In 2019, we published a letter in direct opposition to the New York state bills attempting to regulate doulas, and in full support of autonomy for doulas in their practices. Our position on these matters has not changed. However our support of doulas and their work has been tested. As we have adapted the response to meet the growing demands imposed on doulas, we have worked and continue working with state-based health departments to provide documentation of the Doula Trainings International program. In some cases this has facilitated their approval of DTI doulas to work with Medicaid clients. To be paid for their work, doulas are asked to become either credentialed or registered with states. These are not processes we are in support of or wish to devote our limited resources to, however ultimately we must do what is best for birthing folks: expanding access to doula care is what we're about. We do not want doulas, and particularly DTI doulas, to be strong-armed into taking an additional training they feel is unnecessary. We stand by the integrity of the rigorous program DTI offers.
Doula Trainings International is currently an approved training for Medicaid in Colorado, Maryland, Michigan, Minnesota and Nevada (birth), and is also approved in the District of Columbia.
The state of California does not require doula training from any particular organization, and the state of New York provides a couple of pathways which are inclusive of doulas who have trained through us.
The issues for doulas who wish to serve Medicaid clients, or who already do, are unfortunately numerous. Let's highlight a couple of the most severe:
- In many states, the reimbursement rate is far below market rate. For instance, in the state of Virginia, doulas are reimbursed $859 for eight prenatal and postpartum visits and presence at labor/delivery. Factoring 12 hours of labor support plus 8 hours minimum of additional visits, while $53/hour might seem like a fair wage, it does not factor in the tremendous on-call element of our birth doula role, or speak to the reasons birth doulas work on a flat rate model.
- Doulas spend countless additional hours supporting their clients and running their businesses. Now states are adding the hours it takes to figure out billing processes, filing bills correctly, etc. just to get paid weeks or months after work has already been completed, if they get paid at all.
- The state of Virginia requires training organizations to pay fees in order to be considered for their credentialing process. Nevertheless, we have completed the necessary paperwork and fees and are awaiting approval.
The bottom line is that we will continue supporting our doulas with what they need in the best ways we can. We will communicate with and ask questions of the departments responsible for making these decisions. We will give input whenever key stakeholder meeting invitations are extended, and we will keep tabs on the incredible resource, Doula Medicaid Project offered by the National Health Law Program, on behalf of our doulas.