By Kiara Doyal, The Seattle Medium
Thanks to a coalition of birth workers and anti-racist organizers called Doulas For All Coalition (D4A), Washington state will soon offer access to Medicaid reimbursement for birth doulas for the first time.
Advocates for the measure say that this is a historic win, especially since the reimbursement rate will be the highest in the country. This is particularly significant in the Black community, where several disparities disproportionately impact birthing people in their community.
Doulas are trained professionals who provide guidance and support to another person through significant health-related experiences, such as childbirth, offering emotional and physical support during and after labor.
This new policy aims to address critical issues within the Black community related to prenatal care and mental health by supporting Medicaid reimbursements for doulas. Doulas are known for their role in improving birth outcomes, which is vital in combating the troubling national trends affecting Black maternal health.
While doulas are part of an important tradition, they are often not affordable to parents who need them. Currently, more than 50% of birthing folks in Washington state are enrolled in Medicaid but cannot use Medicaid to pay for doula services.
“Doulas are proven to reduce disparities that we are seeing in birth, such as unplanned c-sections, low birth weight, and early birth,” says Jackie Vaughn, Executive Director of Surge Reproductive Justice, a Black, queer-led organization that focuses on community-directed policy processes. “We are very excited because not only are we going to have the highest reimbursement rate in the country for birth doulas to be reimbursed by Medicaid, but we also worked a lot around equity, and around the pay structure as well to ensure that doulas can receive that reimbursement.”
While the policy is considered important and lifesaving by some standards, it took the coalition a long time to see it get passed by the state legislature. Championed by Senator T’wina Nobles (28th LD), the coalition was finally able to pass a funding package for the legislation during this year’s legislative session.
“This policy process has been a multi-phase process that first started with creating birth doulas as a new profession here in Washington state so that they would be able to bill Medicaid,” says Vaughn. “We passed legislation in 2022, HB 1881, to establish doulas as a new profession. Then, this past legislative session in 2024, we came back to the legislature to ask for the physical parts of this policy, which includes the reimbursement rate, as well as the funding for a doula hub as well.”
The funding package passed by the state includes reimbursements of up to $3,500 per doula, which is the highest reimbursement rate in the nation. It also provides $100,000 to establish the Doula Hub, which will support doulas in navigating the Medicaid billing system and create a referral system for Washington state Medicaid families who want to find a doula.
“Although it has been a five-year process, it has been worth it to people to have their results, and the people who are going to be directly impacted by a policy are the ones who are shaping and leading the development of that policy,” she added.
Cassandra Miles, a member of D4A and a full-spectrum doula who offers support during the entirety of pregnancy, has had many experiences being a doula and a part of the D4A coalition. According to Miles, it is important to understand the distinction between having the technical skills to deliver a baby and having the knowledge as a doula to be able to support a woman accurately and safely in labor.
“I was able to help deliver a woman’s child because her midwife was running late, it was a healthy baby and I got to share the experience of taking the dad through how to catch a baby. This is not typically what a doula should do, but it was a special experience that I like to share because I weighed my options and used my knowledge on short notice, instead of ruining this beautiful experience for the family by calling 911,” says Miles.
Miles says that the outcomes for many expecting mothers may have been different if this policy had been enacted sooner, as she believes many of them would have taken advantage of the opportunity to work with a doula if it was available to them at the time. “Doulas are such giving people that I think if it were something that was more widely accessible during those times, we would have been seeing better birth outcomes,” says Miles. “Getting a doula now, there is a lot of politics and money involved, and so a lot of the times your doula isn’t going to consider themselves an advocate for you because of where their income may come from.”
If everything goes as planned, doulas will be able to submit reimbursement for services as early as January of 2025. While it is a step in the right direction, advocates claim that it is a crucial step towards ensuring adequate maternal care for communities of color in Washington state and creating a healthier environment for women who are expecting.
This story was produced in partnership with our media sponsor Communities of Opportunity, a growing movement of partners who believe every community can be a healthy, thriving community.