Last Updated on April 30, 2022

In March of 2022, the Governor signed a bill, HB 1881, which creates the framework for a voluntary doula certification process.


In 2020, as part of the state budget, the Governor signed a law requiring that the Washington State Health Care Authority (HCA) reimburse maternity services provided by doulas. The bill also required the HCA and the Department to develop methods to secure approval from the Center for Medicaid and Medicare services (CMS) fo reimbursement for doulas.

A workgroup was established in late 2020 to develop recommendations regarding reimbursement of doula services. The workgroup included doulas, midwives, and advocates and culminated in a final report laying outs options, payment rate and model recommendations, and implementation choices. In particular, the workgroup made the following recommendations:

  • Require a Doula to be Credentialed (i.e. certified)
    • The Department estimated cost of credentialing at $100-150 per year if 75% of Washington’s 681 doula’s participate.
  • Payment/Reimbursement Model
    • $50 for antepartum and postpartum visit
      • 2 Antepartum Visits
      • 2 Postpartum Visits
      • Flexibility: four reimbursable visits with variation in timing (i.e., three AP visits and one PP, or even all four PP in the case of a client who unexpectedly delivers early and can use additional support post-delivery)
    • $450 for labor support
    • Total: $650 per birth
    • The report notes that successful provision of doula services may require reimbursement at the median private-pay rate of $900 per pregnancy.

HB 1881 (“Act”) creates the statutory framework for creating a statewide doula certification or credentialing process. The Act allows a doula to voluntarily apply for certification from the department so long as the doula meets all of the following requirements:

  1. Submit a complete application.
  2. Complete competencies that meet requirements to be established by the Department of Health.
  3. Has not engaged in unprofessional conduct.
  4. Not currently subject to disciplinary proceedings.
  5. Paid the certification fee.

The Department is required by the Act to collaborate with community partners to adopt rules establishing the competency-based requirements necessary for certification and certification and renewal fee rates.

Any doula who completes the credentialing process will be permitted to use the title “state-certified birth doula.” The Act does not prohibit an individual from providing doula services even if they are not certified with the state, but such a person may not indicate or imply that they are a state-certified birth doula.

The legislation passed through the house with 85 yeas and 8 nays and then through the senate unanimously (49-0). This legislation is seen as a stepping stone to doulas in Washington state being reimbursed by Medicaid for doula services provided to Medicaid members.

Official Resources

News Articles Related to Enacted Law

Washington state Medicaid reimbursement: Survey of birth doulas

South Seattle Emerald, Birth Doulas Rally for Certification in Washington (March 2, 2022)

Sequim Gazette, Washington State Lawmakers Seek to Professionalize Birth-care Doulas (February 17, 2022)

Last Updated on April 30, 2022