Committee reviews S.53 to certify community-based perinatal doulas and enable Medicaid reimbursement

The Government Operations & Military Affairs committee on Tuesday heard testimony on S.53, a bill to create a voluntary certification for community-based perinatal doulas and to require the Department of Vermont Health Access (DVHA) to reimburse certified doulas under Medicaid once any needed federal State Plan Amendment (SPA) is approved.

The bill matters because supporters say certified community-based doulas provide culturally competent, nonmedical support that improves maternal outcomes for under-resourced and marginalized birthing people and because roughly 38 percent of Vermont births are covered by Medicaid, a committee witness said.

Jen Harvey of the Office of Legislative Counsel introduced the draft language and told the panel the bill creates a new chapter for “community-based perinatal doulas,” defines the scope of the perinatal period and sets a certification pathway that is voluntary but required for Medicaid reimbursement. Harvey said perinatal means “the period of time encompassing pregnancy, childbirth, and up to 1 year postpartum.”

Jen Colon, general counsel for the Office of Professional Regulation (OPR), which performed a sunrise review last session, described why OPR recommended certification. “Certification is a regulatory form that we have that’s voluntary,” Colon said, noting certification is intended to identify a vetted group of doulas that DVHA can accept as Medicaid providers without imposing licensing on the entire profession.

Colon summarized the bill’s main elements: OPR would administer certification and a public registry; the Secretary of State would appoint two certified community-based perinatal doulas as advisors (each must have at least three years’ experience); OPR could adopt rules, require criminal-background checks where appropriate, and discipline certificants under existing OPR authority; fees in the bill are $75 for initial certification and $120 for a two-year renewal; and certification and its rules are slated to take effect July 1, 2026, with OPR directed to begin rulemaking before that date.

On Medicaid coverage, the bill directs DVHA to reimburse a certified community-based perinatal doula for direct emotional, physical, educational and informational services to Medicaid-covered birthing individuals during pregnancy, labor and delivery, and the postpartum period, “regardless of the outcome of the pregnancy.” The bill specifies doulas would not be reimbursed for travel time or mileage.

Sarah Teal, co-director of the Doula Association of Vermont and a doula and researcher, said she strongly supports the measure and described the national trend: “a number of other states provide Medicaid coverage for doulas,” she said, and more states have adopted or piloted such coverage in recent years. She said certification can create competency pathways and accountability while preserving access and urged rulemaking that does not erect costly training barriers.

Witnesses and stakeholders emphasized process and implementation steps rather than immediate policy adoption. Colon said OPR estimated about $25,000 in one-time costs to stand up the certification (technology, outreach, rulemaking, staff time) and indicated the estimate had been included in the Senate-side budget request. Colon also said DVHA must seek a SPA from the Centers for Medicare & Medicaid Services (CMS) if required; the Medicaid coverage provision would take effect July 1, 2026, or upon SPA approval if later.

Committee members asked how the term “community-based” would be applied; Colon and Teal said it designates doulas who primarily serve under-resourced and marginalized communities, often through community agencies, and that certification aims to verify competencies for that work while leaving other doulas unregulated and free to practice without the state title. Testimony repeatedly stressed that doulas are nonclinical supports and are distinct from midwives or medical providers.

The committee did not take final action Tuesday. Members scheduled a follow-up, with a planned formal position and possible vote the next morning to give members time to review stakeholder comments and draft rules language. The hearing record and stakeholder input will feed into OPR rulemaking if the bill passes.

Officials and advocates said key next steps include OPR rule development (to define competency pathways and any criminal-background checks), DVHA’s SPA request to CMS if required, and legislative budget approval for OPR’s startup costs. Supporters urged rulemaking that keeps certification accessible and avoids imposing high training costs that could limit participation by community-based doulas.

If S.53 passes and rulemaking and any necessary federal approvals proceed as planned, proponents said it would create a route for Medicaid reimbursement intended to expand equitable access to doula services for Vermont’s most vulnerable birthing families.