Senate Health and Welfare hears DVHA caution on Medicaid reimbursement for doula services in S.53

The Senate Health and Welfare Committee heard testimony that adding doula services to Vermont Medicaid could improve outcomes but would require new funding and federal approval.

Alex Crafton, identified himself as the director of communications and legislative affairs for the Department of Vermont Health Access, told the committee the department “is not able to recommend coverage of doula services at this time.” Crafton said Vermont Medicaid does not currently reimburse for doulas and the governor’s recommended budget contains no appropriation to pay for reimbursement under S.53.

Crafton said the department followed direction in Act 97 of 2024 to develop a reimbursement methodology and estimate fiscal impacts. Using the average Medicaid births from 2021–2023 (2,033 births), DVHA applied proposed per‑service rates and a utilization assumption tied to the department’s recommended benefit design — described to the committee as 12 prenatal visits and one labor/delivery visit per enrolled member. The department estimated a likely utilization range of about 10%–30% based on other states’ experience; DEVA’s estimate shows roughly $426,000 annually at 10% utilization and about $1.28 million at 30% utilization.

Crafton also told senators that covering doulas would require a Medicaid state plan amendment. He described the state plan amendment process as the formal federal mechanism to add provider types or covered services and said it requires Vermont to request approval from the Centers for Medicare & Medicaid Services (CMS), a process that can be lengthy and subject to federal uncertainty.

Committee members discussed options rather than taking a final vote. One senator said the panel can either keep Medicaid reimbursement language in S.53 and seek funding through the budget process, or remove the Medicaid reimbursement and move forward only with a certification process for doulas. Committee staff noted that even if the Medicaid reimbursement language were removed and the committee pursued only certification, an appropriation of $25,000 to the Office of Professional Regulation (OPR) would still be needed to implement a certification process.

Senators acknowledged the department’s view that, while coverage could yield improved health outcomes and potential downstream cost savings, adopting reimbursement without new appropriations would require shifting funds from other Medicaid services or increasing DVHA’s appropriation. The committee did not take a final vote on S.53 during the portion of the hearing recorded in the transcript.

The committee asked DVHA to provide links to the department’s budget report and reimbursement methodology so members could review the underlying estimates before further action.