Does OHP Cover Doula Support?
About 5 years ago, this exciting thing happened that made a big wave through the birth community.
It was announced that Medicaid in Oregon would actually be covering doula care!
I jumped on it. I got the information to be a part of the registry and put a great deal of time to get my name listed as someone who could serve clients and be reimbursed by Medicaid. Getting on the registry was a less than smooth process and took months to complete.
But I was proud to see my name on there.
Each time I pushed for more information on how to make this a reality, I was surprised by more tidbits.
...It reimburses $75.00 per client. (Although that number is supposedly only for a small percentage of people.)
...This $75.00 service must include 4 prenatal appointments, unlimited labor support, and 2 postpartum appointments.
...A doula couldn’t actually get directly reimbursed by Medicaid. This system required that the doula be 'prescribed' by a doctor, the doctor billing Medicaid, and the doctor then reimbursing the doula.
...The rate might actually be $600.00- although I’ve yet to see anyone local say they’ve actually received that amount of reimbursement yet. Or any reimbursement at all.
...Only specific doula training organizations are approved in order to be on the registry.
...The decision for this reimbursement is made by county. Each individual CCO (Coordinated Care Organization) must agree with it and come up with their own plan for billing. All of this apparently requires meetings with someone toward the top of the CCO. But nobody knows who those people are.
Let's have a moment of honesty.
This rumor of Medicaid Reimbursement has been floating around for 5 years now. As one of the first on the Oregon registry and a very active doula, I haven’t seen this program work.
If we do the math on this reimbursement:
4 prenatals at 1-2 hours each.
On call support- 24 hours a day for a minimum of 4 weeks (that's 672 hours)
Unlimited labor support (let's go with a guesstimate of 15 hours...but it could be 36 hours)
2 postpartum visits at 1-2 hours each
1 hour or so of paperwork for billing purposes (although probably far more)
Total time investment: 694-721 hours (not including driving time, marketing, meetings with providers, continuing education, etc)
At a reimbursement rate of $600.00, doulas being reimbursed through Oregon's Medicaid program are looking at making anywhere from...
Wait. They aren't making anything.
They're paying to attend births.
I've spoken to a few people recently who are interested in doula work, but being able to receive this Medicaid reimbursement is an important piece in their decision of who to certify through.
At this time, the reimbursement through Oregon Medicaid is not easily accessible (if accessible at all) and the rate being paid is not enough to sustain a doula in solo practice work.
I see hope for this program and I look forward to where it might end up down the road. But where things sit right now, I see a disservice in newer doulas believing that Medicaid Reimbursement is an option available to them.
Studies show that doulas save money for insurance providers.
Studies show that having a doula present at a birth increases the satisfaction of the patient.
Yet the doula burn-out rate after 3 years in the career is incredibly high. Much of that is due to how difficult it is to make the career pay a living wage.
We can do better than this, Oregon.
For this program to truly work and benefit ALL sides of the equation, it must pay doulas a reimbursement that allows them to live.
And it must allow FEMALE BUSINESS OWNERS to thrive for the work they do. Doula work cannot continue to be just for those who have other ways to support themselves. The work is far too important.
Annie Willems is the owner of Pacific Northwest Doulas and a Birth & Postpartum Doula. She is committed to professional and reliable support for each unique family situation.