Make maternal health a priority
New York State is in the middle of a maternal health crisis that disproportionately affects historically marginalized communities and underscores the racial health inequities across our country and our state. Black New Yorkers are five times more likely than their white counterparts to die from pregnancy-related causes and more than twice as likely to experience a serious complication of their pregnancy. We don’t have to accept this outcome. It is time to prioritize the maternal health of Black people, as well as the birth workers who care for them.
There are achievable and evidence based ways to improve maternal health and save lives. Research has shown that utilizing doulas — professionals who provide physical, emotional, and informational support before, during, and shortly after childbirth — helps to improve maternal and infant health outcomes and reduce racial disparities.
People who have the support of a doula are less likely to need a cesarean section during birth, have a preterm delivery, or experience postpartum depression, and they are more likely to breastfeed. However, the vital support of doulas is not covered by Medicaid in New York and is often out of reach for the communities of color who would most benefit from it. Current funding and programs for community doula programs are not sufficient to meet the demand for doula support. The only sustainable way to increase access to doula support for patients with Medicaid is for statewide Medicaid reimbursement to be included in the 2024 state budget.
That is why the New York Coalition for Doula Access (NYCDA) is encouraged to see that expanding Medicaid coverage for this vital service has been included in the proposed executive budget for 2024 and we must ensure that adequate funding is allocated to this benefit so that doulas throughout New York State are reimbursed at an equitable, living wage rate.
A statewide Medicaid reimbursement must compensate doulas with an equitable reimbursement rate to meet the demand for doula support, prevent birth worker burnout, and reduce racial disparities in maternal and infant health outcomes. Doulas spend an estimated average of 45 hours caring for a client throughout the perinatal period. However, current Medicaid rates do not constitute a living wage for doulas.
In April 2018, New York State announced a Medicaid pilot program in Erie County and as of September 2022, roughly 19% of all Medicaid births in Erie County have received doula support. This pilot has shown us that access to doula support for patients with Medicaid can transform their birth experience from one that is potentially life threatening to one that is joyful and even “easy,” as one patient described her experience after giving birth with the support of a doula.
Hence why we are proposing investing in a sustainable statewide Medicaid reimbursement program that would pay up to $1,930 per birth: $1,250 for support during labor and $85 for each of eight prenatal and postpartum doula visits (up to two hours each). This rate is based on a collaborative analysis conducted by the New York Coalition for Doula Access, SchellingPoint analytics, and almost 200 stakeholders: doulas, patients, doula organizations, hospital administrators, payers, and health department officials.
Our proposed program will significantly improve access to doulas and will help retain doulas in the profession. It will improve health outcomes and reduce health inequities. And it will reduce health care costs. The Institute for Medicaid Innovation has found that Medicaid reimbursement for doulas translates into an average cost reduction of $1,000 per birth, based on the decrease in cesarean births and NICU costs for preterm babies.
Long-term, we can also expect to boost educational and economic outcomes for families across New York State. Potential long-term health care cost reductions in New York are projected to be upwards of $1,450 per birth, which could offset the initial investment in doula care.
Not only will a statewide Medicaid reimbursement program save money and improve health outcomes for families, this is also an opportunity for Gov. Hochul and New York State legislators to truly address racial health inequities across the state and become national leaders in addressing the maternal health crisis.
Simply put, an equitable Medicaid reimbursement program for doula care will help us save lives, improve care, reduce health care costs, and make doula care more sustainable. The time to act is now! An equitable doula Medicaid reimbursement program must be included in the final 2024 state budget.