COMMUNITY-BASED DOULAS
WHAT ARE COMMUNITY-BASED DOULAS AND WHY ARE THEY IMPORTANT?
Community-based doulas are trained social service professionals who provide non-clinical emotional, physical, and informational support to expectant parents, starting during pregnancy and continuing throughout the postpartum period. Community-based doulas specialize in culturally competent care that reflects the values and lived experiences of their clients, working in tandem with doctors, nurses, and midwives to provide care throughout the perinatal period.1 Doulas support their clients by providing childbirth education, helping them navigate the health care system, advocating for them throughout the perinatal period, and connecting them with community resources.
Support During the Perinatal Period Improves Wellbeing
Community-based doulas act as a buffer to decrease the influence of stressors during pregnancy, birth, and early parenthood by providing information to clients, helping to navigate complex health care systems, and acting as advocates for the wellbeing and wishes of clients.
Information provided to expectant parents includes risk factors and warning signs for issues that affect maternal and infant health outcomes. Community-based doulas teach expectant parents about monitoring a fetus’s movements in utero, sleeping patterns, and positions. They also provide information after delivery by modeling developmentally appropriate behaviors such as responding to an infant’s cues and emotional needs.2 Parenting and child development education provided by doulas can also help foster nurturing parent-child relationships and increase safe feeding practices for infants.
Community-Based Doulas Provide Unique Care
Community-based doulas go beyond the scope of care given by physicians to help their clients navigate complex health care systems and social service providers. Traditional healthcare providers spend an average of 5.75 hours with patients.3 In comparison, community-based doulas are on call 24/7 for their clients and spend an average of 76 hours with each client throughout their perinatal journey.4
This aid can start as early as initial contact in the prenatal period and expand into the postpartum period to help parents provide thriving environments for their children.5 Connections to community resources can mitigate social drivers of health, such as a lack of health literacy or social support issues that are the root cause of health disparities and negative outcomes.6
Community-Based Doulas Can Improve the Birthing Experience as Client Advocates
Community-based doulas act as advocates for their clients and affirm the client’s experience. For example, a community-based doula can recognize and affirm the pain or concern clients feel as they go through the perinatal period and ensure those concerns are taken seriously by medical staff.7 This support is vital for Black expectant parents who are marginalized by the traditional healthcare system and have an increased chance of complications due to racial bias.8
Expectant parents who have a doula acting as an advocate during labor and delivery experience less stress, and are less likely to experience medical interventions, such as cesarean deliveries and labor induction, and have a lower risk of the associated adverse birth outcomes.9,10
Culturally Competent Care Is Critical to Address Disparities
Community-based doulas incorporate reproductive justice and birth justice frameworks and use strategies to address structural racism, intergenerational trauma, and implicit bias. Doulas have served their communities during the perinatal period for centuries, but recently, support of community-based doula care has become a popular policy option for states in response to the recognition of discrimination experienced by people of color in healthcare systems, and the resulting disparities in birth outcomes by race and ethnicity.11 The culturally competent care provided by community-based doulas can be one element of a larger comprehensive system of care that reduces maternal and infant health disparities.12
Community-Based Doula Care Can Be Cost-Effective
Limited research suggests community-based doulas may help states save money in the long run. One study of community-based doulas covered by a Medicaid managed care organization in Minnesota showed that the potential cost savings of decreased preterm birth and cesarean deliveries caused by doula care averaged $986 per patient, and total predicted savings were estimated at $58.4 million each year.13
A simulated cost analysis that compared data from Medicaid births without doula support nationwide and Medicaid births with doula support in Minnesota found that states could save at least $2 million a year due to avoided cesarean deliveries.14 Furthermore, a nationwide cost-benefit analysis determined that the estimated decreases in preterm birth caused by doula care can result in $1.6 billion in annual savings.15
Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on community-based doulas.
WHAT IMPACT DO COMMUNITY-BASED DOULAS HAVE AND FOR WHOM?
Strong causal evidence of community-based doula programs has demonstrated that doula support increases attendance at medical appointments and education classes, encourages responsive parenting behaviors, and enhances child health and developmental outcomes such as breastfeeding initiation rates and safe sleep practices. Additionally, there is evidence that participation in community-based doula programs improves important birth outcomes including preterm birth, low birthweight, and neonatal intensive care unit visits.
More Research Is Needed to Determine the Potential of Community-Based Doulas to Reduce Racial and Ethnic Disparities
Because community-based doulas are specifically trained for culturally sensitive care and to focus on expectant parents who are more likely to experience discrimination and racism in traditional healthcare settings, evidence suggests that the involvement of a community-based doula may decrease disparities in birth outcomes for mothers and infants. Rigorous research on community-based doulas demonstrates beneficial impacts on diverse groups of parents, including mostly people of color, but to date, no strong causal studies directly test for differences by racial and ethnic groups, making it impossible to draw conclusions about whether parents of color benefit at the same or different levels as White parents.
Additionally, studies on other types of birth doulas do not use representative samples and consist mostly of White women. Although there are some rigorous studies showing mixed results, the evidence from these studies is not conclusive regarding the benefits of lay and other birth doulas for diverse populations.
Future research must focus on examining the differential impacts of community-based doulas by race and ethnicity, and socioeconomic status.
For more information on what we know and what we still need to learn about community-based doulas, see the evidence review on community-based doulas.
WHAT ARE THE KEY POLICY LEVERS TO SUPPORT COMMUNITY-BASED DOULAS ACROSS STATES?
The current evidence base does not identify a specific policy lever that states should implement to increase access to community-based doula services to all parents who want this type of care.
We identified two key policy levers that states can implement to increase access to community-based doula services in their state:
- Cover and reimburse community-based doula services under Medicaid, and
- Provide financial support for doula training and workforce development.
Key Policy Lever: Cover and Reimburse Community-Based Doulas Under Medicaid
To foster access to community-based doulas among families with low incomes, states can cover and reimburse doula services during the perinatal period for families enrolled in Medicaid. Without Medicaid coverage, out-of-pocket costs for doula services may be unaffordable for many families who wish to have doula support. Medicaid covers 40% of all live births in the US, therefore including doula services as a covered service expands access to a significant portion of families nationwide.17
In the past year, four states (Arkansas, Louisiana, New Hampshire, and Utah) began reimbursing doulas under Medicaid. In total, 30 states (including the District of Columbia) actively cover doula services under Medicaid, including community-based doulas.
As of September 2026, an additional five states (Maine, Montana, Nebraska, Tennessee, and Vermont) were in the process of implementing coverage of doula services under Medicaid with coverage expected to be effective in late 2026 or later. States can use direct reimbursement or provide reimbursement through managed care organizations (MCOs).
In the last 5 years alone, state leaders interest in community-based doula care has increased and more than half of states implemented a doula Medicaid benefit. Despite this recent momentum, changes to Medicaid funding at the federal level in the last year may impact coverage and services of evidence-based programs such as community-based doulas. Work to determine the full impact of federal Medicaid changes on state offerings is ongoing.
States vary in the number of visits covered by Medicaid (e.g., up to eight total visits) and any requirements regarding when those visits occur (e.g., Oregon requires a minimum of two prenatal visits and requires two postpartum visits). Rates per visit also vary. As of September 2026, reimbursement rates for the total cost of doula care including prenatal visits, labor and delivery, and postpartum care range from $450 for one patient in Florida to $3,982 in the District of Columbia.
Setting fair Medicaid reimbursement rates requires states to recognize the long hours community-based doulas spend with their clients and the true cost of the care they provide. Key factors include market rates for doulas, cost of living, scope of services, supplies, and time spent on clients during and outside of visits, including emotional support, connections to social services and community supports, and 24/7 on-call availability.
To help ensure that rates are sufficient as a sustainable source of income, states can set up a formula or minimum threshold to determine rates. Timely reimbursement is critical for community-based doulas, whose wages often rely on payment from individual clients or health insurance providers.
States also make policy choices around who can become a Medicaid provider and take steps to make policies affecting who is considered a doula more inclusive. To recognize the experience and skills of doulas in the state and encourage participation in Medicaid, states can collaborate with doulas to set requirements on who qualifies as a doula (e.g., certification and core competency requirements).
State certification requirements do not always accurately reflect the diverse backgrounds and expertise of community-based doulas. Rather than requiring certification from a specific organization, states can provide pathways for doulas to meet criteria to become Medicaid providers through demonstrated expertise or experience based on a list of core competencies.
Including community-based doulas in the policymaking process is vital to creating equitable and efficient policies for doula Medicaid coverage. States can involve community-based doulas through advisory boards, listening sessions, or workgroups. Creating policies that are reflective of the doula community, and informed by their expertise and experience, can increase doula participation as Medicaid providers.
Key Policy Lever: Provide Financial Support for Community-Based Doula Training and Workforce Development
States can also implement policies that support the community-based doula workforce by increasing access to education and training opportunities. Financial support can ease the burden of obtaining necessary training for both current and future doulas.
As of September 2026, 14 states provide financial support for doula training and workforce development. In the last year, Massachusetts began offering doula training scholarships and Wisconsin began funding organizations that provide doula training.
Arkansas, Missouri, New York, Oregon, and West Virginia fund grant programs, California, Michigan, and New Mexico fund financial support programs, and Colorado also funds a scholarship program to increase access to doula training and education.
Additionally, the New Jersey Department of Health started the New Jersey Doula Learning Collaborative, which operates as a regional hub model to assist with Medicaid billing and enrollment, workforce development, and training opportunities. Similarly, Washington uses state appropriations to fund a doula hub to provide technical assistance, development, and training. Finally, Nevada has an education loan repayment program for health care providers, including doulas enrolled as Medicaid providers.
State Policy and Administrative Choices Affect Access to Community-Based Doulas
States can enact policies that increase access to community-based doulas beyond Medicaid reimbursement and financial support for training and workforce development. Requiring private insurance to cover doula services is one way to further expand access to doulas beyond those covered by Medicaid. Currently, eight states (Arkansas, California, Colorado, Delaware, Illinois, Louisiana, Oregon, and Rhode Island) require private insurance coverage of doula care. Arkansas, Delaware, Illinois, and Oregon implemented coverage in the last year.
States can also issue statewide standing recommendations for doula services, which would eliminate the need for expectant parents to seek individual referrals for doula services. Typically, to receive doula services through Medicaid, recipients need a physician recommendation. Eight states (California, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, and Washington) have issued statewide standing recommendations to eliminate this barrier to care. Maryland does not have a standing recommendation but considers doula Medicaid coverage to be a self-referred benefit, meaning any doula enrolled as a Medicaid provider in good standing can receive payment for providing services without a physician referral.
Furthermore, states can increase access to community-based doulas by maintaining statewide doula registries or directories. A registry or directory lists various contact and care information about community-based doulas in the state to allow families to easily find a provider. The lists can be optional for doulas to join and can be funded by the state to remove financial barriers to participation for doulas. As of September 2026, a total of 16 states (Arkansas, California, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Vermont, and Virginia) offer a statewide registry or directory for doulas.
States vary considerably in their level and type of support for community-based doula services. These policy choices can lead to variation in the number of people who have access to this effective strategy. However, no single source of national data exists to understand and compare access to community-based doulas. Data are needed to explore access to doula care and to better understand the availability of doulas and the workforce challenges they face.
For more information on the state policy levers to maximize the reach and effectiveness of community-based doulas see our State Policy Lever Checklists.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO INCREASE ACCESS TO COMMUNITY-BASED DOULAS?
During the 2026 legislative session, more than half of states introduced legislation related to support for community-based doulas. Among the 28 states that introduced legislation related to doulas, eight states (Colorado, Missouri, Nebraska, New Jersey, Oregon, Tennessee, Vermont, and Virginia) successfully enacted legislation.
4 States Newly Implemented Medicaid Coverage for Doula Services
In the last year, Arkansas, Louisiana, New Hampshire, and Utah fully implemented Medicaid coverage for doula services through state plan amendments (SPA) approved by the Centers for Medicare and Medicaid Services (CMS). The states have varying requirements for coverage and reimbursement rates. All four states previously enacted legislation to implement Medicaid coverage of doula services.
Several States Made Progress Towards Medicaid Coverage for Doula Services
Nebraska and Tennessee took meaningful steps towards implementing Medicaid coverage for doula services this year. Nebraska legislators enacted a bill to require Medicaid coverage of doula services by January 2029 and to create an implementation plan by January 2027. Tennessee legislators adopted a resolution which urges TennCare to add Medicaid coverage for doula services. In 2025, The Doula Advisory Board in Tennessee released a report that included pilot programs in the state and policy options for doula certification and Medicaid reimbursement.
Three states (Maine, Montana, and Vermont) enacted legislation in 2025 to require Medicaid coverage of doula services and are currently in the process of implementation. As of September 2026, no state plan amendments have been approved for the states working on implementation.
Additionally, eight states (Alabama, Indiana, Massachusetts, Minnesota, Missouri, New York, Oklahoma, and Virginia) introduced legislation to require private insurance coverage of doula services. As of September 2026, none of those bills had passed.
In the last year, Vermont enacted legislation which will delay the effective date for Medicaid coverage of doula services and the establishment of a state community-based perinatal doula certification program from July 2026 to July 2027.
Montana announced in the last year that officials are working toward implementation of a doula Medicaid benefit despite being behind schedule of the expected early 2026 start date. Maine is projected to implement by 2028. Additional stress may be placed on states working on implementation of Medicaid coverage due to budget constraints related to federal Medicaid funding cuts in 2025.
6 States Introduced Legislation to Cover Doula Services Under Medicaid
Six additional states (Alabama, Indiana, Kentucky, North Carolina, West Virginia, and Wisconsin) introduced, but did not enact, legislation to cover doula services under the state Medicaid program. In addition, Mississippi legislators introduced, but did not enact, a bill which would have required a study on certification of doulas including the establishment of a Mississippi-specific doula training program, a doula registry, and reimbursement models for doula services, including Medicaid coverage.
2 States Began Funding Scholarships for Doula Training
In the last year, Massachusetts and Wisconsin began funding scholarship and training opportunities for doulas. The Massachusetts Department of Public Health started offering scholarships for individuals who are interested in becoming doulas or doulas interested in additional training. The Wisconsin Department of Health Services announced Title V Maternal and Child Health Block Grants for three doula organizations to provide training for new doulas and to fund other continuing education opportunities.
In the Fiscal Year 2027 budget, Delaware removed proposed funding for the Do Care Doula Foundation that provides doula training and development. The state appropriated $5,000 to the Foundation in FY2026. Additionally, Connecticut no longer offers funding for scholarships and continuing education programs for doulas.
Multiple States Continued to Support Doula Workforce Development
In the last year, four states (Arkansas, Missouri, New York, and Washington) enacted legislation to continue their support for doula workforce development. These states appropriated funding in FY2027 budgets to support doula organizations, programs, and funds that provide grants and scholarships for doula training, continuing education, and technical assistance.
- Arkansas continued funding the Maternal Health Workforce Trust Fund at the University of Arkansas for Medical Sciences which can be used for doula certification opportunities. Arkansas appropriated $2 million to the fund in FY2027.
- Missouri continued funding for the Cora Faith Walker Doula Training Program, appropriating $500,000 for the program.
- New York continued funding for the Doula Expansion Grant Program which provides funding for doula training, recruitment, and development. New York appropriated $250,000 for the program.
- Washington appropriated $1 million in additional funding for the state to develop a statewide doula hub and referral system through a contract with an external organization. The state previously invested funds to start the statewide doula hub.
Additionally, six states (Florida, Massachusetts, Mississippi, New Jersey, North Carolina, and Rhode Island) introduced, but did not enact, legislation to establish grant programs for the perinatal and/or doula workforce or other workforce development options for doulas.
4 States Explored Doula-Friendly Hospital Policies
Colorado legislators enacted a bill requiring health facilities to make a statement available, electronically or in writing, on respectful maternity care including the right to a birthing companion or doula during labor and delivery by January 2027. Similar legislation was introduced, but not enacted, in Florida, New York, and Wisconsin.
5 States Considered Doula Public Awareness Campaigns
New Jersey legislators appropriated $100,000 in the FY2027 state budget for the New Jersey Maternal and Infant Health Innovation Authority’s Doula and Midwife Services Public Awareness Campaign. The campaign will provide information to the public about the services offered by doulas and midwives, the benefits of doula and midwifery care, and resources available to individuals. Four additional states (Illinois, Louisiana, Maryland, and New York) introduced legislation to increase public awareness of the availability and benefit of doula services. As of September 2026, none of those bills had passed.
Federal Changes to Medicaid May Impact State Medicaid Offerings
In 2025, the federal government passed the One Big Beautiful Bill Act (OBBBA) making cuts to federal funding for Medicaid.18 States will continue to face budget constraints as the full effects of OBBBA are put into place, which may ultimately have a detrimental impact on state support for evidence-based policies and strategies such as community-based doulas.
For more information on each state’s progress on community-based doulas, find our individual state summaries under Additional Resources below (and here).
ADDITIONAL RESOURCES
View our Policy Impact Calculator, which illustrates how policies, such as state minimum wage, paid family and medical leave, out-of-pocket child care expenses, taxes and tax credits, as well as federal nutrition benefits, interact to impact overall household resources.
View a summary of community-based doula policies across states here. (PDF, Coming Soon)
NOTES AND SOURCES
- Mallick, L. M., Thoma, M. E., & Shenassa, E. D. (2022). The role of doulas in respectful care for communities of color and Medicaid recipients. Birth, 49(4), 823–832. https://doi.org/10.1111/birt.12655
- Hans, S. L., Thullen, M., Henson, L. G., Lee, H., Edwards, R. C., & Bernstein, V. J. (2013). Promoting Positive Mother-Infant Relationships: A Randomized Trial of Community-based doula Support For Young Mothers: Community-based doula Randomized Trial. Infant Mental Health Journal, 34(5), 446–457. https://doi.org/10.1002/imhj.21400
- Bey, A., Brill, A., Porchia-Albert, C., Gradilla, M. & Strauss, N. (2019). ADVANCING BIRTH JUSTICE: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities. https://everymothercounts.org/wp-content/uploads/2019/03/Advancing-Birth-Justice-CBD-Models-as-Std-of-Care-3-25-19.pdf
- Chen, A., & Robles-Fradet, A. (2022, March 2). Challenges Reported by California Doula Pilot Programs. National Health Law Program. https://healthlaw.org/resource/challenges-reported-by-california-doula-pilot-programs/
- Bey, A., Brill, A., Porchia-Albert, C., Gradilla, M. & Strauss, N. (2019). ADVANCING BIRTH JUSTICE: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities. https://everymothercounts.org/wp-content/uploads/2019/03/Advancing-Birth-Justice-CBD-Models-as-Std-of-Care-3-25-19.pdf
- Kozhimannil, K. B., Vogelsang, C. A., Hardeman, R. R., & Prasad, S. (2016). Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth. The Journal of the American Board of Family Medicine, 29(3), 308–317. https://doi.org/10.3122/jabfm.2016.03.150300
- Salinas, J.L., Salinas, M. & Kahn, M. (2022). Doulas, Racism, and Whiteness: How Birth Support Workers Process Advocacy towards Women of Color. Societies, 12(19). https://doi.org/10.3390/soc12010019
- Bey, A., Brill, A., Porchia-Albert, C., Gradilla, M. & Strauss, N. (2019). ADVANCING BIRTH JUSTICE: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities. https://everymothercounts.org/wp-content/uploads/2019/03/Advancing-Birth-Justice-CBD-Models-as-Std-of-Care-3-25-19.pdf
- Masten, Y., Song, H., Esperat, C.R., & McMurry, L.J. (2022). A maternity care home model of enhanced prenatal care to reduce preterm birth rate and NICU use. Birth, 49, 107-115. DOI: 10.1111/birt.12579
- Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD003766.pub6
- Salinas, J.L., Salinas, M. & Kahn, M. (2022). Doulas, Racism, and Whiteness: How Birth Support Workers Process Advocacy towards Women of Color. Societies, 12(19). https://doi.org/10.3390/soc12010019
- Bakst, C., Moore, J.E., George, K.E. & Shea, K. (2020). Community-Based Maternal Support Services: The Role of Doulas and Community Health Workers in Medicaid. Institute for Medicaid Innovation. https://www.medicaidinnovation.org/_images/content/2020-IMI-Community_Based_Maternal_Support_Services-Report.pdf
- Kozhimannil, K. B., Hardeman, R. R., Alarid‐Escudero, F., Vogelsang, C. A., Blauer‐Peterson, C., & Howell, E. A. (2016). Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. Birth, 43(1), 20–27. https://doi.org/10.1111/birt.12218
- Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O’Brien, M. (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries. American Journal of Public Health, 103(4), e113–e121. https://doi.org/10.2105/AJPH.2012.301201
- Eastburn, A., Hubbard, E., Mitchell, A., & Chen, A. (2024). A Cost-Benefit Analysis of Doula Care from a Public Health Framework. National Health Law Program. https://healthlaw.org/resource/a-cost-benefit-analysis-of-doula-care-from-a-public-health-framework/
- Bey, A., Brill, A., Porchia-Albert, C., Gradilla, M. & Strauss, N. (2019). ADVANCING BIRTH JUSTICE: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities. https://everymothercounts.org/wp-content/uploads/2019/03/Advancing-Birth-Justice-CBD-Models-as-Std-of-Care-3-25-19.pdf
- Osterman, M.J.K., Hamilton, B.E., Martin, J.A., Driscoll, A.K. & Valenzuela, C.P. (2026). Births: Final Data for 2024. National Vital Statistics Reports. 75(2):1-47. https://stacks.cdc.gov/view/cdc/252440
- KFF. (2025). Health Provisions in the 2025 Federal Budget Reconciliation Bill. KFF. https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
