Utah bill proposing Medicaid-covered birth doula services nears passage in the Senate


Maddie McCarthy


Senate Bill 85, sponsored by Sen. Luz Escamilla (D-Salt Lake County), unanimously passed its second reading during its hearing in the Utah Senate on Monday.

The bill, which passed in the Senate but not the House during last year’s legislative session, would require the Utah Department of Health and Human Services (DHHS) to apply for a Medicaid amendment that would allow for doula services to be covered by Medicaid. It would also establish training and registration requirements for doulas in the program.

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“It creates a mechanism so doulas could be reimbursed through Medicaid,” Escamilla said at the Senate Health and Human Services Committee hearing earlier this month. 

If the bill passes the legislature and becomes law, Utah will be on its way to join the 12 states and Washington DC that are all actively covering doula services through Medicaid. 

During Monday’s hearing, Escamilla discussed how having doulas available to people can lower the state’s maternal healthcare costs and improve maternal health outcomes.

“The annual healthcare cost in the US with preterm delivery is $26.2 billion, or $51,000 per infant. By using doulas, we are significantly preventing cesarean and preterm birth rates, and doula care was associated with a savings of $58.4 million. That is 3,800 fewer preterm births annually.”

— Escamilla

Most people do not use birth doulas. Those who do use them, however, are not only less likely to experience a cesarean delivery or preterm birth, but also less likely to experience postpartum depression or postpartum anxiety.

Kristi Ridd-Young, founder of the Utah Doula Association, spoke with State of Reform about how doulas can be of help to the people who need it. 

“Studies show that a doula reduces a lot of interventions by being present because they help parents understand how to use their own voice and how to advocate for their own choices,” Ridd-Young said. 

She also noted how doulas can help the partner become more involved in the birth, because often they are unsure of what to do or how to help, and they can be intimidated by the system. 

“When a doula is there, they can kind of guide the partner in knowing how to do the hands-on comfort measures right, and how to ask questions, and really be involved,” she said.

While birth doulas are different from postpartum doulas, the birth doula can be an asset to the mother after delivery. Ridd-Young said that usually, birth doulas perform two post-birth visits. They are also trained on signs of postpartum mental health disorders.

Postpartum doulas support the mother in a variety of ways after the birth. Ridd-Young made the distinction that postpartum doulas do not perform childcare, but they are there so the family can focus on taking care of themselves and the baby.

“The relationship is so strong that usually, if a mom is worried about what is going on, she’ll probably call her doula before she’ll call anybody else,” Ridd-Young said.

She also noted the affordability issues currently associated with doula services, as many services can be prohibitively expensive.

“Having been a doula for almost 40 years now, it has been, all of this time, still a middle class privilege. And most people can’t afford a doula.”

— Ridd-Young

She said Medicaid-covered doulas would expand access to people who traditionally wouldn’t be able to afford them. However, she also expressed concerns over compensation for Medicaid-covered doulas, because the compensation can be too low and requesting for reimbursement is a difficult process.

“To navigate the system of requesting reimbursement for Medicaid is a problem that I hear a lot of doulas struggle with,” she said.

Ridd-Young said she was happy to see that if the bill is passed and made law, DHHS would be working alongside doulas and other healthcare professionals involved in maternal health to develop the new state plan amendment.

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