Maryland undertakes efforts to fund Medicaid reimbursement of doula services through the Department of Health (MDH).
In 2020, legislation–SB 163–was to include doula services as a Medicaid benefit. When health priorities shifted to the pandemic SB 163 did not progress. The state has taken another route to begin addressing statewide disparities in maternal health: funding through MDH.
In 2021, the Governor proposed a $72 million maternal and child health care transformation initiative to fund a program addressing health disparities statewide for four years. The rulemaking process that would permit the program to go into place began in 2021 to establish coverage, requirements, and reimbursement procedures for doulas who enroll as Medicaid providers.
As of February 21, 2022, Maryland Medicaid began reimbursing doula/birth worker services to Medicaid members. A doula must enroll with Medicaid to administer doula services. To enroll a doula must meet the following requirements:
- Be at least 18 years old.
- Obtain and maintain liability insurance.
- Attest to being trained and certified by an MDH approved organization*
- Doula Trainings International
- The Childbirth and Postpartum Professional Association (CAPPA)
- Black Doula Training (BDT)
- Ancient Song Doula Services
- Mamatoto Village
- Doulas of North America (DONA)
- International Childbirth Education Association (ICEA)
- Childbirth International (CBI)
- Maternity Wise
- Obtain appropriate National Provider Identifier from the Center for Medicaid and Medicare Services
- Enroll in ePREP as fee-for-service Medicaid provider
- Pass a background check
A doula may be reimbursed for up to 8 perinatal visits and attending labor and delivery. This model permits any combination of prenatal and postpartum visits that equals 8 or fewer per client. Perinatal visits are broken into 15 minute increments and will be reimbursed up to an hour.
|Description||Per Unit Rate||Max Units per service|
|Prenatal (15 minutes/unit)||$16.62||4|
|Labor and Delivery (flat rate)||$350||1|
|Postpartum visit (15 minutes/unit)||19.62||4|
Total Possible (0:1:8): 977.84
While a doula is permitted to do visits in a variety of settings–home, a providers officer, or other community-based setting–there are some limits which MDH has imposed. Perinatal visits may be in-person or by telehealth but labor and delivery services must be in-person and can only be at a hospital or freestanding birth center. To be reimbursed, an OBGYN, family med. doctor, or certified nurse midwife must be present at the birth.
Anyone with questions regarding the requirements of the regulation should reach out Marcia Crandall (email: email@example.com; phone: 410-767-6824), Health Policy Analyst.
News Articles Related to Enacted Law
Announcement: The Office of Governor Larry Hogan, Governor Hogan Announces Launch of $72 Million Maternal and Child Health Care Initiative (July 6, 2021)