Help Shape the Future of Doula Care in NH

In 2023, New Hampshire took an important step toward making doula care more accessible to families when a bipartisan group of legislators passed Medicaid coverage for doula services through MOMnibus 1.0. Now, the state is proposing rules and reimbursement rates (what doulas would be paid) for that coverage, and we need your help!

So, what exactly is a doula and why does doula care matter?

Doulas are trained professionals who provide physical, emotional, and educational support during pregnancy, childbirth, and the postpartum period. They help families prepare for birth, understand their options, navigate labor, get breastfeeding support, and adjust to life after birth. Doulas also provide important support for families experiencing pregnancy loss.

And research shows that doula care makes a difference! Studies have linked doula support to lower rates of C-sections, more positive birth experiences, and better postpartum care.

But for many families, the cost of doula care puts that support out of reach. Medicaid coverage could change that, but only if the rules work for both families and doulas. Among other challenges, the proposed rates are extremely low, both compared to what doulas are paid generally in New Hampshire and compared to what other state Medicaid programs pay doulas. If reimbursement rates are too low or families have to jump through too many hoops to get care, this benefit won't live up to its promise.

The New Hampshire Department of Health and Human Services (DHHS) is accepting public comments on their proposed doula services rule through Wednesday, November 18th, and they need to hear from you!

Alongside our partners Reproductive Equity Now, NH Women’s Foundation and New Futures, we’ve drafted a comment highlighting some of our concerns, including fair pay for doulas, flexibility in how families receive care, and removing barriers that could make these services harder to access. You can submit it as written, but we encourage you to edit it and make it your own! Whether you're a doula, a parent, or someone who cares about maternal health, your experiences and perspective matter.

Dear Administrator Raadmae, I'm writing to share my feedback on the proposed rules for Medicaid doula coverage (He-W 545). I'm glad New Hampshire is moving forward with this important benefit, but I want to make sure the final rules work for both the families who need doula care and the doulas providing it. Doulas play an important role in supporting families during pregnancy, childbirth, and the postpartum period. But Medicaid coverage only makes a difference if families can actually find doulas who accept the rate Medicaid pays. The proposed rule sets the reimbursement limit to $500, drastically lower than the average state Medicaid reimbursement rate of $1,500. Reimbursement rates need to reflect the time, training, and work that goes into providing doula care, including support during labor and delivery. If rates are too low, doulas may not be able to afford to participate, leaving families with no actual option for doulas. I urge DHHS to establish fair reimbursement rates, be transparent about how those rates are determined, and work directly with doulas to make sure they're realistic. I'm also concerned about the limits on how much care families can receive and the requirements for how those hours are used. The proposed rule limits prenatal and postpartum services to eight hours combined, among the lowest limits of any state’s Medicaid doula benefit. Every pregnancy and birth experience is different. Some families may need more support during pregnancy, while others may need more help after giving birth or experiencing pregnancy loss. I encourage DHHS to adopt a flexible model that allows families to receive care based on their individual needs, with higher limits for hours of care that compare with other states’ upper limits. I also encourage DHHS to make it as easy as possible for families to access doula services. Families should be able to seek out doula care without having to first obtain a recommendation from a health care provider. Doulas also need clear information and support to navigate certification, Medicaid enrollment, and billing requirements. These processes shouldn't discourage doulas from participating or prevent families from getting the care they need. Families enrolled in Medicaid managed care plans should also have the same opportunity to access these services. I’m proud that New Hampshire has made a commitment to expanding access to doula care, and I hope DHHS will consider this feedback as it finalizes the rule so this benefit can reach the families who need it most.

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