Private Insurance Coverage for Doula Care: Spring of 2024 State of States

Introduction

The United States is the country with the highest mortality rates among high-income countries for pregnant women and people giving birth, and especially for Black women and people giving birth. Doula care can be a cost-effective and evidence-based strategy to reduce the overall mortality rate for pregnant and birthing women and to address racial differences in perinatal outcomes. Doulas can improve health outcomes during pregnancy and the postpartum period. They can also save billions by reducing the number c-sections and hospitalizations for infants due to preterm delivery. Racial disparities persist in maternal health, even among the wealthiest pregnant women of color. This blog post will discuss the growing number of states that are also beginning to require coverage for doula services in private health plans. This blog post will discuss the growing number of states that are also beginning to require coverage for doula care in private health plans.

Private Insurance Coverage for Doula Services

While 27 states and Washington DC either currently include or are in the process of implementing Medicaid coverage for doula care, only two states (Rhode Island and Louisiana, shown in red below) currently require coverage of doula care in private insurance plans.Four states (shown in orange) are in the process of implementing the requirement. California and Utah (shown below in purple) passed legislation that includes some coverage for doula services but does not require coverage for those enrolled in state regulated private plans. In 2021, the state passed H 5929, which required both private plans and Medicaid to cover doula service according to each insurer’s “respective principle and mechanisms of reimbursement and credentialing” and “contracting”. The bill was a result of a successful coalition of BIPOC birth advocates and doulas. The bill’s provisions were shaped by consultation with doulas, including the decision to not require that doulas are supervised by licensed practitioners. Following implementation, Rhode Island doulas participating in listening sessions with the Department of Labor’s Women’s Bureau reported receiving more inquiries from potential clients, but that low pay and reimbursement rates remain a challenge and the financial and administrative burden of participating in private insurance and Medicaid can be prohibitive.

Louisiana

, the state with the highest percentage of births covered by Medicaid at 61%, is the only state that has passed legislation mandating coverage of doula care for privately insured pregnant and birthing people but not Medicaid enrollees. Louisiana became the second state after Rhode Island to require private insurance coverage. HB 272 was passed in June 2023. The bill did specify the scope of coverage and allowed insurers to set a $1,500 limit per pregnancy. State-regulated private health plans in Louisiana were required to incorporate doula coverage by January 1, 2025.

States in the Process of Implementing Doula Care Coverage Requirements for Private Plans

Colorado,

Virginia,

Illinois

, and Delaware have all passed legislation mandating doula care coverage in state-regulated private plans, though none of the laws have yet been implemented.Colorado’s SB24-175 was signed into law in June 2024 and will require state-regulated private plans to cover three hours of prenatal doula care, three hours of postpartum care, and support during labor and delivery. The requirement will not go into effect until July 1, 2025 at the earliest.The Virginia legislature passed SB 1118 in April 2024, requiring that state-regulated private insurers cover a minimum of eight doula visits plus labor and delivery support across the perinatal period for policies issued on or after January 1, 2025. As of this writing, the State Corporation Commission in Virginia that regulates health insurance policies has not included doula services on its list. Colorado’s experience shows the importance of working directly with doulas to create provider registration systems. Medicaid payment rates in Virginia for doulas have not been adequate to cover the costs of care. Although Colorado will require that state-regulated private plans cover the same number of hours of doula care as the Medicaid benefit, Virginians enrolled in state-regulated private plans will have access to at least eight pre- and postpartum doula visits while people enrolled in the state’s Medicaid program are limited to a maximum of eight perinatal doula visits.

The Illinois

legislature enacted HB 5142 in July 2024, requiring that, beginning in 2026, state-regulated private plans cover at least sixteen prenatal visits, labor and delivery support, and sixteen postpartum home visits with a perinatal doula. Illinois’s Medicaid doula benefit went into effect in December 2024, and has a slightly different coverage scheme, covering the perinatal period plus up to twelve months, regardless of how the pregnancy ends.Delaware has passed legislation requiring coverage of doula care in both Medicaid and state-regulated private health plans, but neither law has yet been fully implemented. Delaware’s private coverage requirement, HB 362, passed in September 2024. It will take effect in 2026. Both Medicaid and state-regulated private plans must cover three prenatal and three postpartum doula visits, as well as doula support during labor and delivery, though private plans will also be required under HB 362 to cover additional postpartum visits at the recommendation of a licensed clinical provider.

States with Limited Expansion of Doula Care Coverage

Recently, two states passed laws extending doula care coverage to state employees.Utah’s HB 415, signed into law in March 2023, makes doula care available to state employees and their families through the Public Employees’ Benefit and Insurance Program. Utah’s

HB 415, signed into law in March 2023, makes doula care available to state employees and their families through the Public Employees’ Benefit and Insurance Program. Public Employee Health Program is used by nearly 160,000 people or 4.7% of Utah’s population. The bill was a “negative fiscal note”, meaning that expanded access to doula services is projected to save money for the state. However, like Louisiana, Utah does not yet require Medicaid coverage for doula care.California’s

Public Employees’ Retirement System (CalPERS), the largest state pension plan in the country, began including coverage for doula services for members and their families in the 2025 health plans. California Medi-Cal (the state’s Medicaid) enrollees have access to doula coverage as of January 2023. In October 2023, AB 904 became law. AB 904 does not require that all state-regulated plans cover doula services, but it lists several ways to incorporate doula care into plans that meet the law’s requirements. While AB 904 does not explicitly require that all state-regulated plans cover doula services, the bill lists several ways to incorporate doula care into plans that meet the law’s requirements.

Conclusion

Efforts to expand state doula coverage requirements in private insurance are gaining momentum, with six states introducing doula coverage requirement legislation in the first two months of 2025 alone. Arkansas (HB1252), South Carolina (S0042, and H3108), Massachusetts (H.2576), Nevada, and New York (A5140), if passed, would require doula coverage in both Medicaid plans and private insurance. Texas’ HB2477 would mandate that certain group benefits plans for government employees, retirees, and retired military personnel cover doula services. The challenges and successes states have experienced in implementing doula services through Medicaid can be used to inform how they design similar benefits for those enrolled in private health insurance plans. Coverage of doula services by Medicaid and private insurance plans is an important step in creating a safe, affirming and healthy environment for all pregnant women and birthing mothers.