On December 15, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the new Transforming Maternal Health (TMaH) Model. We’ll get into all the details in this article, but let’s pause to share the most important thing for us: doulas covered by Medicaid!
Yes, some doulas covered by Medicaid have existed for a while. However, in the US, there has never been a federal level initiative for doula coverage through Medicaid.
Not all US parents are covered by Medicaid, in fact, many are not. However, this is relevant for all parents as Medicaid models of care often serve as a model for private insurance programs.
What is The New Transforming Maternal Health (TMaH) Model?
The Centers for Medicaid and Medicare Services (CMS) is part of the US federal government. The Transforming Maternal Health (TMaH) Model is the newest model to come from CMS. It is uniquely focused on improving maternal health care for people enrolled in Medicaid and Children’s Health Insurance Program (CHIP).
It is important to note that in the US, Medicaid is managed at the state level. The US federal government provides guidelines, funding, etc. However, each state runs their Medicaid program in a unique way.
“The model will support participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy.
“The goal of the model is to reduce disparities in access and treatment. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.”
While the TMaH model is designed to support improved outcomes, it is important to remember that the implementation may vary state to state. It is also possible that not all states will choose to apply for the funding associated with this model of care.
Doulas Covered by Medicaid – What Services Are Involved?
As mentioned, the implementation of this model of care will vary from state to state. We already see some states’ Medicaid programs providing coverage for doulas. Of states where doulas covered by Medicaid exist, the exact coverage varies significantly.
Why is CMS providing a new model of care which includes potential doula coverage? Despite spending more per capita on maternal healthcare than any other nation, we have abysmal maternal morbidity and mortality when compared to other developed nations.
We also have a serious and statistically significant disparity in outcomes based on maternal race and ethnicity.
A summary of the three main pillars involved in TMaH:
- “Access to care, infrastructure, and workforce capacity: TMaH will support relationship building and education to help participating states address barriers that limit access to valuable resources, such as midwives, doulas, and perinatal Community Health Workers (CHW).”
- “Quality improvement and safety: Participating SMAs will implement quality initiatives and protocols with a goal of making childbirth safer and improving both the mother and baby’s overall experience. These evidence-informed interventions are called “patient safety bundles.”
- “Whole-person care delivery: Pregnancy and birth are deeply personal experiences, and every person’s journey is unique. Under the TMaH Model, participating SMAs will strive to ensure that every mother receives care that is customized to meet their specific needs by supporting the development of a unique birth plan.”
As a professional birth worker, it is encouraged that you take time to read the initiative in its entirety, directly from CMS website. This will ensure you fully understand the program and what impact it might have on your work.
Why are Doulas Covered by Medicaid Part of This Initiative?
Unfortunately, as mentioned above, the US has poor maternal health outcomes. Evidence clearly shows that continuous labor support and perinatal education can improve birth outcomes. Doulas are a professional source of both.
The TMaH model is a 10-year initiative hoping to:
- Reduce c-section rate, especially primary c-section rates.
- Reduce mortality and morbidity associated with cardiovascular conditions, preeclampsia, perinatal hypertension, etc.,
- Provide support for those with substance use disorders during and after pregnancy.
- Improve maternal mental health and provide support for PMADs.
- Improve safety in birth facilities.
- Increase whole-person holistic care which accounts for more than just basic pregnancy care.
Remember, this is just a brief summary of this new model of care. Please be sure to read it in its entirety.
How Can Doulas Get Involved?
As mentioned, Medicare services vary from state to state. At this time, you can begin looking at any current Medicaid doula programs in your state. You can also take time to reach out to your state representatives to encourage them to apply for funding.
Per the CMS website, “CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024.”
Be sure you have completed your certification. Being a certified doula is an important part of being prepared to work with any government or insurance company. Even if you choose not to participate with Medicaid and insurance, you can do your part in the community to help encourage your state to take part in the federal funding.
While we cannot be a doula for every client, we can be part of ensuring there is a doula available for every client who wants access to one.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...