The Department of Health Care Services (DHCS) is reminding all Medi-Cal maternal health care providers and facilities, including but not limited to OB/GYNs, family medicine physician, midwives, clinics and hospitals, of the importance of doula services for Medi-Cal pregnant and postpartum members. These providers and facilities are encouraged to take proactive steps to foster a doula-friendly environment that respects the important role that doulas serve, as part of a Medi-Cal member’s care team, in the development and implementation of individualized birth plans, and in hospitals leading up to and as part of the labor and delivery process.

Doulas provide personal support to members and families throughout pregnancy and up to one year postpartum by providing services including, but not limited to, the following:

• Emotional and physical support provided during pregnancy, labor, birth and the postpartum period, as well as support for and after miscarriage and abortion.
• Development of birth plans and advocating for member’s personal preferences.
• Assistance with lowering stress and anxiety, increasing the member’s feelings of empowerment and autonomy as part of the birthing process and improving health and delivery outcomes.

Through DHCS’ extensive work on the Birthing Care Pathway initiative, including focus group discussions, it was commonly shared by stakeholders that feeling respected and heard by maternal health care providers is of critical importance to a member’s overall experience. Further, it was highlighted that when members feel that their birth plans and other individual choices are not respected, it can result in negative experiences and an inability to build comfortable, trusting relationships with their maternal health care providers and facilities. To this end, maternal health care providers and facilities should take time to understand Medi-Cal members’ concerns and personal preferences with empathy and without judgment and explain when clinical recommendations might differ.

All Medi-Cal maternal health care providers and facilities should undertake efforts to meaningfully integrate and welcome doula services as part of their overall maternal health care approach in alignment with clinical practice and professional guidelines from California-based and nationally recognized maternal health-focused organizations. This includes having clear policies and procedures, robust clinical and non-clinical staff education and training and interdisciplinary collaboration that recognizes doulas as an important member of Medi-Cal members’ care teams.

To help reduce barriers and increase access to care, DHCS has prepared materials and resources for Medi-Cal maternal health care providers and facilities which are available on DHCS’ Doula Services as a Medi-Cal Benefit webpage, and include but are not limited to:

• Recommendation for Doula Services for Pregnant and Post-Partum Medi-Cal Members, issued by Dr. Karen Mark, DHCS Medical Director.
• Medi-Cal Doula Services Recommendation Additional Postpartum Visits form (DHCS 8474), which assists with obtaining additional postpartum visits.
• Doula Directory, which assists with locating doulas enrolled in Medi-Cal.
• Frequently Asked Questions (FAQ) documents on DHCS’ Doula Providers webpage, which include topics such as enrolling as a Medi-Cal doula, contracting with Medi-Cal managed care plans, billing and reimbursement, hospital collaboration and dispute resolution processes.
• Doula Services section of the Medi-Cal Provider Manual, which outlines coverage and reimbursement policies.
• The California Department of Public Health’s All Facilities Letter #25-13, which was prepared in partnership with DHCS to help reduce barriers for doulas accompanying Medi-Cal members in hospital settings.

In addition, there are informational materials, such as Pregnant People and New Parents and Finding the Right Care Team for Your Pregnancy fact sheets that Medi-Cal maternal health care providers can provide directly to members. DHCS has also created a dedicated email inbox, DoulaBenefit@dhcs.ca.gov, which is available to anyone to reach out and directly ask DHCS questions.