New York is one of many states leading the expansion of doula care services under Medicaid. In response to high maternal health care spending and poor maternal health outcomes, New York launched a pilot doula program in 2024. The results showed high client uptake. Nearly all participants reported that their doula contributed to an improved birth experience, a higher rate of vaginal births, and more culturally competent care — especially for non-English-speaking clients. In 2024, New York expanded doula Medicaid coverage statewide. Twenty-seven states and Washington, D.C. now cover some doula care, though coverage varies widely by state. 

Though Medicaid doula coverage has proven effective, early reviews of state doula programs suggest that the reimbursement rate caps are too low, and the administrative burden on doulas is too high. In New York, doula advocacy groups asked for a higher reimbursement rate than the state ultimately granted. Doulas reported rigid visit structures, payment delays, and claim problems. To me, the reimbursement rate demonstrates what the state believes the work is worth. Some doulas opt out of working with Medicaid because the rate is too low to sustain their business; others, particularly in rural areas with fewer alternatives, have little choice but to accept it.

Medicaid coverage of doula care is a step in the right direction and is likely to continue to reduce maternal mortality rates and birthing expenses. But states need to pay providers enough to keep experienced doulas in the field and avoid pushing them toward burnout through larger caseloads to make ends meet. Medicaid’s investment in doula care is still new. Building policy that works will mean listening to both the families utilizing support and the doulas who provide it. When I speak with doulas, I see the passion and care they bring to this work every day. Seeing that kind of dedication met with growing public investment makes me optimistic about where maternal health policy is headed.