Here are the best information about Does insurance cover doulas public topics compiled and compiled by our team
“One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”
—Caughey, Cahill, Guise, and Rouse (2014)
One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.
Doula care, which includes nonclinical emotional, physical, and informational support before, during, and after birth, is a proven key strategy to improve maternal and infant health. Medicaid and private insurance reimbursement for doula care would increase the availability and accessibility of this type of support and would advance the “Triple Aim” framework of the National Quality Strategy by
Rigorous studies show that doula care reduces the likelihood of such consequential and costly interventions as cesarean birth and epidural pain relief while increasing the likelihood of a shorter labor, a spontaneous vaginal birth, higher Apgar scores for babies, and a positive childbirth experience (Hodnett, Gates, Hofmeyr, & Sakala, 2013). Other smaller studies suggest that doula support is associated with increased breastfeeding (Health Connect One, 2014) and decreased postpartum depression (Wolman, Chalmers, Hofmeyr, & Nikodem, 1993). This body of research has not identified any harms of continuous labor support.
Studies in three states (Minnesota, Oregon, and Wisconsin) have concluded that Medicaid reimbursement of doula care holds the potential to achieve cost savings even when considering just a portion of the costs expected to be averted (Chapple, Gilliland, Li, Shier, & Wright, 2013; Kozhimannil, Hardeman, Attanasio, Blauer-Peterson, & O’Brien, 2013; Tillman, Gilmer, & Foster, 2012). Cesareans currently account for one of every three births, despite widespread recognition that this rate is too high. Cesareans also cost approximately 50% more than vaginal births—adding $4,459 (Medicaid payments) or $9,537 (commercial payments) to the total cost per birth in the United States in 2010 (Truven Health Analytics, 2013).
Studies in three states (Minnesota, Oregon, and Wisconsin) have concluded that Medicaid reimbursement of doula care holds the potential to achieve cost savings even when considering just a portion of the costs expected to be averted.
Because doula support increases the likelihood of vaginal birth, it lowers the cost of maternity care while improving women’s and infants’ health. Other factors associated with doula support that would contribute to cost savings include reduced use of epidural pain relief and instrument-assisted births, increased breastfeeding and a reduction in repeat cesarean births, and associated complications and chronic conditions.
Because the benefits are particularly significant for those most at risk for poor outcomes, doula support has the potential to reduce health disparities and improve health equity. Doula programs in underserved communities have had positive outcomes and are expanding, but the persistent problem of unstable funding limits their reach and impact.
In August 2013, the Centers for Medicare and Medicaid Services (CMS) Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid/CHIP included providing coverage for continuous doula support during labor among its recommendations (CMS, 2013).
Currently, only two states—Minnesota and Oregon—have passed targeted legislation to obtain Medicaid reimbursement for doula support, including continuous support during labor and birth, as well as several prenatal and postpartum home visits. Implementation has been challenging, and bureaucratic hurdles make obtaining reimbursement difficult. At this time, few doulas, if any, have actually received Medicaid reimbursement in either state. Across the country, a relatively small number of doula agencies have contracted with individual Medicaid managed care organizations and other health plans to cover doula services. The extent of these untracked local arrangements is unknown.
The recently revised CMS Preventive Services Rule (42 CFR §440.130[c]) opens the door for additional state Medicaid programs to cover doula services under a new regulation, allowing reimbursement of preventive services provided by nonlicensed service providers (Mann, 2013). However, the absence of clear implementation policies or national coordination would require each state to spend considerable resources devising new processes and procedures to achieve Medicaid reimbursement for doula support.
