Lawmakers hear S.53 to certify community-based perinatal doulas and add Medicaid coverage

Vermont lawmakers heard testimony on S.53, an act to establish voluntary certification for community-based perinatal doulas and to require Medicaid reimbursement for services provided by certified doulas.

The bill, introduced to the committee by Jen Tarvin of the Office of Legislative Counsel, would create a new chapter in Title 26 (chapter 84) defining "community-based perinatal doula," establish a certification process administered by the Office of Professional Regulation (OPR), and add doula services to the list of health-care professions for which OPR may inquire into criminal background histories. "This is S.53, an act relating to certification of community based perinatal doulas and Medicaid coverage for doula services," Tarvin told the committee.

The bill would allow noncertified doulas to continue practicing but would require certification to participate as a Medicaid provider. Certification criteria would be set by OPR and may include demonstration of competencies acquired through experience, mentorship, formal training, or a combination determined by rule, plus any criminal-history or registry checks required by the director by rule. The OPR director would be required to maintain a registry, grant and renew certificates, and refer disciplinary matters to an administrative law officer. OPR also would appoint two adviser appointees who must have at least three years' recent experience providing community-based perinatal doula services and who would be eligible for per diem compensation and reimbursement of expenses.

The bill establishes fees for the program: a $75 initial application fee and a $120 biennial renewal fee. The committee's fiscal presenter, Nolan, summarized the fiscal estimates, saying the state estimates 70–100 practicing doulas in Vermont and that initial application revenue in fiscal 2027 could range roughly from $4,500 to $7,500. Nolan also presented potential Medicaid cost estimates if the benefit were implemented in fiscal 2027: an estimated $426,930 gross cost in the first year, including about $176,000 from the general fund, and an out‑year gross range of approximately $500,000 to $1.3 million depending on utilization and awareness.

Certification would take effect July 1, 2026, provided OPR begins rulemaking beforehand; Medicaid coverage would take effect July 1, 2026, or later if a state plan amendment (SPA) from the Centers for Medicare & Medicaid Services is required and not yet approved. The bill explicitly excludes reimbursement for travel time or mileage. Tarvin summarized the timeline and dependencies: OPR rulemaking must start before the July 2026 certification effective date, and DBEDT (the bill directs the relevant agency) would seek any required SPA from CMS for Medicaid reimbursement.

Witnesses and committee members emphasized maternal-health and equity rationale. Representative Goldman, who described having two births supported by a doula, told the committee, "It was really important for me to have a doula at my birth because I didn't have family local, and I had a partner who traveled a lot." Maria Rossi, a doula and social worker who coordinates a doula program at Washington County Mental Health Services and is active with the Doula Association of Vermont (DAV), said community-based doulas provide extended, culturally congruent support to underserved individuals and argued that doulas improve outcomes. "If a doula were a drug, it would be unethical not to use it," Rossi said, citing evidence linking doula support to lower rates of premature birth, cesarean delivery and perinatal mood disorders.

Committee discussion covered regulatory scope, criminal-background checks, startup costs, and utilization risks. Members noted that OPR would be given explicit authority to inquire into criminal histories for licensure purposes and that statutes governing OPR discipline would apply for unprofessional conduct or misuse of the certified title. The committee discussed a one-time appropriation of $25,000 (not in S.53 itself) to help OPR stand up the program; Nolan said that appropriation was included in broader budget conversations. Members also pressed the fiscal presenter and witnesses on utilization uncertainty: studies from other states show low early uptake among Medicaid beneficiaries after coverage is added, driven by lack of awareness, provider enrollment barriers, low reimbursement rates, billing-code and administrative burdens, and workforce shortages. Nolan told the committee that uptake often grows slowly and that initial spending in other states has been low while awareness and enrollment rise over time.

Witnesses described workforce and training considerations. Rossi and other doula witnesses said Vermont currently has an estimated 70–100 doulas, and that community-based doulas typically provide more intensive prenatal and postpartum support than shorter "package" models. The Doula Association of Vermont said it is building training capacity and expects to add new trained doulas over the coming year. Committee members raised questions about outreach and how Medicaid would publicize the new benefit once or if it becomes effective; members flagged communication and provider‑enrollment work as necessary to achieve utilization.

No motions or votes were taken during the hearing. Committee staff said the committee will hear testimony from OPR and the state Medicaid agency (referred to in testimony as "Diva"/DVHA) at a subsequent session.

Next steps noted in the hearing record: OPR is expected to begin rulemaking so rules can be in place by the July 1, 2026 effective date for certification; the state agency will pursue any necessary SPA with CMS to enable Medicaid reimbursement; and the committee will receive further testimony from OPR and the Medicaid agency in a follow-up hearing.