Medicaid Coverage for Post-partum Women and Doulas - PowerPoint Presentation

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Medicaid Coverage for Post-partum Women and Doulas

September 2020 Learning Institute Maternal Health Topic Session

This session will explore how state Medicaid programs are extending post-partum Medicaid coverage to women beyond the standard 60-day coverage, and how state Medicaid programs are paying for the services of Doulas. There will be time for participants to share innovations going on in their own states and ask questions.

Learning Objectives

Understand traditional Medicaid policy for post-partum coverage for women covered via pregnancy eligibility

Learn how state Medicaid programs are extending post-partum coverage beyond 60 days

Learn how state Medicaid programs are paying for the services of Doulas

Understand the legal mechanisms (SPA, 1115 waiver, etc.) for making these changes at the state level

Agenda

Postpartum Medicaid Coverage

Overview of current policies

Options for extending postpartum coverage

Discussion

Medicaid Coverage for Doulas

Overview of current policies

Options for States

Discussion

Wrap up

Postpartum Medicaid

Current Policies

Traditionally, state Medicaid coverage for women eligible due to pregnancy ends 60 days after birth.

National focus on maternal mortality has led many states to extend coverage up to one year postpartum.

As of July 2020, 19 states have approved or are considering postpartum extensions, usually for one year

Three bills have been introduced in Congress to allow states to extend coverage as a permanent part of their Medicaid programs

H.R. 4996, placed on House Union Calendar 9/21/2020

NOTE: Coronavirus Families First Response Act requires continuous Medicaid coverage during the COVID emergency.

State Efforts to Extend Coverage

Options for States

1115 Waivers

Requires legislative action in some states

What most states are using

State Plan Amendment

Not available without a change in Medicaid law

Pending legislation in Congress

Medicaid Expansion

Eligibility may not be as broad as for traditional pregnant women eligibility group

Discussion

What has been going on in your state?

What has been working?

What challenges have you experienced?

For states that haven’t extended coverage, what questions do you have?

For states that have extended coverage, what advice do you have for other states?

ACOG Advocacy Resources

Policy Priorities: Extend Postpartum Medicaid Coverage

State Legislative and Regulatory Pathways

Postpartum Extension Q&A

Postpartum Extension Talking Points

Postpartum Medicaid Coverage Extended During COVID-19: Resources for Your Practice

Other Resources

Equitable Maternal Health Coalition (2020) Postpartum Medicaid Toolkits

Making the Case for Extending Medicaid Coverage Beyond 60 Days Postpartum: A Toolkit for State Advocates

Continuing Medicaid/CHIP Postpartum Coverage

Frequently Asked Questions: Continuing Medicaid/CHIP Postpartum Coverage

Doulas

Current Policies

Minnesota (SPA, 2014), Oregon (THC, 2011), and DC have had coverage for doulas in their Medicaid plans for several years.

Additional states are beginning to phase in coverage of doula services, several states with enacted legislation in 2019 and 15 states (MD, VA, AZ, TN, RI, WA, IL, CA, NJ, MA, LA, CT, NY, OH, NC) with bills or budget items relating to doulas in 2020.

Legislation also includes study committees and creation and/or changes to doula certification.

Options for States

Federal matching funds for Medicaid spending currently apply only to payments to licensed providers. States have the option to:

Add doulas to current licensing agencies

Use a State Plan Amendment to allow licensed professionals to bill on behalf of non-licensed professionals for services recommended by the licensed provider (MN)

Inclusion as a mandated preventive service, set qualifications, but allow doulas to bill under traditional health worker (OR)

Medicaid managed care options

“in lieu of” services that are medically appropriate & cost effective

“value-added” services not included in capitation rate (NE)

Medicaid value-based payment options/Medicaid waivers

Lessons Learned

Efforts for Medicaid coverage for doula care should proceed with direct guidance and input from practicing doulas. 

Workforce

Lack of centralized certification or credentialing requirements for doulas in the United States

Lack of diversity in the doula population as compared to the potential Medicaid patient population

Payment

Review of various options for coverage, including inclusion as a mandated preventive service, Medicaid managed care options, Medicaid value-based payment options, and Medicaid waivers

Billing & Reimbursement

Downsides of billing mechanisms that require doulas to seek reimbursement by working under a licensed Medicaid provider

Recommendations for alternative billing models, including recent implementation of direct doula billing in Oregon, and reimbursement to groups of doulas, such as doula collectives

Discussion

What has been going on in your state?

What has been working?

What challenges have you experienced?

For states that don’t cover Doulas, what questions do you have?

For states that do cover Doulas, what advice do you have for other states?

Resources

NASHP Report on Four State Strategies to Employ Doulas

Health Law Project on Doulas in Medicaid with State Legislative tracker

NASHP Doula ROI Infographic

Oregon's Doula Scope of Practice