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.
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.
Find out how to apply online.
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.
Advocates have pushed the state to increase compensation since the benefit’s inception.
“If the reimbursement rate is not adequate, there will not be an adequate work force and the program will not be successful,” was one takeaway from a 2022 panel discussion hosted by the National Health Law Program. A dozen other states cover doulas through Medicaid and those that paid below market rate often failed to serve the vast majority of people who qualified for care.
“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.”
Doulas’ health education, emotional support, and advocacy is associated with healthier births and lower health care costs.
“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.”
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.
Chen, with the National Health Law Program, has researched Medicaid doula programs throughout the country.
“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.
Straight from the source:
Learn more about the doula Medi-Cal Benefit from the Department of Health Care Services, including training on how to enroll as a provider.
From the community:
These organizations have offered and in-person and virtual information sessions for interested Medi-Cal recipients and doulas that want to serve them:
Speak up:
The Department of Health Care Services has a doula stakeholder workgroup. The next virtual meeting is Wednesday, Jan. 31, 2024 at 4 p.m. Send written comments to doulabenefit@dhcs.ca.gov.
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.”
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:
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.
