Medi-cal will cover doulas at more than twice California’s initial proposed rate

California will cover doula services for low-income residents at more than twice the state’s initial proposed rate under a spending plan lawmakers passed last week.

Some advocates welcomed the new benefit in Medi-cal, the state’s Medicaid health insurance program, as a step toward professionalizing this group of nonmedical birth workers. They say better pay may encourage more people to become doulas. Other advocates, however, called it a partial victory, saying that the rate is still too low for the amount of time and work it takes to ensure healthy deliveries.

Doulas had initially criticized the state for offering one of the lowest rates in the nation, $450 per birth — so low that many said it wouldn’t be worthwhile to accept Medical patients. In response, Gov. Gavin Newsom last month increased his proposal to $1,154, far higher than in most other states.

For some, that still won’t be enough in a high cost-of-living state with caseloads limited by the unpredictability and time-consuming nature of doula work. Many doulas can serve only two or three clients a month as the work frequently requires they be on call.

“I’m wildly unimpressed,” said Samsarah Morgan, a doula in Oakland who has been in the field for over 40 years. “That’s not a living wage for someone to do this work.”

The rate in other states that offer doula services through Medicaid typically runs between $770 and $900.

Oregon this month joined Rhode Island in offering the highest rate, at $1,500 per birth.

California lawmakers passed a budget on June 13. Once the governor signs the new spending plan, Medi-cal coverage for doula services will take effect in January 2023 and cost $10.8 million a year. California would pay about $4.2 million, and the rest would be covered by the federal government.

“We recognize the value of the work that doulas provide to mothers and infants, specifically, the intensity of the services and length of time doulas spend,” the state’s Department of Health Care Services, which administers Medi-cal, wrote 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 through the postpartum period. Doula services have been associated with better birth outcomes, such as lower rates of cesarean sections, more breastfeeding, and fewer babies born underweight.

Doulas also serve women undergoing abortions or experiencing miscarriages — something the doula advisory group hopes the state will agree to cover in the future.

Yet it’s hard to know how many doulas work in California because the field is unregulated. Most of their work is for patients who pay out-of-pocket, up to $3,500 depending on location and the doula’s experience.