ADVOCACY & ACCESS · POLICY & PRACTICE
Medicaid Doula Coverage:
Every Birth Deserves a Doula: Medicaid is Getting On Board
Doula School International is on a mission to make sure its graduates can get paid for the life-changing care they provide. Here's why Medicaid coverage is the most important equity fight in birth work right now.
By Stefanie Antunes and Julia Forest co-directors of Doula School International | Updated July 2026
There is a quiet revolution happening in maternity care in the United States: one birth at a time, one state legislature at a time, and one Medicaid application at a time. And Doula School International is a part of it.
Across the United States, Black, Indigenous, and brown birthing people die from pregnancy-related causes at rates two to three times higher than their white counterparts. Rural families go without support for lack of providers. Low-income parents face the impossible choice between paying a doula and paying rent. These aren’t footnotes in a policy document, they are the lived realities of the communities that birth work has always meant to serve.
That’s why Medicaid coverage for doula services isn’t just a billing question. It is a racial justice issue. It is a health equity issue. It is a human rights issue.
“When doula care is only accessible to people who can pay out of pocket, we have built a two-tiered system of birth and that is not acceptable.”
What DSI Is Doing About It
Doula School International has committed to becoming a recognized training organization in every state that requires formal training approval for Medicaid reimbursement. That work is already well underway. In Maryland, DSI is fully approved — meaning DSI graduates can directly pursue provider enrollment through the state’s Medicaid program today. Active approvals are also in progress in Delaware, Florida, Kansas, California and the list is growing.
In addition to pursuing formal approval where state frameworks require it, Doula School graduates are already positioned to access Medicaid reimbursement in a growing number of states that do not maintain restrictive approved-organization lists, including California, New York, Pennsylvania, Massachusetts, Delaware, Rhode Island, Kansas, and Florida.
Why This Matters for Birth Equity
Medicaid covers roughly half of all births in the United States. If doula care is only reimbursable through private pay, we have designed equity out of the system before a single client walks through the door. The research is clear: continuous doula support is associated with shorter labors, fewer cesarean sections, lower rates of preterm birth, and stronger breastfeeding outcomes, benefits that are even more pronounced in communities that have historically faced the most barriers to quality care.
But the benefits don’t stop with the birthing person. When doulas are reimbursed fairly, doula work becomes a viable, sustainable career and especially for community-based doulas of color who are most often serving the highest-need communities. Medicaid coverage is workforce development. It is community economic development. It is how we keep brilliant, culturally connected care providers in this work for the long haul.
Many state Medicaid programs are specifically prioritizing pathways that reduce barriers for community doulas including experience-based qualifications, language accessibility, and culturally congruent care models. DSI’s curriculum is built to support all of these goals.
The Road Ahead
State-by-state policy change is slow. It is imperfect. And it requires sustained advocacy, relationship-building with state health agencies, and a willingness to show up even when the process feels bureaucratic and exhausting. DSI is in this for the long haul.
Over the coming year, DSI will continue submitting applications in states with formal approval processes, aligning curriculum with emerging state standards, and advocating loudly for pathways that recognize high-quality, accessible doula education wherever it comes from.
If you are a DSI graduate navigating your state’s Medicaid enrollment process, you are not doing this alone. Reach out to info@doulaschool.com for your certification documentation, course syllabus, or guidance on next steps. And stay connected because this landscape is changing fast, and every policy win is a win for every family who deserves a doula at their side.
The birth equity movement is building. DSI graduates are part of the movement.
FOR THE MOST CURRENT STATE-BY-STATE MEDICAID DOULA COVERAGE INFORMATION, VISIT THE NHELP DOULA MEDICAID PROJECT INTERACTIVE MAP AT HEALTHLAW.ORG/DOULAMEDICAIDPROJECT/MAP. LAST UPDATED APRIL 2026.
Julia Forest
Julia is a doula, childbirth educator, and birth advocate whose work has touched thousands of lives across more than 20 countries. As co-founder and co-Director of Doula School International, Canada’s largest doula training organization with over 6,500 graduates worldwide, she has spent over two decades redefining what exceptional birth support looks and feels like, both for the families being served and the practitioners doing the serving. Her teaching is trauma-informed, evidence-based, and grounded in the belief that a birth worker’s inner life is inseparable from the quality of care they offer. She is the co-creator of the Sacred Birth Yoga and Doula Training and brings 20 years of study in massage therapy, prenatal yoga, and embodied movement practice to everything she teaches.
Stefanie Antunes
Stefanie Antunes has been a Lamaze® Educator and doula since 2002, inspired by the birth of her second son and the importance of preparation and support in childbirth. She is a leader in the birth field, having founded Ontario’s first doula agency, helped secure insurance for doulas, created the Birth Doula Program, and helped establish Ontario’s first hospital doula program. She has held leadership roles with the Association of Ontario Doulas and DONA International, served as a DONA-approved Doula Trainer for 13 years, and now leads Doula School. Stefanie is also a published author, contributor, and media writer, and was named Canadian SME Business Woman of the Year in 2022 for her work improving birth experiences and supporting families.