California Medi-Cal will cover doulas – InsuranceNewsNet

California will cover doula services for low-income residents at more than double the initial rate proposed by the state under a spending plan passed by lawmakers this week.

Some supporters hailed the new perk by Medical, the state Medicaid health insurance program, as a step toward professionalizing this group of lay birth attendants. They say a better salary can encourage more people to become doulas. Other supporters, however, called it a partial victory, saying the rate is still too low for the time and work needed to ensure healthy deliveries.

Doulas initially criticized the state for offering one of the lowest fares in the country, $450 by birth – so low that many said it would not be worth accepting Medical the patients. In response, the governor Gavin Newsom last month increased its proposal to $1,154much higher than in most other states.

For some, that still won’t be enough in a state where the cost of living is high and the workload is limited by the unpredictability and length of doula work. Many doulas can only serve two or three clients a month because the job often requires them to be on call.

“I’m totally unimpressed,” said Samsarah Morgan, a doula from Oakland who has been in the business for over 40 years. “That’s not a living wage for someone doing this job.”

The rate in other states that offer doula services through Medicaid is generally between $770 and $900. Oregon join this month Rhode Island by offering the highest rate, $1,500 by birth.

California legislators passed a budget June 13. Once the governor has signed off on the new spending plan, Medical coverage for doula services will take effect in January 2023 and the cost $10.8 million a year. California would pay approximately $4.2 millionand the rest would be covered by the federal government.

“We recognize the value of the work that doulas provide to mothers and infants, particularly the intensity of services and duration of doulas,” the state said. Department of Health Serviceswho administers Medicalwritten in a May 13 email to a group of doulas and researchers advising the department on the new benefit.

Doulas act as coaches, guiding families through pregnancy and advocating for them in the hospital during labor and delivery, as well as the postpartum period. Doula services have been associated with better birth outcomes, such as lower rates of C-sections, more breastfeeding, and fewer babies born underweight.

Doulas also serve women undergoing abortions or miscarriages — something the Doula Advisory Group hopes the state will agree to cover in the future.

However, it is difficult to know how

many doulas work in California because the domain is not regulated. Most of their work is for patients who pay out of pocket, up to $3,500 depending on the location and the experience of the doula.

Advocates hope that adding doulas to covered Medi-Cal services could help reduce maternal mortality rates, especially for black mothers, who die due to childbirth at a rate nearly three times higher than that of white mothers.

During the negotiations, the doulas sought as much as $3,600 for each pregnancy and for maternal support for one year after birth. They wanted $1,000 to assist in labor and delivery and $100 each for up to six sessions before birth and 20 sessions postpartum.

Under the Governor’s latest proposal, the state would pay $126.31 for a first visit and $60.48 up to eight shorter subsequent visits. Labor and delivery would be reimbursed at $544.28. The state or Medical insurers may approve additional visits.

The Newsom administration set compensation for doula labor and delivery at the same rate as doctors and midwives. “This proposal recognizes that although doulas have less formal training than a licensed practitioner, doula services are different and generally last much longer than a visit or birth event with a licensed practitioner,” said writes the state in the May 13 email, the authenticity of which has been confirmed by KHN.

Doulas could have negotiated a flat rate with the administration, but thought charging for each visit would be fairer to workers, said Anu Manchikanti Gómez, associate professor at the School of Social Welfare to University of California, Berkeley who is studying doula programs in California. The downside, however, is that some doulas may not earn full price if their clients do not use all of their allotted visits before or after the birth.

“Because the rate of perinatal visits is so low, it doesn’t make a huge difference overall in terms of state spending,” Gómez said. “But $900 versus. $1,100 could be extremely important for a doula.

Although the reimbursement rate was lower than what the doulas were asking for, some said it still represented progress. Khefri Riley, a Los Angeles doula who helped negotiate the new rates, said he introduced doula services in Medical could create a pathway for new workers from birth to enter the profession. “The needle was moved a little bit,” Riley said.

Others said the new rate is more acceptable but the numbers are still tight for doulas. Chantel Runnels serves customers in the Inland Empire and can travel over 100 miles round trip for patients. With gas prices above $6 a gallon, Runnels said, “everyone feels the pressure.”

Some doulas report that local governments and private insurance programs pay even more. A pilot doula program in Los Angeles paid up to $2,300 by birth, and one on Riverside paid up to $1,250.

“We live in one of the most expensive states, and I think there are a lot of big wins in the review that reflect that they listen to the nature of doula work,” Runnels said. “There is still a lot of room for improvement.”

State governments will often determine what is reasonable by checking rates in other states. California looked Oregonwho offered $350 by birth. But that rate was so low that few doulas were willing to accept Medicaid patients.

Then, on June 8, Oregon announced that it would start paying doulas $1,500 by birth. Raeben Nolan, Vice President of the Oregon Doula Associationsaid the increase was the product of seven or eight years of lobbying.

Nolan said California originally raced Oregon basically with his first proposal. Now she’s applauding California’s turnaround.

“I love that they have so many paid visits,” Nolan said. “I think it’s really good.”

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