Doula Integration Toolkit // Financial Considerations
Financial Considerations
Collaborative relationships may or may not involve financial integration. If the type of collaboration includes a financial component, hospitals, health systems, and providers should consider their relative power and experience in insurance negotiations, medical billing, and revenue cycle management.
Collaboration that involves financial integration should occur in a cooperative way that does not devalue or silence the expertise of doulas. Even when established healthcare practices utilize their revenue cycle management expertise to help doula organizations, it’s important that the assistance does not come at the cost of doula expertise and knowledge to inform final decisions and program designs.
Financial Considerations
Reimbursement and Payment Methods
National Health Law Program:
Best Practices for Medicaid Coverage of Doula Care
National resource highlighting best practices for Medicaid coverage with many examples from a variety of states including links. Information is organized by phase of doula benefit implementation.
National Health Law Program:
NHeLP’s Doula Medicaid Project: Current State Efforts at Expanding Access to Doula Care
National resource identifying state-based Medicaid initiatives to cover doula services including type of program, reimbursement structure, and relevant links.
Elevance Health Public Policy Institute:
Doula Access Through Medicaid Managed Care Improves Maternal Health
Provides considerations from a Medicaid managed care perspective for doula program benefit design.
National Health Law Program:
Summary of state Medicaid payment rates as of January 2025 and information clarifying all of the activities doulas are involved in related to patient care that should be considered when setting doula payment rates.
Institute for Medicaid Innovation:
Key Learnings from the Doula and Perinatal Community Health Worker in Medicaid Learning Series
Provides key lessons learned related to doula services for Medicaid and Medicaid managed care programs that would be applicable to any program seeking to build a paid doula benefit.
Prenatal-to-3 Policy Clearinghouse Evidence Review:
Discusses approaches to state funding of doula programs outside direct fee-for-service insurance reimbursement
National Health Law Program:
Private Insurance Coverage of Doula Care: Spring 2025 State of the States
Status of private insurance coverage legislative action and adjacent action at the state level.
Health Affairs Scholar:
Explores motivating factors for doula coverage in the commercial market.
MassHealth:
Training developed and required by MassHealth to assist doulas with enrollment.
Connecticut HUSKY Health:
Developed for the Connecticut HUSKY Health Maternity Bundle, a sample code and rate schedule to help providers easily communicate their proposed contracted rates to sub-contracted doulas.
Connecticut HUSKY Health:
Sample Doula Services Financial Flow
This tool was created for the Connecticut HUSKY Health Maternity Bundle to review how funding could flow to providers through the bundle payment. This is an interactive tool and can be updated as necessary to reflect practice volume.
Evidence Supporting Cost-Effectiveness of Doula Services
Birth - Issues in Perinatal Care:
Original research based on Medicaid data finding doulas reduce expensive outcomes such as preterm birth and cesarean births, resulting in cost savings to Medicaid programs.