House advances bill to certify community-based perinatal doulas and seek Medicaid coverage

The House proposed to the Senate amendments and ordered third reading of S.53 on a vote of the body after committee reports and floor debate. S.53 would create a statutory category of "certified community-based perinatal doulas," require certification under the Office of Professional Regulation (OPR), and establish a Medicaid reimbursement methodology for doula services contingent on federal approval.

The bill directs OPR to develop a certification program for community-based doulas, including rulemaking, appointment of experienced doulas as advisers, and use of an external certifying body. According to the bill text and committee summaries, certification will be required for doulas who seek Medicaid reimbursement; doulas may continue to practice without certification but would not be eligible for Medicaid payment.

The House Health Care Committee described evidence presented during its review linking doula support to reduced cesarean and preterm birth rates and to lower rates of postpartum depression. Representative Cortes (member from Bristol) summarized studies cited to the committee, and told members she was relying on national reviews and Vermont-specific analyses presented to the committee. She noted a recommended Medicaid payment methodology developed by the Department of Vermont Health Access (DVHA) of $100 per visit with a minimum 30-minute unit and a service limit of 12 visits per birth.

Ways and Means, which reviewed fiscal impacts, reported that OPR would need $25,000 in fiscal 2026 to stand up the certification program and that initial certification fees were estimated at $75 with renewals at $120. Committee estimates cited an expected population of roughly 70–100 practicing doulas in Vermont and projected application revenues of $4,500–$7,500 per year; Ways and Means noted that the bill itself does not make an appropriation for DVHA’s federal-state work on the Medicaid state plan amendment.

Floor remarks included personal testimony: the member from Fairfax described receiving doula support during childbirth and urged passage; Representative Cortes read a definition of doula care and quoted a researcher, saying, “if a doula were a drug, it would be unethical not to use it.” House committees on Health Care, Ways and Means, and Appropriations each recommended concurrence with the Health Care Committee’s proposal of amendment. The House voted to propose to the Senate to amend as recommended and ordered third reading.

If implemented, actual Medicaid reimbursement would not take effect until DVHA files and receives approval for a state plan amendment from the Centers for Medicare & Medicaid Services; the House amendment moved the target date for DVHA to submit that state plan amendment to no later than 07/01/2026. The bill also adds a statutory chapter authorizing certification and sets administrative duties and fee structures for OPR.

The House record shows committee votes in favor (Health Care 11–0; Ways and Means 10–0–1; Appropriations 10–0–1) and voice votes on the floor. The bill’s fiscal costs to implement the OPR component were reported to be modest; estimated Medicaid cost impacts were described in DVHA analysis to committees but the final state fiscal cost depends on federal approval and future utilization rates.

Provisions still require several administrative steps before Medicaid coverage can begin: OPR rulemaking for certification, DVHA’s submission and federal approval of a state plan amendment, and establishment of the reimbursement claims process.

Speakers and witnesses during committee and floor consideration included OPR staff, DVHA representatives, Joint Fiscal Office analysts, the Doula Association of Vermont, researchers and advocacy witnesses, and multiple legislators from Health Care, Ways and Means, and Appropriations who reported to the floor.