Doula Services Frequently Asked Questions
Doula Providers- General FAQs
The Department of Health Care Services (DHCS) covers doula services in both managed care and fee-for-service delivery systems for pregnant and postpartum individuals. Services include nonmedical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion.
1. What kind of services may doulas provide for reimbursement?
- Doulas may provide various types of support during the perinatal period, including during pregnancy; labor and delivery, miscarriage, and abortion; and up to one year postpartum. Services include guidance; health navigation; evidence-based education for prenatal, postpartum, childbirth, and newborn/infant care; lactation support; development of a birth plan; and linkages to community-based resources. Please see the Medi-Cal Provider Manual: Doula Services for more information.
2. Are there any requirements that need to be met before a member can receive doula services? (Added August 16, 2024)
- Doula services are considered a preventive benefit. Federal law requires that all preventive services first be recommended by a physician or other licensed practitioner of the healing arts. To increase access to services, DHCS issued a standing recommendation for doula services by the DHCS Medical Director, Karen Mark, MD, PhD. This fulfills the federal requirement for a recommendation to initiate doula services and Medi-Cal members do not need to separately obtain a recommendation. Doulas should reference this standing order in their records for the Medi-Cal member.
- If a Medi-Cal member has used all eight perinatal visits and wishes to receive additional doula services during the postpartum period, the member can ask a licensed provider to complete the Medi-Cal Doula Services Recommendation form and give the form to the doula. (Added August 16, 2024)
3. Who can recommend doula services? (Updated August 16, 2024)
- Since the DHCS Medical Director, Dr. Karen Mark, MD, PhD, has issued a standing recommendation for doula services, Medi-Cal members do not need a separate recommendation from a physician or other licensed provider for the initial set of services as described in the Medi-Cal Provider Manual: Doula Services. However, Medi-Cal members will need a new recommendation to receive up to nine additional postpartum visits. This recommendation must be made by a physician or other licensed practitioner of the healing arts acting within their scope of practice under state law. The recommending provider does not need to be enrolled in Medi-Cal or be a network provider with the member’s managed care plan (MCP). The recommendation be with the Medi-Cal Doula Services Recommendation form or a note in the member's medical record.
4. What doula services are authorized by a standing recommendation? (Updated August 16, 2024)
- The standing recommendation allows the member to receive the following doula services:
- One initial 90-minute visit.
- Up to eight additional visits that may be provided in any combination of prenatal and postpartum visits, as determined by the birthing person and doula.
- Support during labor and delivery, abortion, and miscarriage.
- Up to two extended three-hour postpartum visits after the end of a pregnancy.
- A second recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice under state law is required for Medi-Cal members to receive up to nine additional visits during the postpartum period. See questions #5 and #6 below for more information.
5. How many additional postpartum visits are allowed?
- A second recommendation – either noted in the member’s medical record by a licensed provider or a signed Medi-Cal Doula Services Recommendation form – allows members to receive up to nine additional visits during the postpartum period. The standing recommendation does not authorize these additional postpartum visits.
6. Does the second recommendation for postpartum services need to be dated after the pregnancy?
- No. If the member has used or is likely to use all eight additional visits while they are pregnant, a licensed provider may recommend additional visits to be provided during the postpartum period.
7. How long is the postpartum period for doula services? (Updated August 16, 2024)
- For doula coverage, the postpartum period is up to one year after the end of the pregnancy, which allows Medi-Cal members to receive doulas services during this period.
8. Can a member receive doula services only during postpartum period?
- Yes. Doula services are available up to one year after pregnancy. If the member did not have a doula while pregnant, they may use the initial visit and all eight visits during the postpartum period and up to nine additional postpartum visits with a second written recommendation.
9. Will DHCS cover doula services provided during or after a miscarriage, still birth, or abortion?
Yes, doula services are available to support individuals during and after pregnancies that end in miscarriage, still birth, or abortion.
10. Are there any limitations on where doulas can provide services?
- No. Doulas may provide services in the community, at a member’s home, and in hospitals, among other locations.
11. May doulas provide services by telehealth? (Updated March 11, 2025)
- Yes. Doula may provide all services via telehealth, including by telephone. Services rendered via telehealth must be billed consistent with DHCS’ telehealth policy as outlined in the Medicine: Telehealth section of the Medi-Cal Provider Manual. This includes billing with modifier 93 for synchronous audio-only or modifier 95 for synchronous video. Services rendered via text, email, chat, or modalities other than audio-visual or audio-only are not reimbursable. Additionally, all doula services provided via telehealth must meet federal requirements for privacy, including the Health Insurance Portability and Accountability Act.
- Medi-Cal's telehealth policy requires that any provider, including doulas, who are providing services via telehealth be able to provide a warm hand-off to an in-person doula, if requested by the Medi-Cal member.
12. Can a member receive doula services from more than one doula? (Updated August 16, 2024)
- Yes, more than one doula may provide services during a member’s pregnancy and postpartum period. However, the total number of visits that a member may receive are per pregnancy and not per doula. In addition, only one doula may bill for services provided during labor, miscarriage, or abortion.
- DHCS recognizes that there may be various reasons why a Medi-Cal member may see one or more doulas during the course of their pregnancy, or even on the same day. For example, a Medi-Cal member may meet with one or more doulas as part of the process of initially identifying a doula who best meets their individual needs. Similarly, a Medi-Cal member may need to change doulas during the course of their pregnancy. For these reasons, Medi-Cal policy does not prohibit two doulas from providing medically necessary prenatal or postpartum visits during the course of a Medi-Cal member’s pregnancy or even on the same day.
13. Will specialty doulas (e.g., birthing/L&D-only, prenatal-only, postpartum-only, etc.) be able to provide doula services for their specialty?
- DHCS has created a single enrollment pathway for doulas, so they must be able to provide all doula services listed in the Medi-Cal Provider Manual: Doula Services -- prenatal, labor, and postpartum care. Doulas may have areas of specialties. These are listed in the Doula Directory.
14. May doulas assist with a home birth? (added March 11, 2025)
- Yes, a doula may assist with home births provided by a licensed provider. Medi-Cal does not have limits on where doulas may provide services.
15. Where can I get more information or provide feedback?
- Information about the doula benefit and stakeholder meetings is available on the DHCS Doula Services webpage.
- Please email DoulaBenefit@dhcs.ca.gov with any further feedback, questions, and comments.
