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Addressing Maternal Health Disparities: Doula Access in Medicaid

September 2022
Full report

Women using doulas in Medicaid have fewer inpatient hospital admissions during pregnancy, are more likely to attend their postnatal visit, experience lower odds of cesarean delivery, have lower odds of postpartum depression or anxiety, and have lower overall costs compared to women not using doulas.

Several states reimburse for doula services for pregnant women enrolled in Medicaid. Doulas provide person-centered care to pregnant and postpartum women through information, education, and physical, social, and emotional support. Elevance Health examined the use of and outcomes from doula services offered by Elevance Health’s affiliated Medicaid managed care plans in three states: California, Florida, and New York.

The findings from this analysis suggest that doulas offer a personalized and effective approach for improving delivery of culturally competent maternal health care and mitigating birth inequities. State Medicaid programs should continue to consider reimbursing for doula services as part of their overall maternal health strategies.


  • The Role of Doulas
  • State Medicaid Programs’ Doula Models
  • Analysis and Results
  • Policy Options and Considerations

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Doula Access Through Medicaid Managed Care Improves Maternal Health

Doulas serve as an effective strategy to address disparities in maternal health. This evaluation provides evidence that women with doula care experience reduced risk of maternal morbidity, compared to women without doula care.

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Timely enrollment in Medicaid managed care is crucial for individuals who are pregnant, allowing them to access prenatal care earlier in their pregnancy. Timely enrollment can also lead to improved birth outcomes and lower infant birth costs.

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