New York State Medicaid Doula Services Benefit

The NYS enacted 2023-24 Executive Budget includes expanded Medicaid coverage of preventative care, including Statewide Medicaid coverage and higher reimbursement for doulas. The NYS Office of Health Insurance Programs will continue to engage doula stakeholders to implement the Medicaid doula services benefit.

Medicaid Members Looking for a Doula

The NYS Medicaid Doula Directory can be found here. The doula directory lists all of the doulas who are enrolled as NYS Medicaid fee-for-service providers and is updated regularly.

On and after 3/1/2024, in order to comply with federal requirements, Medicaid-enrolled members must obtain written recommendation for doula services.

Doula Stakeholder Meetings

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Recommendation for Doula Services

On and after 3/1/2024, in order to comply with federal requirements, Medicaid-enrolled members must obtain a written recommendation for doula services. This recommendation must be dated prior to the initiation of doula services. Doulas must maintain a copy of each recommendation in their records.

This recommendation can be completed using the form provided by the NYSDOH. It is not necessary to use the NYSDOH form as long as the NYS licensed practitioner's written recommendation for doula services includes the following:

• Medicaid Member's first and last name;
• Medicaid Member's date of birth;
• Licensed practitioner's first and last name;
• Licensed practitioner's license number;
• Date of recommendation; and
• Licensed practitioner's signature.

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Doula Services Statewide Enrollment Information

All enrollment support sessions are voluntary. If you have any questions, you can email doulapilot@health.ny.gov.

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Things Doulas Can Do to Prepare for NYS Medicaid Enrollment and Billing

Review the Information on the NYS Medicaid Doula Services Benefit Website:

• Attend an Enrollment Informational Session and/or review the previous sessions above.
• Sign up for an Enrollment Support 1:1 Session
• Review past Town Hall slide decks and recordings above, including the 2023 Virtual Town Hall Archive.

Ensure Doula Meets Enrollment Requirements:

• Review all requirements listed in Doula Enrollment Instructions (PDF)
• Choose a pathway for enrollment Training Pathway or Work Experience Pathway Requirements (PDF)
• Refer to the Doula Sample Practitioner Enrollment Form (PDF) when completing the Practitioner Enrollment Form.

Review Doula Services Benefit Policy Manual

• This manual contains all provider guidelines including enrollment, reimbursement, covered services, and billing codes: Doula Services Benefit Policy Manual

Subscribe to Medicaid Updates:

• All formal announcements, effective dates, and updates to the NYS Medicaid doula services will be published via Medicaid Updates.
• All NYS Medicaid doula services providers will be expected to follow updated guidance.
• To subscribe, email: medicaidupdate@health.ny.gov.

Review General Billing Guidance on eMedny.org, including

• Live trainings
• Recorded videos
• Additional Information and Resources

Ensure Applicant Meets Training Pathway or Work Experience Pathway Requirements (PDF)

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Provider Enrollment Feedback Sessions

On January 12 and January 17, 2024, NYS Medicaid hosted two one-hour, virtual sessions with 22 stakeholders who volunteered to provide feedback about the Medicaid enrollment process for doulas. Stakeholders provided their perspectives about strengths, weaknesses, and suggestions for the Erie County doula pilot enrollment materials and draft provider enrollment materials for the upcoming statewide benefit for doula services. NYS Medicaid thanks all participants for their time and feedback to improve the enrollment process.

A summary of the feedback can be found in the table below.

Date	Time	Registration Link	Slide Deck	Summary
Friday, January 12, 2024	1:00pm-2:00pm	Concluded	PDF	PDF
Wednesday, January 17, 2024	12:00pm-1:00pm	Concluded	PDF	PDF

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Doula Services Statewide Implementation Updates

The State Plan Amendment (SPA) for NYS Medicaid Doula Services was submitted for federal approval on December 28, 2023, and approved March 25, 2024. There are two ways to view the SPA:

1. Visit the Proposed and Approved State Plan Amendments website.
   • Open the year 2024
   • Click 'Non-Institutional Services'
   • Find SPA 24-03, Doula Services, and click the link under the column "Original Submission"
2. Link to SPA 24-03

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The Federal Public Notice (FPN) for doula services was published in the NYS Register as of December 13, 2023. The FPN allows for formal public comment on the proposed NYS Medicaid doula services benefit from the FPN publication date, December 13, 2023, until federal approval. The public comment period is now closed. There are three ways to view the FPN:

1. Link to the Dec 13, 2023, NYS Register (page 79 of the document, page 85 of the PDF).
2. Visit the State Register website.
   • The doula services FPN can be found in the issue labeled "December 13, 2023/Vol. XLV, Issue 50.".
   • To review issues, scroll down to the bottom of the State Register website and use the search function.
3. View the PDF of the Dec 13, 2023, NYS Register (page 79 of the document, page 85 of the PDF).

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Doula Services Benefit Frequently Asked Questions

• Updated FAQ coming soon.

FAQ Archive

• December 2023

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Doula Pilot Program

On April 23, 2018, New York State announced a comprehensive initiative to target maternal mortality and reduce racial disparities in health outcomes. This initiative included a pilot program to provide Medicaid coverage for doula services to pregnant and postpartum people. A doula, also known as a birth companion, birth coach, or post-birth supporter, is a non-medical person who provides physical, emotional, and informational support to pregnant people before, during, and after delivery. Doulas receive training from either a national organization or a community-based organization, and these trainings vary in content, requirements, and duration. There are no universally accepted standards for doula certification and doulas are not licensed. Doulas do not prescribe treatment, complete a physical or behavioral health assessment, or provide medical care or advice.

Starting on March 1, 2019, pregnant people who were enrolled in Medicaid and living in Erie County were eligible to enroll in the New York State Doula Pilot Program. The pilot was initially established for a two-year period and was extended. Reimbursement for doula services continued through February 29, 2024, and doulas were able to enroll in the pilot through February 28, 2023.

All doulas who are currently enrolled in New York State Medicaid via the Doula Services Pilot will remain enrolled through February 28, 2025. To revalidate on or before February 28, 2025, doulas who are currently enrolled in New York State Medicaid via the Doula Services Pilot will need to follow updated revalidation requirements according to statewide guidelines.

As of April 9, 2024, 1,117 people enrolled in one of six different Medicaid Managed Care Plans or Medicaid Fee-for-Service participated in the pilot program.The pilot covered up to four visits with the doula before delivery, up to four visits with the doula after delivery, and doula support during labor and delivery. To date, approximately 81% of claims were for prenatal visits, 6% were for labor and delivery support, and 13% were for postpartum visits.

Participating people were all sent a survey to assess satisfaction and experience with the pilot. To date, 94% of respondents said having a doula improved or somewhat improved their childbirth experience and 92% of respondents rated their doula as good or excellent.

A report has been published sharing findings from focus groups conducted with pilot doulas and pilot doula clients. The September 2023 report can be accessed here: Findings from Focus Groups of Doulas and Clients in Buffalo (PDF)

Information about the NYS Doula Pilot Program has been archived and can be found here.

To receive updates on the Medicaid doula services benefit, email doulapilot@health.ny.gov.

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Para ver esta información en español, visite Doula Services en español.