Since Medi-Cal began covering doula services in 2023, many doulas have encountered significant difficulties securing timely and accurate reimbursements. These challenges have led to delayed payments or, in some cases, no payment at all. Advocates argue that these issues undermine the program's goal of addressing racial disparities in maternal health outcomes for Black and Brown mothers. Doulas are now calling for clearer guidelines and better support from Medi-Cal managed care plans to ensure they receive proper compensation for their vital work.
Two years after Medi-Cal introduced coverage for doula services, numerous doulas report facing persistent obstacles in obtaining reimbursement for their work. In a letter sent to California’s Department of Health Care Services (DHCS), doulas and advocacy groups highlighted ongoing issues with denied and delayed claims. The lack of timely payments has raised concerns about the sustainability of the program and its ability to provide continuous support to pregnant individuals who rely on Medi-Cal.
The introduction of doula services into Medi-Cal was intended to address critical gaps in reproductive care, particularly for marginalized communities. However, the implementation has been fraught with challenges. For instance, Tahira Ali, a doula serving Medi-Cal patients in South Los Angeles, expressed frustration over unpaid claims, which have forced her to rely on credit cards to cover living expenses. This situation is not unique; many doulas find themselves in financial distress due to delayed payments.
Michelle Brenhaug, a doula from the San Gabriel Valley, noted that navigating the billing process has been particularly difficult. She estimates that she has only been paid for less than 10% of the Medi-Cal services she provided since June. The complexities of medical billing and insurance have left many doulas struggling to understand how the system works, further exacerbating the delays in receiving payment.
Amy Chen, who leads the National Health Law Program’s Doula Medicaid Project, pointed out that integrating non-clinical services like doula care into the healthcare system presents unique challenges. While the work of doulas is crucial for emotional and physical support during pregnancy, it does not fit neatly into traditional medical frameworks. As a result, both state Medicaid agencies and health plans face difficulties in adapting to this new type of care.
Despite these challenges, some managed care plans, such as Kaiser Permanente, have committed to providing prompt and accurate reimbursement to doulas. However, the broader issue remains unresolved, leaving many doulas questioning whether they can continue to serve Medi-Cal patients without jeopardizing their financial stability.
Ultimately, the success of the Medi-Cal doula program hinges on resolving these reimbursement issues. Without timely and fair compensation, the workforce may dwindle, potentially depriving families of the reproductive care they deserve. Advocates emphasize that addressing these challenges is essential to ensuring that the program can achieve its goals of improving maternal health outcomes for all.