Senate approves amendment directing HHS to seek Medicaid coverage for doulas
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Summary
The Senate adopted AM 31-28, directing the Department of Health and Human Services to submit a Medicaid state-plan amendment to enable doula reimbursement; sponsors said the amendment sets competencies and leaves reimbursement rates to HHS and MCOs, with pilots already underway.
The Nebraska Senate voted to adopt AM 31-28, a provision directing the Department of Health and Human Services to submit a Medicaid state-plan amendment to establish doulas as a reimbursable service for Medicaid-eligible patients.
Senator Spivey, who opened the amendment, described it as a narrowly drawn measure that requires HHS to develop and submit a federal state-plan amendment but does not require the Legislature to set reimbursement rates. "What my bill does is say that HHS will do a state plan amendment to CMS around what doula reimbursement will look like in the state," Spivey said, adding that the amendment does not mandate reimbursement levels and gives HHS and managed-care organizations time to design the program.
Spivey noted two managed-care organizations are already running doula reimbursement pilots and that the bill identifies a subfund and health care cash fund as potential sustainable revenue streams so the measure would not require general-fund dollars. In response to questions, Spivey said the amendment excludes abortion doula work from reimbursement and that certification, competencies and scope of practice will be set through the state-plan process and the stakeholder work group.
Senators also discussed the original fiscal estimate on standalone LB701, which Spivey said estimated about $15,000 in the first year and $120,000 in the second year if rates had been set; she emphasized AM 31-28 itself does not set rates and therefore carries no immediate general-fund hit. Lawmakers pressed on stakeholder composition (including targeted-universalism provisions) and on how HHS will oversee certification and implementation. Supporters argued the measure can improve maternal and infant outcomes and save long-term Medicaid dollars by reducing complications; critics raised fiscal caution and asked whether a sunset or review would be appropriate.
The Clerk reported adoption by voice/recorded count; AM 31-28 passed on the floor (32 ayes, 11 nays). Spivey asked colleagues for a favorable vote and said the change would allow Nebraska to build on existing pilots and establish an administrable path for doula reimbursement.
