Senate committee reviews bill to certify community-based perinatal doulas, link certification to Medicaid coverage

The Senate Appropriations Committee reviewed Senate Bill 53 on March 19, a measure to create a voluntary certification program for community-based perinatal doulas and to allow Medicaid reimbursement for services provided by certified doulas, committee staff and sponsors said.

Jen Carter, counsel with the Office of Legislative Council, told the committee the bill "is creating a voluntary certification process," and that certification would be limited to community-based perinatal doulas — defined in the bill as individuals providing nonclinical emotional, physical and informational support to birthing people during pregnancy, childbirth and up to one year postpartum. Carter said certification would be required only for doulas who seek Medicaid reimbursement.

The bill would direct the Office of Professional Regulation (OPR) to establish and administer the voluntary certification program. An amendment from the Senate Health and Welfare Committee proposed a one-time $25,000 appropriation from the general fund to OPR to cover start-up costs, including staff time, IT, outreach and rulemaking. Committee staff said OPR expects ongoing program work to be funded by certification fees after start-up.

A legislative fiscal staffer summarized the fiscal estimates presented to the committee: modest per-diem costs for advisory appointments, projected licensure fee revenues of roughly $4,500 to $7,000 after certification begins, and a one-time OPR start-up appropriation of $25,000. The fiscal staff also reported a rough, preliminary estimate for Medicaid costs tied to reimbursement under the state plan amendment: a gross cost estimate of about $426,000 and roughly $176,000 per year, with the caveat that those figures are highly dependent on program uptake and are therefore uncertain.

The committee discussed how Medicaid coverage would proceed if the bill becomes law. Carter and staff advised that Medicaid reimbursement could not begin without a federal approval of a state plan amendment; the bill links the effective date for coverage to the later of July 1, 2026, or the date the Centers for Medicare & Medicaid Services approves the state plan amendment.

Senator Gulick, who said she has experience with doulas and serves on the Senate health committee, described research and testimony the committee previously heard, saying "when a doula is in the room with a birthing family, there's a 20 percent reduction in the odds of a preterm birth, a 40 percent reduction in the likelihood of a cesarean section," and that doulas are associated with reductions in postpartum anxiety and depression. She also recounted a personal birth experience and argued the services can improve outcomes and lower some costs to the health-care system.

Committee members raised procedural and budget questions. One motion, made on the floor during the hearing, sought to report the bill favorably while removing the OPR appropriation. Committee members debated whether the panel could strike or amend the Health and Welfare Committee's amendment procedurally in the appropriations hearing; the transcript records discussion of next steps but does not record a final vote on that motion.

Committee staff and fiscal analysts emphasized uncertainty in the Medicaid cost estimates, noting that uptake and federal approval will determine actual fiscal impact. Staff repeated that certification would take effect July 1, 2026, but Medicaid coverage would not be available to beneficiaries until the state plan amendment is approved by the federal government.

The committee did not record a final vote on the amendment or on final passage during the portion of the transcript provided. Committee staff said they would continue to track any appropriation attached to the bill as it proceeds through the budget process and advised members on the procedural options for addressing committee-level amendments.

Looking ahead, the bill would create the voluntary certification program administered by OPR, allow Medicaid reimbursement for certified community-based perinatal doulas after federal approval of a state plan amendment, and leave fee and ongoing funding details to rulemaking and the OPR special fund processes.