The New York State Medicaid Doula Services Benefit helps people covered by Medicaid access doula care—an essential service that improves maternal and infant health outcomes. While the coverage of doula services was a welcome addition to the New York State Medicaid program, improvements to program administration would increase participation by providers and client access to services, leading to improved  perinatal health outcomes.  

This report presents findings that are the result of a research project coordinated by The Century Foundation (TCF) and Ancient Song. The goal of the project was to increase access to community-based doulas in New York State by ensuring that those doulas can provide care to their clients equitably and sustainably. To work toward this goal, The Century Foundation and Ancient Song evaluated the implementation of the New York State Medicaid Doula Services Benefit. The research included a survey and listening sessions targeted to doula service providers operating across New York State. The online research was followed by an in-person meeting of doulas, policy advocates, and public health professionals in New York City to discuss findings and deepen recommendations.

Key Takeaways

  • Survey respondents, listening session participants, and meeting attendees all noted that the Medicaid reimbursement rates do not sufficiently cover the full scope of doula services and care delivery.
  • Listening session participants noted that some doulas elect not to participate in the New York State Medicaid program because the reimbursement does not match the time and energy they put into their work.
  • ​​Doula service providers also described additional barriers that complicated Medicaid participation, such as limited access to information about rejected claims (which resulted in multiple claim resubmissions), difficulties with finding information about Medicaid reimbursement timelines, and challenges that arose when billing Medicaid managed care organizations/plans (MCOs) separately.
  • A recurring recommendation was for the creation of a universal Medicaid billing system along with a global payment model, a request that might be impossible to facilitate.
  • Doulas who participated in the survey, listening sessions, and meetings all requested better guidance and more streamlined, transparent processes.

Background

Years of research have shown that doula support for pregnant and post-partum people is associated with a wide range of positive outcomes, from patients receiving more respectful care1 to lower rates2 of Cesarean section and higher rates of breastfeeding initiation. Doula care also reduces3 perinatal health care spending, making it a smart investment for managed care organizations and government public health administrators.

The New York State Medicaid Doula Services Benefit was launched with a pilot program4 in 2019 after years of advocacy by groups such as Ancient Song, the New York Coalition for Doula Access, and Health Leads, among others. Evaluation of the pilot found that Medicaid members who engaged with doulas reported high levels of satisfaction and believed a doula improved their childbirth experience. 

The State Plan Amendment (SPA) was approved in March 2024. On April 1, 2025, doula care was broadly added to Medicaid Managed Care (MMC) benefit packages.

Doula Survey Participant Demographics

Sixty-seven doula service providers from diverse backgrounds participated in the online survey, and shared a wide variety of experiences with Medicaid reimbursement and doula care delivery in New York State. Survey participants were also invited to participate in one of three listening sessions. A total of twenty-two doula service providers participated in the listening sessions after participating in the survey.

This analysis included both quantitative and qualitative data from the surveys and listening sessions, highlighting the doula service providers’ experiences with New York State’s Medicaid program and managed care organizations.

Of the doula service providers surveyed, all sixty-seven were currently practicing in the state of New York, with half concentrated in New York City and the other half in other parts of the state. The majority of survey respondents assisted up to ten pregnancies/births per year (68 percent). Another 27 percent assisted between eleven and forty births per year. Thirteen percent of respondents had more than ten years of experience as a doula, 40 percent had three to ten years of experience, 34 percent had one to three years of experience, and 12 percent were in their first year of doula practice at the time of the survey. Nearly half of survey respondents identified as Black, with the remaining half identifying as White, Hispanic, or multiracial.

Findings

The following findings are primarily based on data from the survey, validated by the listening sessions, and discussed at the in-person stakeholder meeting. Survey respondents and listening session participants only included doulas providing services in New York State. The in-person meeting included doulas, policy advocates, and public health professionals.

Low reimbursement rates might deter doulas from participating in the program.

Despite having years of experience supporting pregnant and parenting clients, many surveyed doula service providers reported not receiving payment commensurate with their experience or the value they provide to clients. Like many doulas across the country, survey respondents reported no or low payment compared to the level of effort and care they provide.

Under New York State’s Medicaid program, reimbursement rates for doula services per pregnancy are $1,500 in New York City and $1,350 for the rest of the state.5

Medicaid’s limited reimbursement rates can deter doulas from participating, as they don’t find it financially worthwhile. Some doulas opt to only provide care to clients who can pay out-of-pocket. This means that there is a deficit in service providers for low-income clients who cannot afford out-of-pocket payment, which is estimated to be $3,000 or more per pregnancy.

Overall, doulas participating in the survey agreed that the Medicaid reimbursement does not constitute a living wage considering the amount of time they spend with clients, the administrative load, transportation, and their own personal costs for child care and living expenses. Participants noted that some doulas elect not to participate in the New York State Medicaid program because the reimbursement does not match the time and energy they put into their work.

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Figure 2

Doulas need more support enrolling in the Medicaid program.

Survey respondents and meeting participants found the Medicaid enrollment, billing, and payment processes to be complex. They described the enrollment process as long and unclear, especially when trying to enroll on their own, even though New York State Medicaid offers resources such as training videos, checklists, and one-on-one sessions to help doulas enroll in the program.6 Doulas who were aware of the resources and had utilized them found them to be helpful, and noted that Medicaid was responsive to their requests for enrollment assistance. Unfortunately, many doulas are unaware of the support available to them and might only hear about the helpline through word-of-mouth from their peers. 

​​Doula service providers also described additional barriers that complicated Medicaid participation such as limited access to information about rejected claims (which resulted in multiple claim resubmissions), difficulty finding information about Medicaid reimbursement timelines, and challenges that arose when billing managed care organizations separately. Issues with billing and denied claims resulted in additional administrative responsibilities (which can be unduly burdensome) and limited financial resources to fund care delivery and their own livelihood as they await reimbursement.

Fifty respondents had received information about the Medicaid doula benefit being extended across New York State prior to the survey and the same amount had taken steps to enroll. Thirty-six respondents were fully enrolled as Medicaid doula service providers, but only twelve were enrolled with one or more Medicaid managed care plans.

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Figure 5

Doulas reported some difficulty with billing and reimbursement.

In addition to providing doula services, many of the providers surveyed have also had to manage their billing processes, only to have their Medicaid claims denied or partially paid.

About 42 percent of respondents (21 of 50 respondents who answered) have handled billing via Medicaid or private health insurance plans for their doula services. None of the surveyed doula service providers used a third-party billing service.

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Recommendations

In June 2025, TCF and Ancient Song hosted a gathering of doulas, advocates, and public health professionals at Pfizer Inc. in New York City where they reviewed the survey findings. The group generated specific recommendations in response to the findings and their experience engaging with Medicaid.

Improve reimbursement for doula Medicaid service providers.

Recommendations for improving the reimbursement coalesced around increasing reimbursement rates, offering reimbursement for travel, and extending postpartum coverage.

Increase reimbursement rates. As anticipated, reimbursement rates and payment for doula services emerged as a major priority. Survey respondents (56 percent), listening session participants, and meeting attendees all noted that the Medicaid reimbursement rates do not sufficiently cover the full scope of doula services and care delivery. 

As of July 2025, doulas in New York City could be reimbursed up to $1,500 and doulas serving the rest of New York state could receive up to $1,350 per pregnancy.7 Survey respondents recommended increasing the reimbursement rate to better account for the depth of services, the time that doulas spend with clients, and the administrative cost of participating in the program. A report found that doulas spend around thirty-two hours caring for a client.8 Meeting participants proposed that a higher reimbursement rate similar to California’s (up to $3,263) would better account for the time, travel, and effort doulas put into providing care. While California’s reimbursement rate is ideal, meeting participants suggested that the absolute minimum should be at least $1,900 across the entire state. 

Offer reimbursement for travel. Reimbursement for travel or travel benefits should be offered, especially with consideration for doulas providing services in rural areas. Many doulas do not have an office where clients can visit, so if any visits happen in-person they must travel to their clients. 

Doulas suggested that having the flexibility to meet clients virtually or in-person would help guarantee access for clients who cannot travel or who need in-person support. Currently, perinatal doula services are eligible for reimbursement when provided in-person or via telehealth in alignment with Medicaid doula provider and Medicaid telehealth policies. Meeting participants were not aware of this option.

Allow reimbursement for extended postpartum coverage. In-person support is preferred by doulas throughout their client’s pregnancy, but becomes essential during the postpartum period when many clients need additional support adjusting to their new infant. Meeting participants acknowledged that one or two hours is not enough to help postpartum clients. They also noted that each client has different needs, with some parents benefitting from extra time with a doula. Doulas should be able to request additional sets of prenatal or postpartum hours for their clients, as needed, and have those covered by Medicaid.

Make it easier to enroll.

Despite the availability of enrollment assistance and other resources provided by the New York State Department of Health, participants suggested that the state expand access to technical assistance and troubleshooting support for Medicaid enrollment and billing specific to the managed care organizations participating in the program. Specifically, doulas requested:

  • in-person trainings to walk through all the paperwork for Medicaid enrollment and billing;
  • translating material to ease the process where it’s not intuitive, such as during enrolling or claim submission;
  • training and resources from the state and from MCOs; and
  • checklists with next steps.

Participants expressed a need for a streamlined enrollment application for the state and managed care organizations. The standard Council for Affordable Quality Healthcare (CAQH) application forms are blanket forms that apply to clinical providers, offering options that are irrelevant to doula care but which must be filled in for the form to be considered complete. For example, the form asks for a Drug Enforcement Administration license, certificate numbers, and physical location where services are provided—none of which apply to doulas. Doulas recommended that MCOs use the information the doulas provide to New York State without requiring additional CAQH paperwork. The enrollment form for New Jersey was lifted up as an ideal example.9 This issue falls within the jurisdiction of the Health Plan Contracting and Oversight team at the New York State Department of Health.

Standardize billing and coding for doulas.

Given that many doula service providers manage their own billing and enrollment processes without additional support staff (including providers who are new to the Medicaid program), New York State’s Medicaid program and managed care organizations must determine how to better support doula participation. Survey respondents and meeting participants requested better guidance and more streamlined, transparent processes.

Create a universal billing system and payment model. A recurring recommendation was for the creation of a universal Medicaid billing system for billing along with a global payment model. Meeting participants suggested that all MCOs use one billing platform or task an external entity with creating it. Doulas also requested better platforms to take encounter notes that transition more easily to billing forms. According to feedback from the New York State Department of Health, creating a universal billing platform is not feasible within the managed care environment.

Coordinate clearer information from managed care organizations. Participants expressed a need for more transparent information from each managed care organization on what reimbursements they provide and how payments are made. For example, one managed care organization provides payment in the form of a mailed gift card, despite other payment options being available for other service providers in their network. This concern falls within the jurisdiction of the Health Plan Contracting and Oversight team at the New York State Department of Health. Meeting participants requested information sessions and resources specific to the MCOs to enhance their understanding of how to best work with them.

Supply grant funding to cover administrative support. Because of the complexity and the amount of time spent on administrative tasks, doula service providers suggested that grant funds to hire part-time support could be helpful. Currently, doula service providers must pay out-of-pocket for any administrative support they hire.

Designate champions to advocate on behalf of doulas.

At the in-person meeting, doulas and community stakeholders in attendance suggested entities that could influence managed care organizations or related stakeholders and leverage that influence to act as champions on behalf of doula service providers.

Doulas recommended that the New York State Department of Health encourage changes to better coordinate the seventeen managed care organizations participating in New York state Medicaid, who each have their own processes. In particular, the state should:

  • ensure there are clear electronic funds transfer (EFT) options,
  • negotiate timely reimbursement to doulas from MCOs,
  • advocate for changes where items do not apply to doulas,
  • advise MCOs to hold monthly meetings to provide information to help doulas enroll and bill, and
  • collate issues from doulas and quantify and describe the issues clearly to the MCOs.

Groups such as the New York Coalition for Doula Access (NYCDA) can help spread the latest information to doula service providers and offer collaborative learning. This work could benefit from engaging clinicians and other service providers as allies.

Raise public awareness of doulas and clients alike.

Launching public health awareness programs to expand access to information about Medicaid coverage for doula care services may encourage more beneficiaries to find and connect with participating doula service providers. Without an understanding of the full set of covered benefits, pregnant and postpartum Medicaid beneficiaries may be hesitant to seek doula care. In particular, the New York State Department of Health should:

  • expand engagement efforts to increase awareness about Medicaid coverage for doula care and promote doula care utilization among Medicaid beneficiaries;
  • establish a large scale media campaign on doula care in New York, including education about the benefits of doula care; this campaign should utilize creative methods, such as storytelling “zines” to share information on the utility of doula care more broadly and on Medicaid coverage; and
  • disseminate information on doulas to Medicaid participants through trusted entities such as federally qualified health centers, child care facilities, social care networks, reproductive justice organizations, community-based organizations, domestic violence programs, and county departments of health and social services.

Moving Forward

Listening session and meeting participants valued the opportunity to discuss successes and challenges of the doula Medicaid program. Given that the conversation mostly included stakeholders based in New York City, participants suggested that the conversation should continue, including stakeholders from across the state, particularly doulas who are not yet enrolled.

The most immediate and practical opportunity identified from the discussions is for the New York State Department of Health to establish a clear, streamlined process for collecting feedback from doula service providers. This feedback should specifically target issues related to enrollment, coverage, billing, and reimbursement within the New York State Medicaid program. Creating this consistent feedback loop will be mutually beneficial. Doulas will be better able to understand the process, what aspects can be improved, and which entities are responsible for any necessary changes. Concurrently, program administrators will be better equipped to manage the program effectively with a deeper insight into doulas’ experiences.

Regardless of which of the above recommendations move forward, transparent and consistent communication between doulas and program administrators is essential for the program’s success. Improving on the success of the program is crucial: every doula that opts out of the Medicaid program means there is one less doula to serve New York State residents with financial need, contributing to ongoing inequities in maternal health and birth outcomes.

Acknowledgment: The author would like to thank Vina Smith-Ramakrishnan and Kennedy Austin (Ancient Song) for their help with data collection.

Notes

  1. Lindsay M Mallick, Marie E. Thoma, Bx Edmond D Shenassa, “The role of doulas in respectful care for communities of color and Medicaid recipients,” Birth 49, no. 4 (December 2022):823-832. doi: 10.1111/birt.12655.
  2. Alexandria Sobczak et al., “The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review,” Cureus 15, no. 5 (May 24, 2023): e39451, doi: 10.7759/cureus.39451.
  3. Alexis Robles-Fradet and Mara Greenwald, “Doula Care Improves Health Outcomes, Reduces Racial Disparities and Cuts Cost,” National Health Law Program, August 8, 2022, https://healthlaw.org/doula-care-improves-health-outcomes-reduces-racial-disparities-and-cuts-cost/.
  4. See “New York State Medicaid Doula Services Pilot Summary,” New York State Department of Health, April 23, 2018, https://www.health.ny.gov/health_care/medicaid/program/doula/docs/2025/final_summary.pdf.
  5. “NYS Medicaid Doula Services Benefit,” New York State Department of Health, May 2023, https://www.health.ny.gov/health_care/medicaid/program/doula/docs/2023-05-30_doula_town_hall.pdf.
  6. “Doula Provider Enrollment and Billing Information,” New York State Department of Health, https://www.health.state.ny.us/health_care/medicaid/program/doula/enrollment.htm.
  7. “NYS Medicaid Doula Services Benefit,” New York State Department of Health, May 2023, https://www.health.ny.gov/health_care/medicaid/program/doula/docs/2023-05-30_doula_town_hall.pdf.
  8. Jennet Arcara et al., “What, when, and how long? Doula time use in a community doula program in San Francisco, California,” Women’s Health 19 (March 4, 2023), https://pmc.ncbi.nlm.nih.gov/articles/PMC9989372/.
  9. See “Individual Doula Provider Applicant Packet,” State of New Jersey Department of Human Services, Division of Medical Assistance and Health Services, https://www.njmmis.com/downloadDocuments/DoulaIndividual.pdf.

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