Black Maternal Health Week: Implementing Doula Care into Medicaid
By Kelly-Jessie Tounou
Held annually on April 11-17th, Black Maternal Health Week is a week-long campaign to build awareness about the maternal health disparities that exist among Black birthing people. Of the many action plans discussed during this week, one of them includes promoting comprehensive public insurance coverage. Given that Medicaid covers more than half of births in Illinois and is the largest payer of maternity care, it is imperative that we make actionable changes to address service gaps.
Due to CHaSCI’s geographic location in Chicago, IL, this piece focuses on Chicago-specific maternal health disparities and Illinois-specific legislative solutions—but these concepts can also be applied to the United States as a whole.
At the intersection of race and class, Black people with lower incomes are at higher risk of poor birth outcomes. Doula care integration is one of the most hopeful approaches to reducing health disparities in maternal health. Doulas, as non-clinical caregivers, can advocate for and facilitate communication between patients and providers while also offering emotional support prior to, during, and after childbirth. People who receive doula care are more likely to have shorter labors and lower rates of caesarean births. Additionally, doulas can help reduce the impact of racism and racial bias in health care. Doula services are needed in neighborhoods in Chicago’s South and West sides, known as “birth deserts” due to their limited birthing options.
Source: Amy Chen, Doula Medicaid Project: February 2024 State Roundup. National Health Law Program (NHeLP)
As of January 2024, twelve states and Washington, DC have implemented legislation supporting doula care (see the map above). In April 2021, Governor J.B. Pritzker signed the Illinois Health and Human Services Reform Act into law, requiring doula services to be covered under medical assistance programs. This legislation also includes:
Medicaid coverage for doula services and home visiting services, to begin in the perinatal period and continue into the postnatal period
Funding for safety net hospitals
Required racism and implicit bias training tied to license renewal
In October 2021, Governor Pritzker signed the Improving Health Care for Pregnant and Postpartum Individuals Act into law. Key components of this legislation include:
Requiring reimbursement for postpartum care
Expanding programs to serve high-risk pregnant and postpartum people
Establishing a universal postpartum visit within the first 3 weeks of childbirth and a comprehensive visit within four to twelve weeks
The Illinois doula benefits were supposed to begin in July 2022, but implementation is still in progress. Since doulas lack an accreditation body, there has been difficulty implementing insurance policies. Doulas must meet Illinois’s qualification standards to be enrolled as a provider and receive reimbursement from the state's Medicaid program, but there is presently no statewide certification system for them.
Black Maternal Health Week is a time to reflect on strides taken in Illinois and beyond to reduce service gaps. While initiatives like Medicaid coverage and the integration of doula care signify steps in the right direction, there remain hurdles to overcome. We must continue advocating for comprehensive public insurance coverage and culturally competent care, while centering on the needs of Black mothers and having conversations with local stakeholders and government officials.
To learn more,
check out The National Health Law Program (NHeLP)’s Doula Medicaid Project.
Through our work in training and policy, CHaSCI aims to eliminate health disparities, achieve equitable health outcomes, and advocate for whole-person care and strong communities. We support Medicaid advancements that help break down barriers to quality care for low-income individuals.
Learn more about:
How CHaSCI breaks down barriers to care through policy change
How CHaSCI trainings can help build cultural competency on your team