Implementation of Medicaid Coverage of Doula Services: A Qualitative Study of Medicaid and Public Health Stakeholders
Statement of Problem
Morbidity and mortality of birthing people during a birth and in the vulnerable period after it remains a public health crisis in the United States. Black birthing people are significantly more likely than white birthing people to die from pregnancy-related causes and experience a preterm birth. Social drivers of health contribute to these disparities, and many minoritized and low-income birthing people report poor communication and negative pregnancy experiences.
Research shows that doulas—trained professionals who provide continuous one-on-one emotional, informational, and physical support during the perinatal period—are associated with improved outcomes, including reduced cesarean rates, preterm births and postpartum complications.
Recognizing these benefits, a growing number of states have passed Medicaid coverage for doula services policies to expand access and advance equity. However, there is no standardized approach to implementing Medicaid covered doula services and there is limited uptake of these services in the states that have implemented the benefit. Research has not examined the perspectives of Medicaid and public health officials involved in policy rollout.
Description
Evaluating state implementation processes of Medicaid coverage of doula services may allow for better understanding of how this policy could have greater impact.
Through a qualitative study using one-on-one interviews and community-informed interview questions, our team will evaluate the experiences Medicaid and public health officials have with implementing doula benefits in their state Medicaid program.
We will evaluate:
1. how strategies for implementation changed over time
2. barriers encountered and methods of troubleshooting
3. plans for program evaluation throughout implementation
The perspectives of community-based doulas will help to guide this evaluation. Additionally, through these interviews, our team will define key stakeholders in implementation and their role in implementation.
Next Steps
This project has the unique opportunity to contribute to the ongoing implementation of doula services in state Medicaid programs. Through this work, the team aims to identify best implementation practices for Medicaid covered doula services and measurable goals that can be used to assess progress and impact.
This page was last updated in March 2026.
Suggested Citation
Children's Hospital of Philadelphia, PolicyLab. Implementation of Medicaid Coverage of Doula Services: A Qualitative Study of Medicaid and Public Health Stakeholders [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].