula services; the other is Oregon. However, the early implementation of Minnesota’s doula coverage law has been fraught with challenge. On April 13, 2015, as part of a research study evaluating the implementation of the law, we sent letters to the CEOs of all of the Minnesota Managed Care organizations that participate in Medicaid with a request for information regarding the implementation status of the legislation. The responses we received revealed thoughtful insights on implementation, from the payer perspective.
Respondents noted several key challenges with implementation regarding network development, billing, and consumer outreach. In the first year of Minnesota’s experience with Medicaid coverage for doula services, the most frequently mentioned challenge was the requirement that doulas bill for services through a supervising provider and use that provider’s National Provider Identification Number for billing purposes. (This is required because Minnesota’s Medicaid program only reimburses licensed providers, and doulas are certified, but not licensed, in Minnesota.) For example, 1 payer noted that “few, if any, physicians or nurse practitioners have agreed to act as a supervising provider due to quality concerns and liability.” Another organization noted that “most doulas have operated independently, rather than under the auspices of a specific provider or provider group; the women they support receive care from a wide variety of providers and deliver at a variety of hospitals” making the requisite supervisory relationship a challenge.
In addition to highlighting this key challenge, respondents offered several recommendations for improving implementation of the doula benefit under Minnesota Medicaid, and these suggestions may also be applicable to private health plans or self-insured employers considering the possibility of extending benefits to include doula services.
  • Establishment of a unique provider type for doulas, which would be used by all health plans.
  • Facilitating a dialogue with clinics to understand their perspectives on doula care and piloting doula care within clinics where the health plan has an established relationship.
  • Educating the doula community about the Medicaid fee schedule and the process of contracting with health plans. 
  • Educating plan members on the benefits and value of doula care.
Overwhelmingly, managed care organizations emphasized the complexity of the relationships between members, clinics, medical providers, doulas, health plans, and regulators, but all of the respondents also highlighted their interest in overcoming barriers to improve access to doula services.
The idea to reach out to health plan CEOs to solicit their insights and recommendations for change came from a colleague who works at a health plana colleague who had a wonderful birth experience supported by a doula. As the evidence base around the potential benefits of doula access grows, and as more families experience these benefits, the conversation about inclusion of doula services as a covered benefit has extended beyond the water cooler and into executive suites and legislative discussions, where it belongs, as our country grapples with troubling trends and persistent disparities in birth outcomes.

Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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