Medicaid Coverage for Postpartum Women and Doulas - Learning Session Overview
Explore how state Medicaid programs are extending postpartum coverage for women beyond the standard 60-day period and paying for doula services. Learn about current policies, options for coverage extensions, and legal mechanisms at the state level. Discover efforts to improve maternal health outcomes through Medicaid initiatives.
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Medicaid Coverage for Post- partum Women and Doulas September 2020 Learning Institute Maternal Health Topic Session This session will explore how state Medicaid programs are extending post-partum Medicaid coverage to women beyond the standard 60-day coverage, and how state Medicaid programs are paying for the services of Doulas. There will be time for participants to share innovations going on in their own states and ask questions. MaternalHealthLearning.org
Learning Objectives Understand traditional Medicaid policy for post-partum coverage for women covered via pregnancy eligibility Learn how state Medicaid programs are extending post- partum coverage beyond 60 days Learn how state Medicaid programs are paying for the services of Doulas Understand the legal mechanisms (SPA, 1115 waiver, etc.) for making these changes at the state level MaternalHealthLearning.org
Agenda Postpartum Medicaid Coverage Overview of current policies Options for extending postpartum coverage Discussion Medicaid Coverage for Doulas Overview of current policies Options for States Discussion Wrap up MaternalHealthLearning.org
Postpartum Medicaid MaternalHealthLearning.org
Current Policies Traditionally, state Medicaid coverage for women eligible due to pregnancy ends 60 days after birth. National focus on maternal mortality has led many states to extend coverage up to one year postpartum. As of July 2020, 19 states have approved or are considering postpartum extensions, usually for one year Three bills have been introduced in Congress to allow states to extend coverage as a permanent part of their Medicaid programs H.R. 4996, placed on House Union Calendar 9/21/2020 NOTE: Coronavirus Families First Response Act requires continuous Medicaid coverage during the COVID emergency. MaternalHealthLearning.org
State Efforts to Extend Coverage MaternalHealthLearning.org
Options for States 1115 Waivers Requires legislative action in some states What most states are using State Plan Amendment Not available without a change in Medicaid law Pending legislation in Congress Medicaid Expansion Eligibility may not be as broad as for traditional pregnant women eligibility group MaternalHealthLearning.org
Discussion What has been going on in your state? What has been working? What challenges have you experienced? For states that haven t extended coverage, what questions do you have? For states that have extended coverage, what advice do you have for other states? MaternalHealthLearning.org
ACOG Advocacy Resources Policy Priorities: Extend Postpartum Medicaid Coverage State Legislative and Regulatory Pathways Postpartum Extension Q&A Postpartum Extension Talking Points Postpartum Medicaid Coverage Extended During COVID-19: Resources for Your Practice MaternalHealthLearning.org
Other Resources Equitable Maternal Health Coalition (2020) Postpartum Medicaid Toolkits Making the Case for Extending Medicaid Coverage Beyond 60 Days Postpartum: A Toolkit for State Advocates Continuing Medicaid/CHIP Postpartum Coverage Frequently Asked Questions: Continuing Medicaid/CHIP Postpartum Coverage MaternalHealthLearning.org
Doulas MaternalHealthLearning.org
Current Policies Minnesota (SPA, 2014), Oregon (THC, 2011), and DC have had coverage for doulas in their Medicaid plans for several years. Additional states are beginning to phase in coverage of doula services, several states with enacted legislation in 2019 and 15 states (MD, VA, AZ, TN, RI, WA, IL, CA, NJ, MA, LA, CT, NY, OH, NC) with bills or budget items relating to doulas in 2020. Legislation also includes study committees and creation and/or changes to doula certification. MaternalHealthLearning.org
Options for States Federal matching funds for Medicaid spending currently apply only to payments to licensed providers. States have the option to: Add doulas to current licensing agencies Use a State Plan Amendment to allow licensed professionals to bill on behalf of non-licensed professionals for services recommended by the licensed provider (MN) Inclusion as a mandated preventive service, set qualifications, but allow doulas to bill under traditional health worker (OR) Medicaid managed care options in lieu of services that are medically appropriate & cost effective value-added services not included in capitation rate (NE) Medicaid value-based payment options/Medicaid waivers MaternalHealthLearning.org
Lessons Learned Efforts for Medicaid coverage for doula care should proceed with direct guidance and input from practicing doulas. Workforce Lack of centralized certification or credentialing requirements for doulas in the United States Lack of diversity in the doula population as compared to the potential Medicaid patient population Payment Review of various options for coverage, including inclusion as a mandated preventive service, Medicaid managed care options, Medicaid value-based payment options, and Medicaid waivers Billing & Reimbursement Downsides of billing mechanisms that require doulas to seek reimbursement by working under a licensed Medicaid provider Recommendations for alternative billing models, including recent implementation of direct doula billing in Oregon, and reimbursement to groups of doulas, such as doula collectives MaternalHealthLearning.org
Discussion What has been going on in your state? What has been working? What challenges have you experienced? For states that don t cover Doulas, what questions do you have? For states that do cover Doulas, what advice do you have for other states? MaternalHealthLearning.org
Resources NASHP Report on Four State Strategies to Employ Doulas Health Law Project on Doulas in Medicaid with State Legislative tracker NASHP Doula ROI Infographic Oregon's Doula Scope of Practice MaternalHealthLearning.org
