California will cover doula services for low-income residents at more than twice the rate originally proposed by the state under a spending plan passed by lawmakers last week.
Some advocates welcomed the new benefit in Medi-Cal, the state health insurance program Medicaid, as a step towards professionalizing this group of non-medical births. They say better pay can encourage more people to become doulas. However, other defenders called it a partial victory, saying the rate was still too low for the time and work needed to ensure a healthy supply.
Dulas had initially criticized the state for offering one of the lowest rates in the nation, $ 450 per birth – so low that many said it would not be worth taking Medi-Cal patients. In response, the governor. Gavin Newsom increased his bid to $ 1,154 last month, far higher than in most other states.
For some, this will still not be enough in a state with a high cost of living with loads limited by the unpredictability and time-consuming nature of working with a muzzle. Many doulas can only serve two or three customers a month, as work often requires them to be on call.
“I’m not impressed,” said Samsara Morgan, a doula in Auckland who has worked in the field for more than 40 years. “It’s not a living wage for someone to do this job.”
In other states that offer Medicaid doula services, the price is usually between $ 770 and $ 900. Oregon joined Rhode Island this month in offering the highest price – $ 1,500 per birth.
Lawmakers in California adopted a budget on June 13. After the governor signs the new spending plan, Medi-Cal’s coverage for doula services will take effect in January 2023 and costs $ 10.8 million a year. California will pay around $ 4.2 millionand the rest will be taken over by the federal government.
“We recognize the value of the work that doulas provide to mothers and infants, in particular, the intensity of services and the length of time doulas spend,” the US Department of Health, which runs Medi-Cal, wrote in May. 13 emails to a group of doulas and researchers advising the department on the new benefit.
Dooley acts as a coach, guiding families during pregnancy and advocating for them in the hospital during childbirth and childbirth, as well as after childbirth. Doula’s services are associated with better birth resultssuch as lower caesarean section ratemore breastfeeding and fewer babies born underweight.
Doulas also serve women who have had abortions or miscarriages – something the Doula Advisory Group hopes the state will agree to cover in the future.
Still, it’s hard to know how many doulas work in California because the field is unregulated. Most of their work is for patients who pay out of pocket, up to $ 3,500, depending on the location and experience of the doula.
Defenders hope that adding doulas to Medi-Cal’s covered services could help reduce maternal mortality, especially for black mothers who die due to premature birth. almost three times that of white mothers.
During the negotiations, the doulas asked for up to $ 3,600 for each pregnancy and for maternal support for up to a year after birth. They asked for $ 1,000 to attend the birth and $ 100 for up to six prenatal sessions and 20 postpartum sessions.
According to the governor’s latest proposal, the state will pay $ 126.31 for the initial visit and $ 60.48 for up to eight subsequent shorter visits. Labor and delivery will be restored at $ 544.28. State or Medi-Cal insurers could approve additional visits.
The administration of Newsom determined the payment of the doula for labor and childbirth at the same rate as doctors and midwives. “This proposal recognizes that while doulas have less formal training than a licensed practitioner, doula services are different and usually last significantly longer than a visit or event of birth with a licensed practitioner,” the state wrote in an email on May 13. , the authenticity of which has been confirmed by KHN.
Dullas could negotiate a flat rate with the administration, but he believed that charging for each visit would be fairer for workers, said Anu Manchicanti Gomez, an associate professor at the University of California, Berkeley School of Social Welfare who studies doula programs in California. The downside, however, is that some doulas may not win the full rate if their clients do not use all of their scheduled visits before or after birth.
“Because the percentage of perinatal visits is so low, it doesn’t make a huge difference in terms of government spending overall,” Gomez said. “But $ 900 against. $ 1,100 could be extremely important for a doula. ”
Although the recovery rate is lower than the doula’s demands, some said it was still progress. Kefri Riley, a Los Angeles doula who helped negotiate the new prices, said the introduction of doubles services at Medi-Cal could pave the way for new births to enter the profession. “The needle has shifted slightly,” Riley said.
Others said the new rate was more acceptable, but figures were still tight for doulas. Chantel Runnels serves customers in the Inner Empire and can drive more than 100 miles of round-trip travel for patients. With gas prices above $ 6 a gallon, Runales said, “everyone feels the tension.”
Some doulas point to local government and private insurance programs that pay even more. One pilot program for a doula in Los Angeles pays up to $ 2,300 per birth, and one in Riverside pays up to $ 1,250.
“We live in one of the most expensive states, and I think there are a lot of profits in auditing that reflect that they listen to the nature of working with a doula,” Runels said. “There’s still a lot of room for improvement.”
Governments will often find out what makes sense by checking tariffs in other states. California looked at Oregon, which offered $ 350 for the birth. But that percentage was so low that few doulas were willing to accept Medicaid patients.
Then, on June 8, announced Oregon will start paying the doula $ 1,500 for childbirth. Reiben Nolan, vice president of the Oregon Doula Association, said the increase was the result of seven or eight years of lobbying.
Nolan said California was initially competing with Oregon to the bottom with its first offer. Now she is applauding California’s turn.
“I like that they have so many paid visits,” Nolan said. “I think that’s really good.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs in KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on the nation’s health issues.
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