Establishes a 14 member doula Medicaid reimbursement work group within the department of health to set reimbursement rates for doulas in the state Medicaid program and address other criteria related to their practice; requires the work group to conduct a study and evaluate the costs, benefits and issues that may be associated with Medicaid reimbursement for doulas and for providing doula care to Medicaid recipients; makes related provisions.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5709
SPONSOR: Solages TITLE OF BILL:
An act to establish a work group to set reimbursement rates for doulas
in the state Medicaid program and address other criteria related to
their practice
PURPOSE:.
The purpose of this legislation is to establish a work group composed of
majority doulas and other multidisciplinary experts to examine and study
the benefits, costs, and issues related to Medicaid reimbursement for
doulas providing doula care services to Medicaid recipients across the
state.
SUMMARY:
Section 1. Declares work group purpose.
Section 2. Establishes the work group.
Section 3. Details work group composition.
Section 4. Describes work group compensation and reimbursement.
Section 5. Sets appointment timeframe.
Section 6. Describes work group duties.
Section 7. Establishes final report deadline.
Section 8. Sets the effective date.
JUSTIFICATION:
Historically excluded and low-income communities in the United States
are at disproportionately higher risk of poor birth outcomes, maternal
mortality, and other pregnancy-related complications. On April 13, 2022,
the New York State Department of Health released a report titled "New
York State Report on Pregnancy Associated Deaths in 2018," detailing the
state of maternal health affairs in the state. According to the report,
from 2016-2018, New York improved to 23rd in the United States with a
maternal mortality rate of 18.1 deaths per 100,000 lives versus the rate
of 24.4 between 2008-2010
1. While the decreased rate is noticeable,
BIPOC people experienced pregnancy-related deaths four to five times
more than non-Hispanic White pregnant people.
The emerging popularity of doula care is a promising approach in
addressing maternal health and combating maternal health disparities.
Research suggests that a doula's presence during pregnancy, birth, and
the postpartum period will result in decreases in negative birthing
outcomes
2. Despite the benefits of doula care, only a small percent-
age of pregnant people use a doula due to lack of information and
economic barriers. The proposed work group takes a step toward increas-
ing doula accessibility and properly compensating doulas, which in turn
will also help expand the workforce.
Further, in 2019, the Department of Health launched a Doula Medicaid
pilot program to target high maternal mortality rates and reduce racial
disparities in health outcomes in Erie County. The pilot program
enrolled 760 people in one of six different Medicaid Care Plans or Medi-
caid-Fee -for-Service programs. The pilot programs covered up to four
visits with a doula before delivery, up to four visits with the doula
after delivery, and doula support during labor and delivery. The intent
and purpose of this legislation is to create a Medicaid reimbursement
work group that will identify and examine a framework that would provide
New York's Medicaid recipients with quality doula care services while
simultaneously providing doulas with equitable and sustainable
reimbursements for their services.
RACIAL JUSTICE IMPACT:
Pregnant people of color face disproportionately higher rates of preg-
nancy complications, mistreatment during childbirth, and maternal
mortality. Doulas help combat this inequality by finding low-cost
resources, avoiding unnecessary medical interventions, advocating for
the patient, and by serving as a guide for the pregnant person. Doulas
can also help reduce the impacts of racism and racial bias in healthcare
by providing individually tailored, culturally appropriate, and
patient-centered care. This legislation supports the integration of
doulas into New York State's Medicaid system, working to increase acces-
sibility, and adequately compensate doulas,
GENDER JUSTICE IMPACT:
Establishing a work group tasked with examining and recommending the
best practices for integrating doulas in New York States' Medicaid
program aims to ensure the accessibility of and equitable reimbursement
for doula care. This bill benefits both expecting mothers and doulas as
it supports the integration of doulas and recognizes the importance of
their work. 94.3% of the doula workforce is made up of women
3. The
proposed work group will ensure that doulas are compensated fairly so
they do not have to struggle while providing this needed care. This
legislation seeks to improve maternal care and a health sector which is
experiencing a labor shortage and stagnant wages.
LEGISLATIVE HISTORY:
2023-24: A5465; referred to health.
2021-22: A10364; referred to health.
FISCAL IMPLICATIONS:
TBD.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.
1www.health,ny.gov%2Fcommunity%2Faclul ts%2Fwomen%2Fdocs%2Fmaternal
mortality_review 2018,pdf&use=A0vVaw0-0wWinSvaW4-Ley5Gw7Vd.
2 httbs://www.ncbi.nlm.nih.gov/bindarticles/PMC3647727/.
3 https://www.zippia.com/doulajobs/demographics/.
