Though doulas are now covered by Medi-Cal, barriers exist

New research from Dr. Cassondra Marshall predicts stumbling blocks to access

Most insurance plans require pregnant women to pay out-of-pocket for doulas, trained professionals who provide emotional and physical support to women during and after pregnancy. That has made hiring a doula affordable only for the wealthy, and not for the millions of low-income Americans across the country who rely on Medicaid to pay for their medical treatment, including giving birth.

However, this may change in California now that the state’s Department of Health Care Services added doula services as a covered benefit under Medi-Cal earlier this year.

Doulas are beneficial in numerous ways, helping women navigate pregnancy by providing physical, emotional, and informational support for their clients. A 2022 research project led by Dr. Cassondra Marshall found that community doulas who work in low-income communities are vital to filling knowledge gaps between clients and their clinicians by helping them understand the information they receive from medical professionals.

An assistant professor in the maternal, child, and adolescent health program, Dr. Marshall studies health services with a focus on policy interventions that advance reproductive and maternal health equity. This includes measuring racial and socioeconomic disparities in diabetes treatment and government assistance programs such as WIC (Special Supplemental Nutrition Program for Women, Infants, and Children). Little research has looked at the obstacles pregnant women still face accessing services through the Medi-Cal doula benefit rollout. Marshall hopes her current research will remedy that.

In Dr. Marshall’s preliminary findings of interviews conducted with healthcare providers between 2021 and 2022, several months prior to the program’s rollout, results confirmed that there are a number of barriers to mass adoption of doula services, ranging from bureaucracy to cultural preferences as well as the lower fees doulas are able to collect through Medi-Cal. In addition, healthcare services that organize coverage for Medi-Cal beneficiaries may be unaware of the savings and benefits doulas can provide and, consequently, deprioritize their services.

Because the interviews were conducted before the rollout, Marshall’s research is a prediction of what hurdles healthcare providers should expect. “I describe this work as being at the cusp of implementation,” Marshall said.

“What’s nice about doing this at the pre-implementation phase is that there is potential for our findings to help contribute to the successful implementation of the benefit,” she continued. There’s evidence that doulas create a host of positive outcomes for pregnant women, according to Marshall, yet “doula care is inaccessible to many who desire and need this type of support.”

Interviewees in the study believed that lack of public knowledge about the Medi-Cal benefit and reluctance from hospital administrators to work with doulas as potential obstacles to closing the accessibility gap. Building relationships with doula care providers and the communities that need them most – particularly those of lower socioeconomic status – were suggested remedies by study participants.

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