A spending plan passed by California last week will cover Dula services for low-income residents more than double the state’s initial proposed rate under lawmakers.
Some advocates have welcomed the new benefits in Medi-Cal, the state’s Medicaid health insurance program, as a step towards the professionalization of the group’s non-medical birth staff. They say that a good salary can encourage more people to become rich. Other lawyers, however, called it a partial victory, saying rates were still too low for the amount of time and work it takes to ensure a healthy delivery.
Dowlas was initially criticized for offering one of the state’s lowest rates, $ 450 per birth – so low that many said it would not be appropriate to accept Medi-Cal patients. In response, the governor. Gavin News raised its offer to $ 1,154 last month, far more than any other state.
For some, the high cost of living, with the caseload limited by the unpredictability and time-consuming nature of Dula work, may still not be enough. Many doulas can only serve two or three clients a month because they often have to call for work.
“I’m not very impressed,” said Samsara Morgan, a Doula native from Oakland for more than 40 years. “It’s not a living wage to do this job.”
The rates that Dula offers through Medicaid in other states are usually between $ 770 and $ 900. Oregon joined Rhode Island this month at the highest rate, $ 1,500 per birth.
California lawmakers pass a budget on June 13 Once the governor signs the new spending plan, Medi-Cal coverage for Dula services will take effect in January 2023 and will cost 10.8 million a year. California will provide about 4. 4.2 million and the rest will be covered by the federal government.
The state’s Department of Healthcare Services, which operates Medi-Cal, wrote in Medi-Cal 13: Email Dula and a group of researchers advising the department on new benefits.
Doulas works as an instructor, guiding families through pregnancy and giving them advice in the hospital during and after childbirth, as well as during the postpartum period. Doula services have been associated with better birth outcomes, such as lower rates of cesarean section, more breastfeeding, and lower birth weight babies.
Doulas also serves women who have had or are about to have an abortion – some doula advisory groups hope the state will agree to cover the future.
Yet it is difficult to know how many Dulas work in California because the field is uncontrolled. Most of their work is for patients who pay out of pocket, up to $ 3,500, depending on the location and experience of the dowry.
Advocates hope that the addition of Dowlas to Medi-Cal’s covered services could help reduce maternal mortality rates, especially for black mothers, who are about three times more likely to die in childbirth than white mothers.
At the time of the discussion, Doulas had asked for $ 3,600 for each pregnancy and maternity support one year after birth. They demanded $ 1,000 for labor and delivery and up to six prenatal sessions and $ 100 each for 20 postpartum sessions.
Under the governor’s latest proposal, the state will pay 126.31 for an initial visit and $ 60.48 for the next eight, smaller visits. Labor and delivery will be paid at $ 544.28. State or Medi-Cal insurers may approve additional visits.
The Newsom administration fixes double labor-and-delivery pay at the same rate as doctors and midwives. “This proposal acknowledges that while Doula has less formal training than licensed practitioners, Doula services are distinct and significantly longer than meeting or birth ceremonies with licensed practitioners in general,” the state wrote in an May 13 email, confirmed by KHN.
Anu Manchikanti Gomez, an associate professor in the School of Social Welfare at the University of California-Berkeley who studies Doula programs in California, said the Dallas could negotiate with the administration at a flat rate but believed that billing for each visit would be more fair for workers. On the downside, however, some doulas may not get the full rate if their client does not use all of their allotted visits before or after the birth.
“Because the rate of postpartum visits is so low, it doesn’t make a huge difference to state spending as a whole,” Gomez said. “But $ 900 vs. 1 1,100 can be crucial for a dollar.”
Although the compensation rate is lower than what doulas wanted, some say it still represents progress. Khefri Riley, a Los Angeles Dula who helped discuss the new rates, said the introduction of Medi-Cale Dula services could pave the way for new born workers to enter the profession. “The needle has moved slightly,” Riley said.
Others say the new rate is more acceptable, but the numbers are still hard to come by. Chantel Runnels serves clients in the Inland Empire and can run more than 100 miles round trips for patients. With gas prices hovering above 6 6 per gallon, Ranaels says, “everyone is feeling the pressure.”
Some doulas point to local government and private insurance programs that pay more. A Dula Pilot program in Los Angeles paid up to $ 2,300 per birth and up to $ 1,250 in Riverside.
“We live in one of the most expensive states, and I think there’s been a lot of great wins in the review that reflects the fact that they’re listening to the nature of Dula’s work,” Ranaels said. “There is still much room for improvement.”
State governments will often check rates in other states to find out what is reasonable. California looked to Oregon, offering $ 350 per birth. But that rate was so low that some Doula was willing to accept Medicaid patients.
Then, on June 8, Oregon announced that it would begin paying $ 1,500 per birth. The increase is the result of seven or eight years of lobbying, said Raiben Nolan, vice president of the Oregon Doula Association.
Nolan said California is initially pushing Oregon down with its first proposal. Now, he appreciates the change in California.
“I love that they paid for a lot of visits,” Nolan said. “I think it’s really good.”
The story was produced by KHN, which publishes the California Healthline, the editorially independent service of the California Health Care Foundation.
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