Legislative committee weighs S 53 to certify doulas, flags Medicaid timing and costs

A legislative committee discussed S 53, a bill to create voluntary certification for community-based perinatal doulas and to require Medicaid reimbursement for doula services contingent on a state plan amendment, focusing on cost estimates and the time needed to implement Medicaid coverage.

The bill would add community-based perinatal doulas to Office of Professional Regulation (OPR) statutes, establish a voluntary certification with $75 initial and $120 biennial renewal fees, require background checks, set a minimum age of 18, and require OPR to appoint two certified doulas as advisors. Legislative counsel explained the certification program would begin July 1, 2026, with rulemaking completed beforehand; Medicaid reimbursement would begin July 1, 2026, or on approval of a state plan amendment (SPA), whichever is later.

Why it matters: supporters said doula services are associated in research with better birth outcomes and lower use of higher-cost interventions, and that untreated perinatal mood and anxiety disorders impose substantial costs on the state. Opponents and some staff raised concerns about obligating future budgets and the time required for a SPA and IT changes before Medicaid could reimburse doulas.

The bill and certification. James Harvey, Office of Legislative Counsel, summarized the measure: "This is S 53 and [it's] accurate that includes certification of community based perinatal doulas and Medicaid coverage for doula services." He said certification would be voluntary and that individuals could qualify through experience, mentorship, training or formal education, subject to OPR rulemaking. OPR-related provisions include the adviser model and sanctions for unprofessional conduct. The proposed fees are $75 for initial certification and $120 for biannual renewal.

Medicaid coverage and state plan amendment. Committee staff and fiscal analysts said Medicaid reimbursement requires a state plan amendment and IT changes, so coverage could not take effect immediately even if the Legislature passed the bill this year. One staff member noted, "even if we wanted to take effect in '26, it wouldn't," citing the time required for state plan approval and system updates. The bill directs DEVA to seek a SPA if needed and specifies that Medicaid would reimburse certified doulas for services but would not pay travel time or mileage; legislative counsel said intent language calls for reimbursement amounts to be "reasonable and adequate" and consistent with rates in other states.

Fiscal estimates and uptake. Committee discussion cited a range of fiscal estimates and utilization scenarios. Staff referenced an out‑year maximum cost estimate around $1.3 million, described as an upper bound; they said immediate uptake is typically low in other states and that first‑year utilization assumptions of 5–10 percent are more plausible. A staff member summarized a first‑year example: "assuming a 10% uptake ... that's what it would cost the first year," attributing roughly $176,000 of general fund cost under that assumption. Witnesses and analysts emphasized uncertainty and that savings, if any, are likely to accrue over time rather than immediately.

Testimony on health impacts. Amy Johnson of Vermont Care Partners told the committee she was available to answer questions about doula services and described providers in the room. Doula advocate and researcher Sarah Teal said research links doula care with improved immediate birth outcomes and lower rates of interventions. Teal summarized literature findings, including meta‑analytic results showing reductions in cesarean risk, shorter labors and lower rates of interventions, and added, "doulas help the health care system work better for people." Witnesses also cited Vermont‑specific analysis (Mathematica) estimating that untreated perinatal mood and anxiety disorders cost the state about $48 million annually; committee members said they would collect and circulate the cited reports.

Regulatory and policy tradeoffs. Some members raised the possibility of passing only the certification elements and deferring Medicaid coverage to avoid opening the Medicaid state plan for amendment now. Legislative counsel and staff said the two pieces are legally separable but that certification was primarily intended to support Medicaid participation: without Medicaid coverage, incentives to seek certification could be limited. Committee members also asked whether adding a SPA could expose other parts of the Medicaid plan; staff said SPA requests are routine and that CMS reviews the state's plan content during an amendment, but they did not describe any automatic or broad-forced renegotiation of unrelated benefits.

Next steps. The committee deferred final action and planned to reconvene after the floor session for a markup and possible vote, asking members to be prepared to consider S 53 10 minutes after the floor. No formal motion or vote occurred during the recorded discussion.

The discussion combined legislative counsel explanation of statutory language, fiscal staff estimates, and testimony from advocates and program staff; committee members requested additional documentation and emphasized uncertainty about first‑year costs and timing for Medicaid implementation.