Committee hears testimony on S.53 to certify community‑based perinatal doulas and add Medicaid reimbursement

The Senate Health and Welfare Committee heard testimony on S.53, a bill that would create a new certification for community‑based perinatal doulas and require the Department of Vermont Health Access (DVHA) to reimburse certified doulas for perinatal support services to Medicaid beneficiaries.

The Office of Professional Regulation (OPR) recommended voluntary certification of a subset of doulas — ‘‘community‑based perinatal doulas’’ — rather than regulation of the entire profession. OPR said certification is the least‑restrictive form of regulation appropriate to give consumers a market signal about competency while allowing substantive flexibility in how applicants show qualifications (training, mentorship, experience or a combination).

Testimony from a long‑time community doula who co‑founded the Doula Association of Vermont described community doulas’ role serving under‑resourced and marginalized families and summarized research linking doula care to improved outcomes, including lower rates of preterm birth, cesarean deliveries and postpartum mood disorders. The doula testified that community doulas provide culturally congruent, longer‑range support and that 25 states have adopted or are studying similar approaches.

OPR told the committee it had conducted a Sunrise review and stakeholder outreach and that the principal stakeholder concerns were ensuring certification pathways remain flexible and do not create insurmountable barriers for doulas from the communities they serve. OPR recommended certification, not licensure, because certification permits voluntary credentialing for practitioners who want the credential while leaving uncertified doulas able to practice under other titles.

The bill would add a new chapter to Title 26. Certification requirements in the draft include: application and fee procedures; minimum age of 18; demonstration of competency via training, experience, mentorship or formal education as established by OPR rule; a criminal history or registry check if required by rule; and biennial renewal with continuing‑education or competency requirements. The draft includes disciplinary authority consistent with existing OPR statutes and requires the Secretary of State to appoint two practicing community‑based perinatal doulas as advisors to OPR.

The proposed fee schedule in the draft statute is a $75 application fee and a $120 renewal fee every two years. OPR asked the committee for a general‑fund appropriation of roughly $25,000 to cover initial rulemaking, IT setup and stakeholder outreach so OPR can begin rulemaking promptly and meet the bill’s proposed effective date. A representative from OPR said those activities would allow rules to be in effect by July 1, 2026, if the Legislature provides the appropriation and the committee moves the bill forward.

On Medicaid reimbursement, the bill would require DVHA to reimburse certified community‑based perinatal doulas for direct emotional, physical and informational support during pregnancy, labor, delivery and up to one year postpartum, regardless of pregnancy outcome. The draft specifies doulas would not be reimbursed for travel time or mileage. The bill directs DVHA to seek a state plan amendment from the Centers for Medicare & Medicaid Services if needed to enable reimbursement. OPR and other witnesses urged the committee to allow the department to set reasonable and adequate reimbursement rates rather than establishing specific dollar amounts in statute.

Committee members asked whether DVHA had been involved; OPR confirmed DVHA staff participated in Sunrise review meetings and that OPR will continue to collaborate with DVHA on implementation. OPR also requested a fiscal note to clarify the Medicaid budget impact and confirmed it would begin rulemaking immediately if the bill is passed and funded.

The doula advocacy group asked the committee to move the bill forward. Committee staff said they expect to put the measure on the committee’s calendar for a vote at the next meeting and recommended adding an appropriation for OPR’s initial rulemaking costs in the bill.

Ending: Committee staff said they will present the bill again at the next meeting, including an appropriation for OPR and any additional technical edits requested by committee members.