Three days ago, on Friday, April 15, 2022, three U.S. Senators and five Representatives proposed the Mamas First Act to address maternal mortality. The bill expands Medicaid to include doula, midwifery, and tribal midwifery services for Medicaid recipients.
Senator Booker, who also proposed the MOMMIES Act which sought to expand Medicaid eligibility to a year postpartum, issued a statement saying “[t]he United States is facing a maternal mortality crisis that disproportionately impacts Black and Indigenous communities…” He and the other senators and representatives view this bill as a means of addressing that disparity and expanding access to these services that, in the words of Senator Warren, are ‘powerfully important.”
According to the CDC, Medicaid covers about 42% of births across the United States. In general, Black, American Indian, and Alaska Native women are two to three times more likely to die from childbirth related causes than white women. For women this rate goes up with Black and Alaska Native women dying from pregnancy-related deaths at four to five times the rate of white women. These disparities vary from state to state and are tracked by multiple organizations connected with the CDC. If you want more information on maternal mortality in your state, each state has a Maternal Mortality Review Committee which may have a website or contact to reach out to. Go here to find the MMRC for your state.
The bill makes changes to and adds to Medicaid coverage of doula, midwifery, and tribal midwifery services. Related to doulas, the bill defines as doulas as someone who:
- has completed 60 hours of foundational training.
- is certified by an organization that (a) has been established for at least five years and (b) requires continuing education.
- maintains certification by completing continuing education.
Ultimately, the bill requires coverage of doula and midwifery services provided to Medicaid recipients, and in theory, would require all states to reimburse for doula services provided under Medicaid.
There is, however, an exception for states where State legislation would be necessary to come into compliance with such a requirement. Given the current state of legislation and regulation on doula medicaid reimbursement, it is unclear whether this exception applies to states which do not recognize doulas at all, states that recognize but do not regulate or reimburse doulas, or for states that provide Medicaid reimbursement for doulas but have a different definition of “doula.”