As of April 2026, over half of U.S. states, along with Washington, D.C., provide Medicaid coverage for doula care. 27 states and D.C. currently offer coverage, while seven additional states (Arkansas, Maine, Montana, Nebraska, New Hampshire, Tennessee, and Vermont) are in the process of implementing programs.
Under these policies, Medicaid enrollees can receive coverage for doula services, while certified doulas are reimbursed for prenatal and postpartum visits, as well as labor and delivery attendance.
The expansion comes as the United States continues to face a maternal health crisis. The U.S. has the highest maternal mortality rate among comparable high-income countries, with 18.4 maternal deaths per 100,000 live births. The rate is significantly higher for Black women, who experience 50.3 maternal deaths per 100,000 live births.
In response to these disparities, many Black and Indigenous communities have long relied on doula care as a source of support throughout pregnancy, childbirth, and the postpartum period. However, doula services have historically not been covered by Medicaid or private insurance, limiting access for many low-income families.
Doulas are trained, non-clinical professionals who provide physical, emotional, and educational support during pregnancy, birth, and postpartum recovery. The expansion of state doula coverage through Medicaid marks a valuable enhancement of the perinatal health workforce that promotes evidence-based education, connections to resources, and support during delivery.
Oregon became the first state to explore Medicaid coverage for doulas, when it enacted H.B. 3311 inJune 2011. Minnesota followed in 2013, with the passage of SF 699. Since then, momentum has steadily grown across the country.
Implementation varies by state. In Virginia, for example, doulas must first become certified through the Virginia Certification Board, register as network providers, enroll in Medicaid, and complete 60 hours of training before providing services.
Despite growing support for Medicaid-funded doula care, challenges remain. Some doulas have called for “more awareness and outreach, and continuing to give evidence-based information on how doulas are actually beneficial throughout the pregnancy, birth, and postpartum periods.”
Awareness remains a significant barrier. In 2013, only 6% of women reported using doula services. While utilization has increased since then, many pregnant patients are still unaware that they may be eligible for Medicaid-covered doula care. Other challenges doulas have expressed with Medicaid coverage for their care include: a shortage of doulas in some regions, limited Medicaid reimbursements, and independent doulas wanting to be more involved in discussions with state Medicaid staff.
As more states expand Medicaid coverage for doula care, addressing these challenges will be critical to ensuring that patients can fully benefit from these services. Greater awareness, stronger support for the doula workforce, and more equitable implementation could help reduce maternal mortality rates and improve reproductive health outcomes, particularly for historically marginalized communities.