# Doula services for Medicaid beneficiaries in Virginia: access, utilization, and policy lessons

## TL;DR

This study examines how Virginia's Medicaid policy on doula services is working, finding low usage and offering policy suggestions to improve access.

## Contribution

The study provides new insights and policy recommendations for improving Medicaid doula service access and utilization in Virginia.

## Key findings

- Fewer than half of certified doulas in Virginia billed Medicaid, with most providing postpartum care.
- Doula service utilization among Medicaid beneficiaries was less than 1% from 2022 to 2024.
- Geographic disparities exist, with limited doula availability in high-need areas.

## Abstract

Doula support improves maternal health outcomes. States have increasingly included doula services as a covered benefit under Medicaid. We evaluated the implementation of Virginia's Medicaid doula policy and identified lessons to improve access and utilization.

This mixed-methods study used administrative data (Medicaid claims data from January 2022-December 2024 and state-certified doula registry data) and qualitative interviews with 9 doula Medicaid providers to understand the barriers and facilitators to doula care among Medicaid beneficiaries in Virginia.

At the time of the study, there were 130 state-certified doula Medicaid providers in Virginia, but fewer than half billed Medicaid for services, most commonly billing for postpartum care. Additionally, utilization of doula services among beneficiaries was low (less than 1%) from 2022 to 2024. Geographic disparities showed limited doula availability in some high-need areas. Five policy lessons emerged.

State Medicaid programs can strengthen doula policy implementation, and in turn strengthen the doula workforce and expand access to doula care for Medicaid beneficiaries, by revising reimbursement rates and structure to better reflect the scope of doula services, recruiting doulas in underserved areas, providing technical assistance for enrollment and billing, expanding outreach to beneficiaries, and engaging a range of doulas in policy discussions.

Doula care can advance maternal health for high-risk groups. As states expand Medicaid coverage for doula care, Virginia's experience offers important lessons. Drawing on Virginia's first three years of Medicaid doula coverage and the perspective of doulas themselves, this study uncovers workforce challenges, geographic disparities, and key policy recommendations to expand access and strengthen the doula model of care.