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Kansas Medicaid will soon cover doulas. Research shows they reduce birth complications

Sara Skiles, left, is a doula and owner of Wichita Doula.
Courtesy photo
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Wichita Doula
Sara Skiles (left), owner of Wichita Doula, sits with a client.

Doulas help new and expecting families navigate pregnancy, birth and the postpartum period. Studies show their intervention improves maternal health outcomes.

KanCare, Kansas’ Medicaid program, will cover doula services for its pregnant beneficiaries beginning July 1. The Kansas Department of Health and Environment said in a release that the policy change aims to improve maternal health outcomes in Kansas.

"Doulas play a vital role in the health and well-being of mothers and their babies, and this new coverage will ensure more families in Kansas can benefit from their services,” Janet Stanek, KDHE secretary, said in the release.

Doulas serve as advocates and educators for pregnant women. Many of them are on call 24/7, answering anxious texts and phone calls from moms-to-be or rushing to meet their clients in labor to attend their births.

Sara Skiles, owner of Wichita Doula, said doulas bridge the gap between overloaded OB-GYNs and their patients.

“Medical providers can only see the family so many times in the pregnancy and in the postpartum period,” she said. “So a lot of times they don't have anywhere to go or anyone to call for support.”

Skiles said doctors traditionally schedule a follow-up visit six weeks after a person has given birth. She said that six-week period can be a vulnerable time for new moms and their infants.

“A lot of things can go wrong with mental health, physical health, the newborn, challenges with breastfeeding,” Skiles said.

Although doulas are not physicians, they go through various training and certification courses. Skiles said doulas do home visits and talk to their clients about what is and isn’t normal and when to see a doctor.

That type of support can be lifesaving. Moms who use doulas are two times less likely to experience birth complications and four times less likely to give birth to an underweight baby, according to the National Institutes of Health.

And Kansas moms need this type of support.

Severe maternal morbidity, when a person experiences extreme complications during labor and delivery that impact their long- or short-term health, increased by 6.4% annually between 2016 and 2020, according to a study from the Kansas Maternal Mortality Review Committee.

Kansas moms on Medicaid or from low-income ZIP codes and women of color disproportionately bear the brunt of pregnancy and post-pregnancy complications.

Jaima Saunders sits in her mom's home in Kansas City, Kansas, where she meets some of her doula clients. Saunders said she is driven to help Black moms in Kansas City, Kansas, where she is from, because of the disparities they are facing.
Bek Shackelford-Nwanganga
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Kansas News Service
Jaima Saunders poses for a portrait in her mom's Kansas City, Kansas, home in November. Saunders meets some of her doula clients at her mom's house. Saunders said she is driven to help Black moms in Kansas City, Kansas, where she is from, because of the disparities they face.

Doula care coverage was already in the works

Before KanCare’s announcement about expanding coverage to pay for doulas, another Medicaid provider stepped up. In 2022, UnitedHealthcare, one of the state’s three Medicaid providers, began a pilot program to cover doula care for moms in Wyandotte County on the UnitedHealthcare Medicaid plan.

Eventually, Kansas became one of 5 states taking part in a broader pilot program, covering doula services for all moms in Kansas on UnitedHealthcare’s Medicaid program.

Various advocacy groups, such as the Kansas Birth Justice Society in Wichita, have pushed for years for insurance companies to cover doula services.

Jaima Saunders, owner of Mommy Diaries: A Doula Company, primarily serves clients in Wyandotte County. She was one of the early recruits for the pilot program. Since 2022, she said she’s served more than 30 moms on Medicaid. She said she is excited the state Medicaid program will now cover doula services for its beneficiaries.

“It’s been a long time coming,” Saunders said. “I kind of knew about it in the works back in February or March of this year; I just didn't know when they were going to actually roll it out.”

Saunders said before the announcement, she helped multiple Kansas moms on Medicaid switch to UnitedHealthcare so they could access free doula care.

Doula Jaima Saunders shows off various items she uses to make pregnant women more comfortable before and during labor and delivery. During their birth, Saunders does things like play soft, tonal music, soak the mom's feet, and use massage tools to help ease the pain.
Bek Shackelford-Nwanganga
/
Kansas News Service
Doula Jaima Saunders shows off various items she uses to make pregnant women more comfortable before and during labor and delivery. During their birth, Saunders does things like play soft, tonal music, soak the mom's feet, and use massage tools to help ease the pain.

Doula concerns about the KanCare policy change

While the policy change is monumental for women on Medicaid in Kansas, some doulas have concerns. Skiles, the doula from Wichita, said she worries reimbursement rates will not be fair.

“We have heard in some other states the reimbursement rates were below market rate, which would make it really difficult to continue to make a living as a doula,” she said.

The National Health Law Program reports 12 other states, like Oklahoma and Minnesota, and Washington, D.C., have implemented Medicaid coverage of doula care as of January. Missouri hasn't expanded coverage to the state Medicaid program, but Medicaid provider Healthy Blue has a pilot program similar to UnitedHealthcare's.

Skiles is also concerned that Kansas doesn’t have enough doulas to support the influx of clients on Medicaid.

“We're going to have to expand. We're going to have to have more people training to become doulas that want to work with and serve these populations,” Skiles said.

A spokesperson for KDHE said they’ve been working closely with the Kansas Doula Alliance, an arm of the Kansas Birth Justice Society, to spread information to Kansas doulas encouraging them to enroll as KanCare providers and spread the news about the policy change.

“The Alliance will also provide professional development and training to doulas that will prepare them for certification for the KanCare provider enrollment process in order to receive reimbursement for their services,” the KDHE spokesperson said in an email to the Kansas News Service.

The spokesperson said KDHE is also encouraging hospitals, clinics and medical providers in the state to add doulas to their teams.

Saunders said the policy changes are overall a step in the right direction. She said she thinks commercial insurance programs will soon start offering to cover doula services, too, and she is excited to help more moms.

“If a mom is pregnant, her mental health and her baby's mental health starts with pregnancy before the baby even is on the earth,” she said. “So just to be able to take certain stressors off of moms and their families is a total success story every single time for me.”

Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

Bek Shackelford-Nwanganga reports on health disparities in access and health outcomes in both rural and urban areas.