This was supposed to be the year that low-income Californians could hire a doula to guide them through pregnancy and advocate for them in the hospital, but that has been delayed twice as the state and doulas haggle over how much they should get paid.
In most states that offer a doula benefit, the rate Medicaid programs pay is a maximum, which doulas receive if the patient attends every prenatal and postnatal visit. Unlike obstetricians, who see many patients in a day, most doulas accept only a few clients a month.
Doulas are unregulated, and most of their work is for patients who pay out-of-pocket. Most private insurance does not cover doulas, said Cassondra Marshall, an assistant professor at the UC-Berkeley School of Public Health who has conducted research on doulas in the Bay Area. Tricare, the health insurance program for active-duty members of the military,The structure of California’s benefit is still being determined.
Cava said the state’s $450 proposal was modeled after the rates in other states, including Oregon, which was one of the first states to include doula benefits in its Medicaid package, in 2014.But Oregon’s $350 maximum payment is too low to attract enough doulas, said Amy Chen, a senior attorney with the National Health Law Program who studies doula Medicaid benefits across states. “One of the big challenges is that the reimbursement rate is so low that doulas just can’t do it,” Chen said.
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