How WA Doulas are Getting it Right

This year, doula services became a covered benefit for Washington Apple Health (Medicaid) enrollees, with the highest doula reimbursement in the nation. Here’s how Washington Doulas for All made it happen, while other states continue to struggle. 

WA’s doula benefit was designed on the ground by BIPOC doulas. Instead of relying on state officials, BIPOC community doulas organized as the Doulas for All (D4A) coalition and led the charge, building a doula benefit that reflected the care they were already providing and ensuring the work was reimbursed appropriately. 

How did they know they’d be successful? Because their work began early, engaged often, and built requirements for collaboration into its foundation. 

WA Doulas went slow to go fast. The doula benefit process began six years ago. While plenty of states have launched doula coverage without first understanding local doulas’ needs or even building the necessary infrastructure, D4A purposefully wrote and lobbied their own bills step-by-step. This meant when the coverage finally went live, doulas were on board and ready to participate right away.

It took tremendous effort, but D4A operated collectively and put in the work to make it successful. This included training coalition members on the legislative process, advocacy skills, and the Black and Indigenous roots of birth attendance so there was shared language, knowledge, and processes to operate from. 

Key to their success: collective leadership, community-based advocacy, and prioritizing a process and a benefit that are equitable and sustainable. This includes state registration that has both training-based and ancestral credentialing pathways, registration fee waivers to lower barriers to application, and regularly hosting enrollment events – many specific to BIPOC doulas and others entirely in Spanish – to ensure community doulas don’t get left behind. Additionally, WA was the first state to issue a statewide “standing recommendation” for doulas, which means doulas do not have to seek additional clinical referral to provide care.

Maybe most impressively, WA doulas now lead the nation with the highest doula reimbursement at $3500. This increases access to doulas for Apple Health enrollees by allowing doulas to fill their client load (an average of 2-4 births/month) mostly or entirely with Medicaid, paid at rates closely aligned to self-pay clients.

D4A’s next steps: continue designing and securing funding for a statewide administrative hub and referral system, to ensure doulas remain supported and clients can easily connect to doulas of their choice. 

While it’s taken a lot of work, D4A has set an incredible example of what can result from community organizing and centering the voices and needs of Black, Indigenous, and people of color. This template can serve as an inspiration to people across the country and set precedent for continued wins for doulas and other providers — like midwives and lactation consultants — who want to follow similar strategies.