Doulas & Maternity Community Health Workers in Medicaid

Chloe Bakst

In the spring of 2020, the Institute for Medicaid Innovation (IMI) released a new report, Community-Based Maternal Support Services: The Role of Doulas and Community Health Workers in Medicaid. This report was part of a suite of resources IMI produced related to high-value, evidence-based maternal models of care. As part of this project, IMI completed a national environmental scan of initiatives targeted at community-based organizations and Medicaid managed care organizations (MCOs) utilizing doulas and maternity CHWs to better understand their uptake in the Medicaid population. In October 2020, the IMI team will present their findings at the American Public Health Association Annual Meeting during a session on Innovations of Maternity Services.

The IMI project team, along with our Technical Expert Panel, identified nine organizations from the national environmental scan to conduct informational interviews on their experiences utilizing doulas and maternity CHWs. During the 60 to 90-minute conversations, the project team dove deeper into the organizations’ reported success and challenges. After analyzing the data collected from the scan and interviews, four key themes emerged:

1. the importance of community-driven engagement,
2. the importance of continuity of care postpartum,
3. the need for strategic partnerships between community-based organizations and Medicaid MCOs, and
4. the need for developing the business case, including return on investment.

Overall, we found that there were opportunities to further support access to and implementation of community-based maternal support services in Medicaid. Potential project ideas  include a learning series focused on understanding the role and value of doulas and maternity CHWs in Medicaid, similar to the Midwifery and Medicaid Learning Series or launching a comprehensive learning collaborative with teams of state Medicaid agency, health plan, and community-based organization representatives. Future projects may also consider how to build the business case, emphasizing how these models impact and address health equity. Through the potential future projects, Medicaid stakeholders may develop a better understanding of how to support and facilitate partnerships among community-based doulas, maternity CHWs, and Medicaid MCOs. The IMI team continues to explore the clinical, research, and policy opportunities to support high-value, evidence-based maternal models of care in Medicaid.