Committee advances bill to certify community-based perinatal doulas and seek Medicaid coverage

The House Appropriations Committee on May 14 voted to report favorably on S.53, a bill that would create a voluntary certification for community-based perinatal doulas and require the Vermont Medicaid program to seek a state plan amendment to reimburse certified doulas for perinatal services.

At issue is whether the Office of Professional Regulation will create a certification pathway and whether the Department of Vermont Health Access will secure federal approval so Medicaid can reimburse doula services. "This is ... an act relating to certification of community based perinatal doulas and Medicaid coverage for doula services," said Jen Carvey, office legislative counsel, as she summarized the bill and its structure for the committee.

Why it matters: supporters say certified doulas can provide nonclinical emotional, physical and informational support during pregnancy, childbirth and up to one year postpartum for under-resourced and marginalized populations. Proponents and the fiscal analysis cited research associating doula support with reductions in cesarean deliveries, low birth weight and preterm births—outcomes that can reduce longer-term costs—but committee staff cautioned that such offsets are difficult to quantify precisely.

The bill would add a new chapter in Title 26 to authorize voluntary certification for "community based perinatal doulas," allow the Office of Professional Regulation (OPR) to maintain a registry and apply existing OPR complaint and discipline procedures, and require DVHA to reimburse certified doulas for perinatal services once an approved state plan amendment is in place. Certification eligibility would include being at least 18 years old, demonstrating competencies through experience, training or mentorship, and passing criminal-history checks. Certification would last two years and require renewal.

Fiscal and program details discussed at the hearing included: an initial OPR rulemaking and oversight appropriation of $25,000 one-time captured in the budget; an initial licensing-fee revenue estimate of roughly $4,500–$7,500 when the program begins; and an early Medicaid utilization projection of roughly $176,000 in general-fund costs in the first couple of years, with an upper short-term estimate not expected to exceed $400,000. Nolan Langlo of the Joint Fiscal Office described those projections and the assumptions behind them, noting low early uptake in other states because providers and beneficiaries need time to enroll and establish billing systems.

The bill specifies that Medicaid reimbursement would not cover travel time or mileage. The committee also directed DVHA to seek a state plan amendment by July 1, 2026, and set the effective date for certification and Medicaid coverage as July 1, 2026, or upon federal approval of a state plan amendment, whichever is later. Committee members asked whether commercial insurers cover doulas; witnesses said some insurers have piloted coverage and many people currently pay out of pocket.

Public comment included a statement that DVHA’s modeling used a per-client cap of $2,100 in some scenarios. Robert Blackburn, a state official, noted that OPR and Medicaid have mechanisms to investigate and prosecute suspected fraud in billing, as occurs in other programs.

The committee voted to report the bill favorably as amended. During roll call several committee members recorded votes in the affirmative; the clerk announced the result as all yes during the session record. Following the vote, Representative Maricki (who handled the OPR portion) thanked the presenters and the committee confirmed upcoming committee hearings and floor timing for related bills.

The proposal would leave doulas able to practice without certification, but only certified community-based perinatal doulas could be reimbursed by Medicaid under this bill.

Looking ahead: rulemaking at OPR must occur before the July 1, 2026 effective date, and DVHA must receive any necessary federal approval for the state plan amendment before Medicaid reimbursement would begin. The committee placed the bill on the path toward the floor with a favorable report and accompanying fiscal notes.