Birthworkers of Color Collective member Christina Lares speaks with a mother visiting the collective’s opening event on December, 17, 2023. The Long Beach-based organization is helping doulas navigate the Medi-Cal provider enrollment process.
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Brian Feinzimer
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LAist
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Topline:
New parents and pregnant Californians can now request the support of a doula through Medi-Cal, but for the program to succeed, the state needs to attract more birthworkers to the program. This month, California more than doubled what doulas can expect to earn for each client.
Do-what? Doulas provide expecting and new mothers or birthing people with educational, emotional, and physical support before, during, and after a baby is born. “I find myself just reminding people of their strength,” said doula Christina Wherry. Want to learn more? We’ve got a guide for that.
Expanding access: In other states that have rolled out similar programs, low rates are associated with low participation because birthworkers can charge higher rates to families who can afford to pay out of pocket. An estimated 40% of births in California are funded through Medi-Cal and could be supported by a doula. The benefit also applies to families seeking doula support for a miscarriage or abortion.
The new rates: Doulas will earn at least $3,263.21 for providing a family a full set of prenatal and postpartum visits and attending the birth. The previous maximum was $1,152. California also increased its reimbursements for providing other types of maternity care as part of last year’s budget.
California Is Boosting Doula Pay. Will It Bring More Support For Families?
This month, California more than doubled what doulas can earn supporting low-income families through pregnancy, birth, and the year after.
Doulas provide expecting and new parents with educational, emotional, and physical support before, during, and after a baby is born, and also through miscarriages, stillbirths and abortions.
What is Medi-Cal?
Medi-Cal is California’s public healthcare program for low-income residents and pregnant people. In other states, this program is called Medicaid. More than 15 million people were enrolled across California as of October 2023.
The state started covering doulas through Medi-Cal in January 2023, but few families have used the benefit in the year since. The benefit could bring support to more than 100,000 families a year— 40% of births here are funded through California’s Medicaid program.
“My hope is that with this new reimbursement rate, you can now have a situation where doulas… are not just serving Medicaid enrollees as their side, pro bono-ish gig,” said National Health Law Program Senior Attorney Amy Chen. “But this is [work] that they're doing more broadly.”
Christina Wherry completed her first birthworker training in 2017. She also guides people in yoga and meditation.
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Courtesy Christina Wherry
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“You are deserving of having someone there to support you, someone there to answer the questions,” said Christina Wherry, who uses the term birthworker instead of doula, which is derived from the Greek word for female helper or slave.
When Wherry started working with clients in Los Angeles about six years ago, she had to set her own rates.
“Putting a number on caregiving when it's from the heart is definitely difficult,” Wherry said.
With the recent exception of Medi-Cal, most health insurance does not cover doulas, so families pay anywhere from a few hundred to a few thousand dollars out-of-pocket.
“I burnt out very quickly,” Wherry said. “I wasn't charging enough. I was doing the work and I wasn't able to take care of myself.”
New California doula rates are the nation’s highest
As of Jan. 1, doulas will earn at least $3,263.21 for attending a birth and providing a family a full set of prenatal and postpartum visits. The previous maximum was $1,152.
California also increased its reimbursements for providing other types of maternity care as part of last year’s budget. The state’s Department of Health Care Services is also proposing additional rate increases in 2025, wrote an agency spokesperson in a statement to LAist.
Most Medi-Cal enrollees get their health insurance through a managed care plan. In Los Angeles, the major plans include L.A. Care Health Plan, Kaiser Permanente, and Health Net.
Doulas who contract with those insurers can be paid no less than the minimums set by the Department of Health Care Services.
“Higher reimbursement rates does seem to be a trend nationally,” Chen said. She noted that California’s doula payments are now the biggest among the states that offer the program.
Birthworkers and advocates continue to collaborate with state leaders to improve the Medi-Cal benefit; the next meeting is Jan. 31.
Birthworkers of Color Collective: support for birth workers and doula training. The collective recently opened a physical space in Long Beach.
Frontline Doulas: a perinatal health program providing free doula services for qualified Black families in Los Angeles County. They’ve also published a handy resource guide on the Medi-Cal doula program.
National Health Law Program: The health education, advocacy and legal aid organization’s Doula Medicaid Project convenes stakeholders around, shares information about and advocates for doula programs across the country, including California’s.
Wherry said the new rates are “decent,” but that she wants to see more opportunities for doulas to rest and recover.
There is an emotional labor in being present for people’s most vulnerable moments and birthworkers also confront the disparities in California’s health care system. Maternal deaths increased during the pandemic and Black Californians die from pregnancy complications at a rate nearly four times higher than the general population.
Still, Wherry said she plans to enroll as a Medi-Cal provider to work with clients who might not otherwise be able to afford to hire a doula.
“It strikes a chord in providing this service for everyone,” Wherry said. “Making it accessible to everyone who's open to it.”
I'm a Medi-Cal member and I want a doula
Doula benefit information for Medi-Cal members
Medi-Cal members who are pregnant or were pregnant in the last year are eligible for doula services, including to support pregnancies stillbirth, miscarriage, or abortion.
The Department of Health Care Services has issued a statewide standing recommendation for doula services, so people no longer need approval from an individual licensed provider to start working with a doula.
The majority of Medi-Cal enrollees participate in a managed care plan and receive services through a single provider network. Here are the main providers in L.A. County and how to learn more about their doula benefit:
Health Net: Call member services at 800-675-6110 (TTY: 711) to find a contracted doula nearby. If a preferred doula is not contracted with Health Net, members have the option to request a single case agreement. The plan also offers two other programs geared toward expectant and new parents: Start Smart for Baby and First Year of Life.
L.A. Care Health Plan: Members can call the number on the back of their ID card to request doula services and learn more online. The plan also offers a maternal health text messaging program.
Enrollees who participate in fee-for-service would work with a doula who then bills the state directly for their services.
DHCS has the answers to more frequently asked questions regarding doula services for Medi-Cal members here.
