An Examination of Challenges in Improving Doula Reimbursement

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An Examination of Challenges in Improving Doula Reimbursement

Applequist, J., Wilson, R., Perkins, M., Evans, V., Daniel, A., Rookwood, A., Simmons, E., & Louis-Jacques, A. F. (2024). Applying the theoretical domains framework to the implementation of Medicaid coverage for doula services: Doulas’ perceptions of barriers and facilitators in the State of Florida. MedRxiv, 2024.01.06.24300904. https://doi.org/10.1101/2024.01.06.24300904

This study explores the perceptions of doulas in Florida on the barriers and facilitators to Medicaid coverage for doula services. The authors utilize the Theoretical Domains Framework to identify the various barriers and facilitators to Medicaid reimbursement as per the perspectives of the doulas. Major perceived barriers identified include delayed reimbursements, misinformation on doula impact, low reimbursement rates, and a complicated reimbursement structure. The article was selected because it can help redesign the Medicaid doula reimbursement approach to improve doula services.

Arcara, J., Cuentos, A., Abdallah, O., Armstead, M., Jackson, A., Marshall, C., & Gomez, A. M. (2023). What, when, and how long? Doula time use in a community doula program in San Francisco, California. Women’s Health, 19. https://doi.org/10.1177/17455057231155302

This article presents a quality improvement project in which the authors aimed to provide a clear description of the work activities and time use of doulas. Based on observations collected from community-based doula organizations, the authors provide deeper insights into the roles of doulas and how they spend their time in community-based programs. The authors note that the scope of practice for doulas goes beyond birth assistance to include providing prenatal and postpartum support. This article is important as it provides insights into the need to integrate doula services under Medicaid coverage.

Attanasio, L. B., Dacosta, M., Kleppel, R., Govantes, T., Sankey, H. Z., & Goff, S. L. (2021). Community perspectives on the creation of a hospital-based doula program. Health Equity, 5(1), 545–553. https://doi.org/10.1089/HEQ.2020.0096/SUPPL_FILE/SUPP_APPS2.DOCX

This study explores community perspectives on doula care as a part of developing a hospital-based doula program centered on low-income women of color. Based on four focus groups and four individual interviews, the authors found that communities have positive perceptions toward doula services. The article is important as it presents how communities view doulas and how doulas can help resolve racial and ethnic inequities in perinatal health outcomes.

Darvish, N., Gómez, A. M., Marshall, C., McDonald, R., Rouse, L. T., Dinsmore, L., Hecht, H., Berhanu, R., Rajan, G., & Sandhu, J. (2024). What do community doulas think about the future of the doula workforce? Maternal and Child Health Journal, 1–13. https://doi.org/10.1007/S10995-024-03943-1/TABLES/4

This study presents an investigation into the future challenges of maternal healthcare from the doula perspective. It also highlights the major emerging technologies and other opportunities that can strengthen the doula workforce. The article concludes that doulas face various challenges. However, doula practice can be strengthened by recognizing the services as reimbursable under health insurance and adopting practices that can reduce doula burnout. The article is important as it can guide advocacy for a better doula practice in the future.

Gomez, A. M., Arteaga, S., Arcara, J., Cuentos, A., Armstead, M., Mehra, R., Logan, R. G., Jackson, A. V., & Marshall, C. J. (2021). “My 9 to 5 job is birth work”: A case study of two compensation approaches for community doula care. International Journal of Environmental Research and Public Health 2021, Vol. 18, Page 10817, 18(20), 10817. https://doi.org/10.3390/IJERPH182010817

This article presents a case study exploring two compensation approaches for doulas utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. The authors have identified the approaches as contractor and hourly employment with benefits. The study found that the hourly approach provided more adequate compensation than the contractor approach. The authors suggest the need to integrate structural solutions in the compensation of doulas. The article is important as it can guide the development of policy solutions to guide doula compensation methods an promote equitable benefits for community-based doulas.

Mallick, L. M., Thoma, M. E., & Shenassa, E. D. (2022). The role of doulas in respectful care for communities of color and Medicaid recipients. Birth, 49(4), 823–832. https://doi.org/10.1111/BIRT.12655

This study explores the relationship between doulas and respectful childbirth care for vulnerable women due to systemic inequality. Based on a sample of 1977 women from California, doula support led to respectful care. The authors conclude that doula support led to high respectful care, especially for low-income and certain racial/ethnic groups in California. The article is important as it can guide policies that improve equitable access to doula care services, including Medicaid reimbursement policies for doulas.

Mitchell, A. W., Sparks, J. R., Beyl, R. A., Altazan, A. D., Ariel Barlow, S., & Redman, L. M. (2023). Access, interest, and barriers to incorporation of birth doula care in the United States. The Journal of Perinatal Education, 32(4), 181–193. https://doi.org/10.1891/JPE-2022-0027

This article evaluates the interest and barriers to doula care. The authors argue that doulas improve maternal care. However, there are multiple barriers to doula care, including financial constraints. The authors conclude that a majority of people would hire doulas if their services were covered by health insurance. The article is important as it provides evidence regarding people’s willingness to hire doula services; however, the lack of standard insurance coverage is a major barrier, and there is a need for targeted policies.

Mosley, E. A., Lindsey, A., Turner, D., Shah, P., Sayyad, A., Mack, A., & Lindberg, K. (2023). “I want…to serve those communities…[but] my price tag is…not what they can afford”: The community-engaged Georgia doula study. Perspectives on Sexual and Reproductive Health, 55(3), 200–209. https://doi.org/10.1363/PSRH.12241

This article evaluates doula accessibility in Georgia. The authors argue that doulas have the potential to improve perinatal health and reduce disparities. Using a community-based study, the authors identify financial barriers as the major factor reducing the accessibility of doula care in Georgia. The article is important as it can guide doula reimbursement policies, including reimbursement approaches that increase the accessibility of doulas for low-income households.

Ogunwole, S. M., Karbeah, J. M., Bozzi, D. G., Bower, K. M., Cooper, L. A., Hardeman, R., & Kozhimannil, K. (2022). Health equity considerations in state bills related to doula care (2015-2020). Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 32(5), 440–449. https://doi.org/10.1016/J.WHI.2022.04.004

This article reviews state legislation trends on doula reimbursement between 2015 and 2020. The authors argue that the U.S. still has significant racial inequities in birth outcomes. The major focus of the reviewed legislation was those addressing racial health equity. The authors conclude that, although there have been a majority of new doula-related Medicaid reimbursement legislations, only a few have racial equity components. This article is selected because it can guide future doula-related legislation addressing equity concerns, including pay and benefit packages.

Safon, C. B., McCloskey, L., Estela, M. G., Gordon, S. H., Cole, M. B., & Clark, J. (2024). Access to perinatal doula services in Medicaid: A case analysis of 2 states. Health Affairs Scholar, 2(3). https://doi.org/10.1093/HASCHL/QXAE023

This article presents a case analysis of two states: Oregon, with doula reimbursement, and Massachusetts, with pending doula reimbursement. The study examines Medicaid coverage for doula services with a focus on outcomes with Medicaid reimbursement. The authors conclude that Medicaid coverage requires a collaborative and standardized approach. The findings of this study can guide policy development to improve recognition of doula services, improve reimbursement, and support accessibility of related care.

Safon, C. B., McCloskey, L., Gordon, S. H., Cole, M. B., & Clark, J. (2024). Medicaid reimbursement for doula care: Policy considerations from a scoping review. Medical Care Research and Review: MCRR, 81(4). https://doi.org/10.1177/10775587231215221

This scoping review of the literature between 2012 and 2022 distills key policy considerations for the inclusion of doula care as a Medicaid-covered benefit. The authors argue that evidence on the impact of perinatal doula care on maternal health outcomes, especially among low-income pregnant and postpartum people, has led to increased interest by state Medicaid agencies to reimburse for doula services. The authors conclude that there have been various doula reimbursement-related policies with major considerations on prioritizing doula partnerships. This article is important as it provides insights into the considerations for policymakers and advocates to make equitable doula reimbursement policies.

Temple, J. A., & Varshney, N. (2024). Using prevention research to reduce racial disparities in health through innovative funding strategies: The case of doula care. Prevention Science, 25(1), 108–118. https://doi.org/10.1007/S11121-023-01497-2/TABLES/1

This article discusses the economic framework for prevention scientists to use to convince policymakers to make sustainable investments in maternal health through the expansion of doula care funding. The authors argue that despite a few states having Medicaid funding for doula care, most women are at risk of poor maternal health outcomes. Such outcomes are linked to structural racism and a lack of culturally sensitive doula care. The article is important as it proposes various innovative strategies for expanding community-level access to doula services, including state support and strategic funding.

Van Eijk, M. S., Guenther, G. A., Jopson, A. D., Skillman, S. M., & Frogner, B. K. (2022). Health workforce challenges impact the development of robust doula services for underserved and marginalized populations in the United States. The Journal of Perinatal Education, 31(3), 133. https://doi.org/10.1891/JPE-2021-0013

This article investigates the organizational barriers related to doula employment. The authors argue that doulas have significant positive impacts on maternal health outcomes, especially among underserved populations. The authors conclude that the major organizational barriers include varying roles and practices, prohibitive costs of training and certification, and insufficient funding. The article is selected as it provides insights into developing sustainable doula services, including through funding for training and better reimbursement.

Wall, S., Snyder, K., Baruth, B., & Foster, K. (2024). The implementation of a doula grant program directed at families from economically vulnerable backgrounds: A process evaluation. Health Equity, 8(1), 437–445. https://doi.org/10.1089/HEQ.2023.0264/

This study evaluates the process and feasibility of a doula grant program among mothers from low-income backgrounds. The focus of the evaluation was on fidelity, dose delivered/dose received, reach, program satisfaction, and limited efficacy testing. The authors proved that grant-funded doula programs had a high rate of fidelity. The article is important as it can inform the design of doula-related policy and program efforts to ensure they adequately serve communities equitably.

Wodtke, L., Hayward, A., Nychuk, A., Doenmez, C., Sinclair, S., & Cidro, J. (2022). The need for sustainable funding for indigenous doula services in Canada. Women’s Health, 18. https://doi.org/10.1177/17455057221093928

This article presents a qualitative study exploring the management of logistics of providing community-based doula care and the challenges indigenous doulas experience across Canada. The authors identify the lack of sustainable funding as a major challenge to providing indigenous community-based doula services. This is due to a lack of sustainable regulatory support for doula funding. The article is important as it identifies the significance of sustainable funding and regulatory support for doula services and can guide policymakers in developing targeted policies to improve doula reimbursements.

References

Applequist, J., Wilson, R., Perkins, M., Evans, V., Daniel, A., Rookwood, A., Simmons, E., & Louis-Jacques, A. F. (2024). Applying the theoretical domains framework to the implementation of Medicaid coverage for doula services: Doulas’ perceptions of barriers and facilitators in the State of Florida. MedRxiv, 2024.01.06.24300904. https://doi.org/10.1101/2024.01.06.24300904

Attanasio, L. B., Dacosta, M., Kleppel, R., Govantes, T., Sankey, H. Z., & Goff, S. L. (2021). Community perspectives on the creation of a hospital-based doula program. Health Equity, 5(1), 545–553. https://doi.org/10.1089/HEQ.2020.0096/SUPPL_FILE/SUPP_APPS2.DOCX

Darvish, N., Gómez, A. M., Marshall, C., McDonald, R., Rouse, L. T., Dinsmore, L., Hecht, H., Berhanu, R., Rajan, G., & Sandhu, J. (2024). What do community doulas think about the future of the doula workforce? Maternal and Child Health Journal, 1–13. https://doi.org/10.1007/S10995-024-03943-1/TABLES/4

Gomez, A. M., Arteaga, S., Arcara, J., Cuentos, A., Armstead, M., Mehra, R., Logan, R. G., Jackson, A. V., & Marshall, C. J. (2021). “My 9 to 5 job is birth work”: A case study of two compensation approaches for community doula care. International Journal of Environmental Research and Public Health 2021, Vol. 18, Page 10817, 18(20), 10817. https://doi.org/10.3390/IJERPH182010817

Mallick, L. M., Thoma, M. E., & Shenassa, E. D. (2022). The role of doulas in respectful care for communities of color and Medicaid recipients. Birth, 49(4), 823–832. https://doi.org/10.1111/BIRT.12655

Ogunwole, S. M., Karbeah, J. M., Bozzi, D. G., Bower, K. M., Cooper, L. A., Hardeman, R., & Kozhimannil, K. (2022). Health equity considerations in state bills related to doula care (2015-2020). Women’s Health Issues : Official Publication of the Jacobs Institute of Women’s Health, 32(5), 440–449. https://doi.org/10.1016/J.WHI.2022.04.004

Safon, C. B., McCloskey, L., Gordon, S. H., Cole, M. B., & Clark, J. (2024). Medicaid reimbursement for doula care: Policy considerations from a scoping review. Medical Care Research and Review: MCRR, 81(4). https://doi.org/10.1177/10775587231215221

Temple, J. A., & Varshney, N. (2024). Using prevention research to reduce racial disparities in health through innovative funding strategies: The case of doula care. Prevention Science, 25(1), 108–118. https://doi.org/10.1007/S11121-023-01497-2/TABLES/1

Van Eijk, M. S., Guenther, G. A., Jopson, A. D., Skillman, S. M., & Frogner, B. K. (2022). Health workforce challenges impact the development of robust doula services for underserved and marginalized populations in the United States. The Journal of Perinatal Education, 31(3), 133. https://doi.org/10.1891/JPE-2021-0013

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An Examination of Challenges in Improving Doula Reimbursement

-needs to include 10-15 pre-reviewed journal articles
-APA 7th edition
– 4-6 sentences per article found
– double place, hanging indent.5
-needs to describe and evaluate the topic
-needs to be in alphabet order
-need around 6 pages