Increasing access to Doula services is a cost-effective approach to improving maternal and child health among Virginia Medicaid members. Despite historical progress in technology and medicine, the U.S. maternal mortality rate remains elevated compared to countries of similar income levels, and wide racial and ethnic disparities persist. Doulas – community-based individuals who offer a broad set of non-clinical pregnancy-related services based on continuous support to pregnant women throughout pregnancy and in the postpartum period – have been shown to improve a variety of maternal and child health outcomes. Multiple studies indicate that Doula services can be cost-effective and cost-saving.

To address the study mandate(*1), the Office of the Secretary of Health and Human Resources (OSHHR) facilitated five workgroup meetings with stakeholders including Doula practitioners, women with lived experience, licensed practitioners including Certified Nurse Midwives and Obstetrician/Gynecologists, state agencies including Virginia Medicaid, the Virginia Department of Health, the Virginia Department of Health Professions, and organizations including the Virginia Hospital and Healthcare Association, Managed Care Organizations, and the Medical Society of Virginia. The workgroup met to discuss recommendations for a Virginia Medicaid Doula benefit. A full list of stakeholders is available in Appendix III. The recommendations of this report are based on stakeholder input during workgroup meetings, data collected from practicing Doulas in Virginia, information collected on Doula reimbursement in other state Medicaid programs, reimbursement rates for maternal services in Virginia Medicaid for licensed providers, and industry reimbursement standards. It is recommended that a Virginia Medicaid Doula benefit include the following:

• A preventive service through a Medicaid State Plan Amendment;

• Reimburse $859 for up to 8 prenatal/postpartum visits and attendance at delivery, as well as up to $100 in linkage-to-care incentive payments;

• Contain flexibilities for providers that balance individualized, culturally sensitive, trauma-informed appropriate care with minimum requirements that promote delivery of a full package of services, continuity of care, and timeliness in care
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(*1) See Appendix I and II.