A bill in the Maryland Senate would include doulas under the state’s Medicaid program, but some local doulas have called the bill problematic.
Doulas, who are trained, can act as an advocate for a pregnant women as they navigate pregnancy, childbirth and after. Under the Senate bill, written by Sen. Arthur Ellis (D-Charles), Maryland Medical Assistance, the state’s version of Medicaid, would cover certified doula services, including childbirth education and physical as well as emotional support.
Ellis introduced the bill after attending a town hall on maternal mortality in the state. Some doulas attended the town hall and spoke about positive birth experiences due to doula services. They told Ellis they were having trouble financially because they could not bill Maryland Medical Assistance or insurance, he said.
He submitted the bill in hopes of helping make doulas more available to women of color, people in rural areas and lower-income populations, which already have higher maternal mortality rates.
Including doula services under the bill would make it so that low-income families could afford them, said Sara Piccioni, a doula who practices in the Washington metropolitan area, including Frederick County. Doulas range in price but often cost between $1,000 and $3,000.
While the bill in theory is good, it has some flaws, Piccioni said.
“I definitely think there are pros and cons of insurance, including Medicaid, covering doula services,” she said.
The first is that the bill would require doulas to have certification, she said. Piccioni does not have her certification, but has attended more than 175 births in the roughly three years she has been practicing, she said. Certification is almost like a membership fee, she said.
It does not necessarily reflect experience or show that a doula is a good doula, Piccioni said. Experience can be more important.
The inclusion of the certification requirement came from the lawyers during drafting of the bill, Ellis said. A doula who is not certified would not be able to bill Maryland Medical Assistance but could continue to practice and bill as they do now.
The bill includes few certifying agencies when there are many more, including some larger certification agencies, said Jessica Kent, a doula in Frederick. She called the bill “super limiting.”
As written, the bill includes the International Childbirth Education Association, the Doulas of North America, the Association of Labor Assistants and Childbirth Educators or the Childbirth and Postpartum Professional Association as certifying agencies. Ellis is open to amending the bill to include more agencies. He is also considering creating a way for doulas to be certified as community health workers.
Like Piccioni, Kent also said the bill eliminates doulas who are not certified, which may disproportionately affect doulas of color.
The other problem, the doulas said, is that the reimbursement rate was not discussed in the bill. Kent said she had concerns that doulas may not receive enough reimbursement under the bill.
For Kent’s pregnancy and birth package, which includes prenatal visits and doula support during labor, clients pay $1,500. A higher package costs $2,000.
There is some concern among doulas that a reimbursement rate could be much lower than what they are charging, Kent said.
Piccioni also raised concerns about the amount of compensation, saying she would like to see it detailed in the bill. Being a doula is a livelihood and compensation needs to reflect that, she said.
Ellis said that while he is open to amending the bill to address the compensation rate, he is not sure if it is necessary with this bill.
Neither Kent nor Piccioni knew doulas involved in the writing of the bill, both saying they were in touch with others who did not know if doulas were consulted for the bill.
Ellis said he saw this bill as a way to open the door to the possibility of doulas being able to bill the state’s Medicaid. He is open to adapt it.
Ellis has heard from some doulas and reached out to others, he said. One point to be made clear about the bill is that it will not make it so doulas can perform abortions, he said.
Doulas are not midwives or obstetricians, he said, and they do not perform medical procedures. He compared them to football coaches. The players perform and the coaches help them, he said. Doulas are coaches for pregnant people.
“They’re there to help pregnant moms have successful deliveries,” Ellis said.
The bill will be heard before the Senate Finance Committee on Feb. 1.