OPINION | Washington State Doulas Secure Highest Medicaid Reimbursement Rate in the Nation

by Megan Burbank

For six years, birth workers in Washington State have been fighting to make Medicaid coverage for doula support a reality. And in March, they secured a major victory when the Legislature signed off on a reimbursement rate for doulas that will be the nation's highest. With a push from Sen. T'wina Nobles (D-28), lawmakers also approved a $100,000 budget allocation to create a "doula hub" that will help doulas work within Medicaid's billing system and provide referrals for families on Medicaid.

The work was led by Doulas 4 All (D4A), a Queer, Trans, Black, Indigenous, and People of Color—led birth doula coalition, with support from Surge Reproductive Justice (SRJ). Since the coalition's first victory at the Legislature establishing birth doulas as a profession in 2022, it's been working steadily to set up the systems and policies to make Medicaid reimbursement successful, setting credentialing requirements with the Department of Health last summer — and making sure the new system would be inclusive of ancestral birth work practices among Black people, Indigenous people, and Communities of Color.

"We develop the leadership skills of our community to analyze the power dynamics, anti-Blackness and anti-Indigeneity that exists in the policy and legislative process, so that we could build our own process rooted in dismantling those power dynamics while advocating for our policy," said SRJ Executive Director Jackie Vaughn in a news release announcing the reimbursement rate.

When the new policy goes into effect, birth doulas in Washington will be able to claim up to $3,500 for their services, the highest rate in the country. The rate and success of SRJ's budget requests is a historic win for birth workers, but it's also a powerful example of what can happen when policy is crafted in community and embodies the expansive values of reproductive justice, focused on making reproductive health care services more broadly available rather than just preserving the bare minimum access to them. SRJ describes its process as "'community directed policy,' a strategy that

is at the center of all Surge's policy advocacy efforts."

The D4A coalition's work draws on community feedback and an effort to center independent queer, trans, Black, and Indigenous doulas of color, and to present expanded access to doulas as a way of ameliorating poor perinatal health outcomes rooted in systemic inequality. "Many birth workers believe having access to culturally congruent care will be key in efforts to end the Black & Indigenous perinatal health crisis as access to doulas has been proven to lower anxiety, reduce the rate of surgical birth (cesarean birth, or C-section) and other medical interventions as well as create healthier birth outcomes," said SRJ in its news release.

Next up, D4A will go through a rulemaking process with the state Health Care Authority and submit a state plan amendment to the federal Medicaid program later this year, proposing the changes to the service. Washington birth doulas could be able to submit reimbursement claims as soon as January of next year.

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Featured image via Ken Tackett/Shutterstock.com.