The Michigan Department of Health and Human Services (MDHHS) will reimburse for doula services provided to individuals covered by Medicaid beginning Jan. 1, 2023. Doula providers are required to be registered and approved on the MDHHS Doula Registry and enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) as a Medicaid provider. Doulas should contact the Medicaid health plan (MHP) prior to providing services to MHP enrollees, as doulas must be contracted with the MHP or receive approval to provide out-of-network services.
Doulas must be at least 18 years old and possess a high school diploma or equivalent credentials. The MDHHS will certify doulas who have completed training provided by an MDHHS-approved training program or organization.
Additional resources include:
Additional information and resources can be found on the MDHHS Doula Initiative website. The CHAMPS provider enrollment process and resources can be found on the Provider Enrollment website.
Members with questions should contact Vickie Kunz at the MHA.
The Michigan Department of Health and Human Services recently released a second proposed policy to establish coverage for doula services effective Jan. 1, 2023. The MHA supports this proposal and agrees with the MDHHS statement that the policy will improve birth outcomes, address social determinants of health and decrease health and racial disparities for Medicaid beneficiaries. Changes from the previous proposal include:
- Specifying a per visit payment rate of $75 for prenatal and postnatal visits which must be at least 20 minutes in duration.
- Allowing prenatal and postnatal services to be provided via telehealth without documenting barriers to in-person services.
- Covering a maximum of six visits as initially proposed with potential coverage of additional visits through prior authorization.
- Increasing the payment rate for the labor and delivery visit from $350 to $700.
- Clarifying that services will be reimbursed through the MDHHS for Medicaid fee-for-service beneficiaries and the Medicaid Health Plans (MHPs) for beneficiaries enrolled in an MHP.
- Clarifying that Medicaid covers childbirth education and lactation support and counseling separately from doula services.
The initial list of training programs within the proposed policy was compiled during policy development with the assistance of doulas. The MDHHS will continue to review doula training programs, including those created for specific populations such as community-based doula programs, to support cultural and community needs. The MDHHS will also continue to research pathways for legacy certification, or certification of doulas by providing proof of experience in lieu of training, within the confines of state and federal regulations. Opportunities to assist doula providers in navigating the Medicaid program is also being explored.
The MDHHS welcomes feedback will accept comments until Nov. 1. Members with questions should contact Vickie Kunz at the MHA.
The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy for Medicaid coverage of doula services effective Oct. 1, 2022, contingent upon approval by the Centers for Medicare & Medicaid Services. The MHA supports this proposal and agrees with the MDHHS statement that the policy would improve birth outcomes, address social determinants of health, and decrease health and racial disparities for Medicaid beneficiaries.
A doula is a nonclinical person who typically provides physical, emotional and educational support services to pregnant women during the prenatal, labor and delivery, and postpartum periods. Doulas must have a current certification by a doula training program or organization approved by the MDHHS and provide it upon request. They must complete an online application in the Community Health Automated Processing System and enroll with an Individual National Provider Identifier as either a Rendering/Servicing-Only or Individual/Sole Provider to be a Medicaid-enrolled provider.
Under the proposed policy, Medicaid would cover various types of doula services, including community-based, prenatal, labor and delivery, and postpartum services when recommended by a licensed healthcare provider. Doula services are expected to be in-person, with prenatal and postpartum services available via telehealth when there is a barrier to in-person services. Covered services would include a maximum of six total visits during the prenatal and postpartum periods and one visit for labor and delivery. All prenatal and postpartum visits would need to be at least 20 minutes to be eligible for reimbursement. The proposed payment rate is $75 per visit for prenatal and postnatal visits and $350 for attendance at labor and delivery.
Comments are due to the MDHHS June 4. Members with questions should contact Vickie Kunz at the MHA.