Doulas Are Now Covered By Medi-Cal. And Riverside County Is Leading The Way

This year, for the first time, California families can get a doula through the state’s low-income health insurance program.

But first doulas need to navigate a paperwork gauntlet to become a Medi-Cal provider and contract with one or more of the state’s two dozen Medi-Cal managed care plans.

More than 100 doulas have already applied to be a part of the program and early data shows Riverside County has the most birth workers enrolled of any county in the state.

Doulas provide physical and emotional support before, during and after birth. Research shows doula support is associated with healthier pregnancies and babies.

“A lot of times doulas are there just to make sure that the voice of the family is heard, that the birthing person's desires are meant,” said Shené Bowie-Hussey, a doula for more than two decades and the vice president of health strategies at the Riverside Community Health Foundation.

Traditional health insurance on the private market doesn’t typically cover doulas and the out-of-pocket cost is out of reach for many families.

Including doula support as a Medi-Cal benefit has the potential to greatly increase access to the support they provide — an estimated 40% of births in the state are funded by the insurance program, according to data from the Centers for Disease Control and Prevention.

“The dream state is that members that are pregnant are gonna get everything that they need to have a healthy pregnancy, to have a healthy baby, to feel confident in the care that they're receiving,” said Nishtha Patel, a special programs manager at Inland Empire Health Plan, a nonprofit that serves patients who use Medi-Cal.

Lessons from a doula pilot program

Between 17,000 and 20,000 Riverside County and San Bernardino County Inland Empire Health Plan members give birth every year.

In 2019, the nonprofit gathered a group of maternity care providers and doulas to discuss the potential of creating a pilot program that would provide free support to families.

The resulting pilot program connected about 600 families with doulas between 2019 and 2022. The Riverside Community Health Foundation helped establish the program and the Inland Empire Health Plan paid for the doulas’ services.

A more comprehensive analysis of all program participants is underway, but a preliminary review of about 150 participants' experiences showed positive health outcomes, including fewer cesarean-section surgeries, Patel said.

This tracks with existing research that finds doula support is associated with fewer preterm births, cesarean sections, and higher rates of breastfeeding.

IEHP’s pilot program, along with several others in the state, helped inform the creation of the new Medi-Cal benefit. Patel said there is a lesson there for other parts of the health care industry.

“We need to look through the lens of our own community and let the community tell us what they need,” Patel said.

California is one of 10 states that cover doula services through Medicaid. Another five states are in the process of implementing coverage, according to the National Health Law Program.

Support for doulas

Now Inland Empire Health Plan is working to transition the doulas who participated in the pilot program and others in the region into California’s Department of Health Care Services system so they can be paid through Medi-Cal. Patel said they’re in regular contact with about 60 doulas.

“We've spent a lot of time getting to know this community very well over the years,” Patel said. “We're excited to continue working with them.”

Patel and Bowie-Hussey say doulas benefit from having someone there to help them through the two-part sign-up process: Doulas need to enroll as Medi-Cal providers and then contract with individual health plans.

“We like to create space to focus on the doulas so that they can get to the work that they really wanna do,” Bowie-Hussey said. “We wanna make sure that we can decrease as many barriers and challenges as possible.”

There have been at least four training sessions, including an “enrollment party” where doulas could bring their laptops and get in-person help.

“We're all in the community together, all here to help each other implement something that's going to help a lot of people,” Patel said.

Other challenges to implementing the benefit include families’ lack of awareness about doula support and a limited doula workforce. Some hospitals and medical providers may be unfamiliar or unwilling to work with doulas.

LAist reported earlier this year about a family that was allegedly denied access to their doula at an Inglewood hospital. The mother, April Valentine, died during childbirth and the California Department of Public Health is investigating the circumstances surrounding her death.

“We don't want the doula or the family to have to choose between their doula and their partner or their doula and their mother or father,” Bowie-Hussey said. “We want the doula to actually be invited into the space as a provider.”