Members of a group dedicated to improving prenatal and postpartum health outcomes for pregnant women in North Carolina say they will continue to push for state support to make doula services available to Medicaid recipients.
A doula is a non-medical assistant who provides information and support to parents before, during, and immediately after the birth of their baby.
At a meeting Thursday, a committee of the North Carolina Child Death Task Force discussed the possibility of having the Medicaid program pay for doula services.
About 120,000 babies were born to North Carolina residents in 2023, more than half of whom were covered by Medicaid, according to the CDC.
National groups such as the Institute for Medicaid Innovation and the National Legal Health Program are pushing for the inclusion of doula services in Medicaid plans.
A 2022 study found that doula support reduced the likelihood of C-sections and postpartum depression among women on Medicaid, and a 2013 study found that low-income mothers who received doula support before birth were more likely to have healthy babies, less likely to experience birth complications, and more likely to initiate breastfeeding.
North Carolina has been exploring the possibility of providing doula services to Medicaid recipients for years.
Over the past few years, the state Department of Health and Human Services has used grant funding to support several local doula programs run by county health departments.
According to NC Newsline, the association is hosting a Doula Summit in 2022 to explore what Medicaid-supported doula services could look like, and this year the association formed a Doula Action Team to consider best practices.
Gov. Roy Cooper included Medicaid reimbursement in his proposed 2022-23 budget, but the state Legislature has not funded it.
Sen. Jim Virgin, a Harnett County Republican and chairman of the Senate Health and Human Services Budget Committee, said he has done his own research on doulas and thinks they could be a way to give more women access to prenatal care.
“We're going to try to get funding for these efforts next year,” said Bergin, who also sits on the Child Fatality Task Force committee.
Interest in Medicaid-supported doula services is growing nationwide.
The Child Mortality Task Force on Perinatal Health voted to recommend the full committee continue requiring Medicaid to pay for doula services, which cost about $1.5 million a year to reimburse and $550,000 a year to train, promote and employ doulas.One concern doulas have raised is how they will be integrated into the Medicaid payment system.
“Reimbursements are the first step,” said DHHS Division Chief Belinda Pettiford. “You can't reimburse them if you don't have support systems in place for those workers.”
The committee also considered a request to assist certified professional midwives in obtaining licensure.
Certified midwives are licensed to practice in North Carolina. Certification includes a master's degree in midwifery or higher. A bill passed by the General Assembly last year restricting abortions included a provision that would allow experienced midwives to practice without a doctor's supervision.
Certified professional midwives are not licensed in the state, but families hire midwives for home births.
Nicole Havelka, president of the state chapter of the American Association of Certified Professional Midwives, said certified professional midwives could help fill the gap in obstetric care in rural and underserved areas.
According to the National Association, 36 states and Washington, D.C., offer the Certified Professional Midwife credential.
The NC Medical Association has historically opposed CPM licensure.
The committee has not made a final decision on whether to support CPM licensing, saying members need to speak to more people with an interest in the issue.
