A Survey of Birth Doulas: Medicaid Reimbursement in Washington State

Abstract

Abstract A Survey of Birth Doulas: Medicaid Reimbursement in Washington State Ashley Nguyen Chair of the Supervisory Committee: Anne Turner Health Services Background: In an effort to expand access to doulas and improve birth outcomes, Oregon and Minnesota reimburse doulas through Medicaid. Washington State intends to design and implement a similar policy. The purpose of this study is to gather information from birth doulas about the demographics of the birth doula workforce in Washington State; understand how the state could structure Medicaid reimbursement to best support birth doulas and the low-income population; and to explore how birth doulas serve their clients and how they are compensated. Methods: This is a descriptive study based on a survey administered from November 11, 2019 to January 1, 2020 to birth doulas who provide services in Washington State. The researcher used convenience sampling to administer the web-based survey to the target population. Eligible survey respondents were active birth doulas in Washington State ages 18 and older who could read and write in English. Study data were collected and managed using REDCap electronic data capture tools. For all categorical and continuous variables, the researcher conducted an exploratory descriptive data analysis using R statistical software. All qualitative responses were coded using Dedoose Version 8.0.35. Results: There were 221 responses to the survey; 201 were included in the analysis. The birth doula workforce in Washington State is primarily female and between the ages of 21 and 59. Respondents identified as White only (67.4%), multiracial or multiethnic (11.8%), Black or African American only (7.6%), Hispanic, Latino, or Spanish only (4.2%), and African only (3.5%). A majority of birth doulas work in King, Pierce, and Snohomish counties, and less than 15% have worked with tribes or tribal nations. Almost 97% of respondents received formal training to become a doula, and 41.1% have obtained certification. If the Washington State Health Care Authority (HCA) asked respondents to provide 2 antepartum visits, labor support, and 2 postpartum visits, respondents indicated that, on average, they would be willing to work with 18 clients per year at the Medicaid reimbursement rate of $852.65 per birth. Overall, respondents said that Medicaid reimbursement for birth doulas will increase access to doula services. They identified insufficient reimbursement rates, certification and training requirements, and accessibility and affordability as barriers to Medicaid reimbursement for birth doulas. Conclusion: The results of this survey indicate that there is strong support for implementing a Medicaid reimbursement program for birth doulas in Washington State. However, respondents reported a range of potential barriers. The HCA should design a Medicaid reimbursement program alongside doula organizations, including community-based doula programs, to ensure workforce support.