Committee weighs certification and Medicaid coverage for community-based perinatal doulas

The Vermont Senate Committee on Government Operations heard testimony on S.53 on Feb. 19, a bill that would establish a voluntary certification for community-based perinatal doulas under the Office of Professional Regulation (OPR) and require the Department of Vermont Health Access (DVHA) to seek Medicaid reimbursement for certified doulas during pregnancy, labor and delivery, and up to one year postpartum.

Committee sponsor Senator Martine Larocque Gulick, who introduced the bill, said doulas are nonclinical providers who offer continuous emotional, physical and informational support before, during and after birth and that the OPR sunrise review recommended certification rather than licensure or simple registration. “Doulas are really helpful in helping folks navigate the emotional and psychological stress of having a baby,” Senator Larocque Gulick said.

Supporters told the committee the proposal is intended to expand access to doula care for under-resourced and marginalized Vermonters and to create a pathway for Medicaid reimbursement. Jen Harvey of the Office of Legislative Counsel summarized last year’s Act 97, which directed OPR to conduct a sunrise study and directed DVHA to propose a reimbursement methodology and cost estimate. Harvey said DVHA’s budget submission indicates the state would need a Medicaid state plan amendment from the Centers for Medicare and Medicaid Services (CMS) to reimburse doula services.

Doula practitioners and advocates described existing community programs and demand. Maria Rothy, a doula with Washington County Mental Health and a co-founder of the Doula Association of Vermont, said the association estimates roughly 100 doulas statewide based on current outreach and membership and that interest in statewide training is high. A JFO staff member told the committee they had produced an earlier issue brief (2017) estimating 40–50 doulas in Vermont at that time; JFO has been cautious about extrapolating long-term fiscal savings.

Key provisions discussed

- Definitions and scope: The bill would add chapter 84 to Title 26, defining a certified community-based perinatal doula as a nonmedical, nonclinical individual providing prenatal, labor/delivery and postpartum support (perinatal defined as pregnancy through one year postpartum).

- OPR responsibilities: The director of OPR would accept applications, grant and renew certificates, maintain a registry, adopt rules after consulting appointed adviser(s), and handle disciplinary matters in accordance with OPR statutes. OPR would appoint two adviser appointees who must have at least three years’ experience providing community-based perinatal doula services and be actively engaged in Vermont.

- Eligibility and oversight: Applicants must be at least 18, demonstrate competencies (by experience, mentorship, training or education as determined by rule), pass any criminal-history or registry checks required by rule, and meet continuing education or competency requirements for biennial renewal.

- Fees and penalties: OPR-recommended fees in the bill are a $75 initial certification fee and a $120 biennial renewal; use of the certified title by uncertified individuals would be prohibited and enforceable under OPR sanctioning provisions.

- Medicaid coverage: The bill directs DVHA to reimburse certified community-based perinatal doulas for direct emotional, physical, educational and informational services provided to Medicaid-covered birthing individuals regardless of pregnancy outcome. Reimbursement would exclude travel time and mileage. The bill directs DVHA to seek a state plan amendment from CMS if required; the Medicaid coverage provision would take effect July 1, 2026, or upon CMS approval, whichever is later.

Evidence and fiscal questions

Witnesses and staff cited studies from other states showing associations between doula support and reduced preterm birth, lower cesarean rates and related cost savings; advocates said many states (about 25) are in some stage of implementing payment for doula services. Committee members asked for more detail on DVHA’s cost estimates and on JFO’s findings. A JFO staff member noted the scale of any long-term savings depends on uptake and cautioned against assuming immediate budget offsets.

Local access and equity considerations

Testimony emphasized that community-based doulas often serve people of color and people living in poverty, groups with worse maternal and infant outcomes in the U.S. Witnesses described regional concentration of doulas: higher numbers in Chittenden County, active programs in Washington and Addison counties, and very limited coverage in some rural areas such as parts of Essex County described as maternal health deserts.

Next steps

Committee members discussed scheduling further testimony from OPR and DVHA to answer outstanding technical and fiscal questions. The sponsor and members said they expect to vote on the certification portion and then return the bill to the Senate Health and Welfare Committee for the Medicaid implementation work; the committee aims to act at a future meeting but did not take a final vote during this hearing.

The committee also invited additional stakeholders — including midwives, hospital partners and DVHA — to testify at a later session to provide the fiscal and operational details the committee requested.