Rhode Island passed legislation allowing insurance and Medicaid to cover doula services.

This legislation, introduced by Senator Ana B. Quezada, D-Providence, provides medical assistance health care for expectant mothers and establishes medical assistance coverage and reimbursement rates for perinatal doula services.

Under the bill that passed on May 4, services from trained, qualified doulas would be eligible for coverage through private insurance and Medicaid for up to $1,500 per pregnancy. 

In Rhode Island, there is a large disparity for severe maternal morbidity among non-Hispanic Black women (306 out of 10,000) compared to non-Hispanic white women (179.4 out of 10,000).

“There is no question that this bill will save lives and be good for women of color in Rhode Island,” Senator Quezada said, “but it also makes strong economic sense. Women who use doulas often require fewer expensive medical interventions during childbirth, which will save them, the hospitals and the insurance companies money and make the childbirth process much easier for all involved.”

Generations of structural racism have contributed to maternal mortality rates of U.S. Black mothers being three to four times higher than that of white mothers. These Black mothers are also two times more likely than white mothers to experience severe maternal morbidity or adverse pregnancy outcomes that result in long-term health consequences.

Because low-income pregnant, birthing and postpartum BIPOC (Black, Indigenous, People of Color) mothers comprise a disproportionate share of Medicaid enrolled, Medicaid is an important policy lever to reduce inequalities through the coverage of doula services. 

Doula care has proven to improve birth outcomes, reduce costs and improve maternal equity, but as of 2015 (the latest date available), only six percent of birthing mothers received doula care. This low rate is due to several reasons:

1. Lack of awareness of doula coverage among Medicaid beneficiaries, maternity care clinicians and health care delivery systems.
2. Mothers with relatively few sources are often unable to afford the cost of doula services. Costs for doula care often reach $1,500 per birth and in some places, such as New York City, up to $2000. As a result, doula care is often available only to affluent white mothers.
3. Doulas have difficulty becoming enrolled providers with the state’s Department of Human Services and with managed care organizations due to training, certification processes and availability of a diverse doula workforce varying state by state.

The Rhode Island doula bill, which would take effect July 1, 2022. It would set industry standards and create a statewide registry of doulas to assist women in connecting with qualified professionals, assuring that doulas are daily compensated for their work as well as addressing the lack of awareness, cost barriers, and geographical restrictions limiting doula care use, especially among BIPOC mothers.