Doula Services as a Medi-Cal Benefit

The Department of Health Care Services (DHCS) added doula services as a covered benefit on January 1, 2023. Doula services are available in fee-for-service and through managed care plans (MCPs). Services include personal support to individuals and families throughout pregnancy and one year postpartum. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.

DHCS added doulas as a Medi-Cal benefit to help prevent perinatal complications and improve health outcomes for birthing parents and infants. According to a recent review by Sobczak and colleagues (2023) doula care was associated with positive delivery outcomes including a reduction in caesarean sections, epidural use, length of labor, low-birthweight and premature deliveries. Additionally, the emotional support provided by doulas lowered stress and anxiety during the labor period.

Studies examining the impact of continuous support by doulas report increased empowerment and autonomy during birth, high overall satisfaction with the birthing process, and improved breastfeeding success and duration (Sobczak et al., 2023).

As a preventive benefit, doula services require a written recommendation from a physician or other licensed practitioner of the healing arts. To increase access to services, DHCS issued a standing recommendation for doula services from the DHCS Medical Director, Karen Mark, MD, PhD, that fulfills the requirement for a recommendation for an individual who is pregnant or was pregnant within the past year.

The initial recommendation authorizes the following:

One initial visit.
Up to eight additional visits that may be provided in any combination of prenatal and postpartum visits.
Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage.
Up to two extended three-hour postpartum visits after the end of a pregnancy.

An additional recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice is required for up to nine additional postpartum visits. This recommendation can be noted in the member's medical record by the recommending licensed provider, or a member can ask a licensed provider to complete a Standard form, such as the DHCS Medi-Cal Doula Services Recommendation form. The standing recommendation from DHCS cannot be used for additional postpartum visits. For more information regarding recommendations, please see the Frequently Asked Questions for Medi-Cal Members and Frequently Asked Questions for Doulas.

Doula Directory

The Doula Directory lists Medi-Cal enrolled doulas by county who opted to be included in the directory. It includes their specialties, language, ethnicity, contact information, and other information that doulas shared with DHCS for the directory. DHCS will update the directory on a regular basis. As of April 26, 2024, the Department has enrolled 291 individual providers.

Medi-Cal MCP members should contact their MCP to assist them in securing doula services. MCP point of contact for doula services can be found at Managed Care Plan Contact List for Doulas and Members (PDF) . MCP point of contact for general information can be found at Medi-Cal Managed Care Health Plan Directory.

Providers

Doulas who meet the qualifications listed in the Medi-Cal Provider Manual: Doula Services may enroll in the Provider Application and Validation for Enrollment (PAVE) portal and submit their Medi-Cal application.

Doulas interested in providing services to Medi-Cal MCP members will also need to enter into contracts with MCPs. Doulas must enter into contracts with MCPs to receive reimbursement for doula services provided to Medi-Cal MCP members.

Please see the Doula Application Information webpage for more information.

Doula Implementation Stakeholder Workgroup

The Doula Implementation Workgroup is required by Senate Bill (SB) 65, which added section 14132.24 to the Welfare and Institutions Code (WIC). The workgroup will address the following:

Ensuring that doula services are available to Medi-Cal members who are eligible for and want doula services.
Minimizing barriers and delays in payments to a Medi-Cal doula or in reimbursement to Medi-Cal recipients for doula services.
Making recommendations for outreach efforts so that all Medi-Cal members who are eligible for services are aware of the option to use doula services.
Helping to inform DHCS' report to the Legislature with data on Medi-Cal members using doula services and recommendations to reduce any identified barriers to doula services.

Stakeholders who are part of the Doula Implementation Workgroup may speak during public stakeholder meetings. All members of the public are welcome to listen to meetings as attendees, comment using the chat function during meetings, and submit written comments.

Stakeholders may send written comments via email to DoulaBenefit@dhcs.ca.gov.

Doula Implementation Workgroup members

Future Stakeholder Meetings*

April 12, 2024 10:00 a.m. to 12:00 p.m.

Agenda, Presentation, Chat Transcription, Close-Captioned Log

July 12, 2024 10:00 a.m. to 12:00 p.m.
September 27, 2024 10:00 a.m. to 12:00 p.m.
November 15, 2024 10:00 a.m. to 12:00 p.m.
January 10, 2025 10:00 a.m. to 12:00 p.m.
March 14, 2025 10:00 a.m. to 12:00 p.m.
April 11, 2025 10:00 a.m. to 12:00 p.m.
May 9, 2025 10:00 a.m. to 12:00 p.m.

Reasonable Accommodations

For individuals with disabilities, DHCS will provide free assistive devices, including language and sign-language interpretation, real-time captioning, note takers, reading or
writing assistance, and conversion of training or meeting materials into braille, large
print, audio, or electronic format. To request alternative format or language services,
please call or write:

Department of Health Care Services
Benefits Division
1501 Capitol Avenue, Sacramento, CA 95814
DoulaBenefit@dhcs.ca.gov

Please note that the range of assistive services available may be limited if requests are received less than ten working days prior to the meeting or event.