Earlier this year, the Michigan Department of Health and Human Services (MDHHS) officially began covering doulas through Medicaid. State Senator Erika Geiss (D – Taylor) and Kiddada Green, Founding Executive Director at Black Mothers’ Breastfeeding Association, shared their insights about Michigan’s newly enacted policy.
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State of Reform: What inspired you to compose your doula bill?
State Senator Erika Geiss: “Since I entered the legislature in 2015, I’ve been working on various ways to address the black maternal and black health crisis. The outcomes are staggering, particularly with black mothers and infants, which have a higher or have had a higher morbidity rate and lower survival rate, and I wanted to find policy solutions to improve and close those gaps between maternal health mothers of color to their white counterparts.
This is an issue that spans education level, income level, and socioeconomic status. So, we needed to find out what are the policy solutions that will improve the rates and the health of the black mothers and black infants.
I first introduced my bill in 2018, while I was still in the House. Then when I changed chambers, I introduced it again.”
SOR: What is the background information regarding this policy and how did MDHHS get this process initiated?
EG: “Whenever the department makes a change there’s an open comment period. The department initially published their first proposed policy change . . . for doulas. But after taking solicited input from the community, which they took seriously, the department extended the initial comment period so that they could address more issues from the doulas. My office and I made sure that the folks that we’ve been working with over the years were informed regarding this open comment period.
Other states were already doing this, and Michigan was planning on using New Jersey standards as they were the most recent state to utilize doula coverage. Only a handful of states had done it, but the doula utilization rate wasn’t as high as it could have been for a variety of reasons—most often related to the amounts that doulas were being reimbursed.
MDHHS worked with policy leaders, doulas, and the community of professionals about this issue. We had conversations with the department, and one of the things I insisted on was that they were listening to doulas. I am not a doula, I am a mom and I have two children, so when we are coming up with policy changes and legislation that is going to affect that community, we really need to talk with those folks and [be] seeking that input. Otherwise, this is just words on paper if it doesn’t do what it’s ideally supposed to do. Otherwise, it’s useless and it disappears.
We still have some issues with this policy, especially around reimbursement rates. But one of the things I think that’s critically different and significant is the creation of the Doula Advisory Council. So having doulas that are working in the space and who are centered in equity and justice informing the department on how this policy can evolve is going to be critical to making sure that the program meets the needs of the end users as well as the doulas as professionals in their space.”
Kiddada Green: “Because I am not an employee of MDHHS, I cannot say with specifics. However, I can say that Black Mothers’ Breastfeeding Association and others have been advocating for community-based doulas, which goes back to 2013.
We think this newly enacted policy is a step in the right direction, and we don’t believe Medicaid is an end all be all. Doulas are not happy about the reimbursement rate. We still have concerns with the rates, and we will advocate for these rates, and we will advocate for additional ways for funding. There are other models we are looking at like the Maternal Infant and Early Childhood Home Visiting Program. In that program they fund other maternal health initiatives, and doulas should be involved in that program.
There were several rounds of public comments from MDHHS, and the rates increased in the second round. However, doulas cannot make a living with this rate. There could be additional allowance with reimbursements. Overall, though, this policy is a step in the right direction, and with reports being issued through MDHHS, we can use this data to advocate for additional change.
I’m looking forward to seeing what the advisory council will do. Additionally, Michigan is currently hiring a doula specialist for Southeast Michigan. I think the commitment to hiring this person will help to serve future decision making. Consequently, it’s going to be a slow and steady process, and I want to build upon this.”
SOR: Now that this service is implemented, what are the next steps for this policy and how do you feel about the utilization regarding this initiative?
EG: “I am cautiously optimistic that this service will be utilized. Especially if more of the doulas register with the state and are able to utilize the reimbursements.
Along with the advice and feedback that the advisory council, [the members of] which have yet to be named, the better the programs will become.
This is just the beginning. We don’t have the data yet to determine how well it will work but I think that it will be positive because this will improve those outcomes for the very families that it’s to help and assist.”
These interviews were not taken together and edited for clarity and length.