North Dakota hearing on postpartum doula certification and Medicaid coverage highlights training, cost and program questions

House Human Services Committee opened a hearing on House Bill 14-64, which would create a postpartum doula certification process and add postpartum doula services to Medicaid coverage in North Dakota. Representative Gretchen Dobrevitch (D-11, Fargo), sponsor of the bill, told the committee it “recognizes the critical role doulas play in supporting parents and newborns during the postpartum period, the first 6 months after birth.”

The bill would require certification through Doulas of North America or another reputable doula organization determined by the North Dakota Department of Health and Human Services (HHS) by administrative rule, and would add postpartum doula services to medical assistance benefits. Representative Dobrevitch said the fiscal note estimates $280,800 for the biennium, based on 30 certified doulas providing three one‑hour visits per patient billed at $15 per 15‑minute unit.

The committee heard technical and programmatic details from Alicia Belai, assistant director of the HHS community engagement unit, who described training currently provided with Doulas of North America. Belai said HHS and partner organizations trained 36 people in the past year, that certification involves classroom and reading requirements, supervised visits and submission of documentation to the certifying organization, and that an intensive training option offered recently cost about $2,500 for a four‑day virtual course for a cohort of trainees. “Folks don't need to have any kind of credentials ahead of time,” Belai said, noting the training is used to cross‑train community health workers and other frontline staff.

Krista Fremming of the HHS Medical Services Division answered questions about billing and program design. Fremming said the fiscal note assumes a separate 15‑minute billing unit for postpartum doula visits distinct from other prenatal or delivery payments. She told the committee that adding the unit would not, by itself, automatically lower reimbursement rates for labor and delivery services: “It is a 15 minute billing unit, which would be separate and distinct from any other services.” She also said any move to bundled payments would require additional notice and provider engagement.

During questioning committee members asked about certification fees, how many doulas currently practice in the state and program rollout. Representative Dobrevitch said she does not have a statewide count but pointed to HHS witnesses; HHS staff confirmed 36 people trained in the past year and that others may be working toward certification privately. The sponsor asked the committee to consider an amendment to prohibit the department from imposing an additional licensing or certification fee beyond the fees doulas pay to the certifying organization.

No testimony in opposition was recorded. The committee closed the hearing on House Bill 14-64 with no committee vote taken during the session.

The hearing record includes HHS explanations of training content, billing mechanics and the fiscal assumptions underlying the fiscal note; committee members pressed for additional data on numbers of practicing doulas and cost assumptions before any final committee action.