Medicaid is covering doulas… but at what cost?

More states are covering doulas. Awesome, right?

Nebraska just advanced a bill that would require Medicaid reimbursement for doula services. 

A lot of people are celebrating, and I understand why.

Across the country, more states are adding Medicaid coverage for doulas. This is becoming the new model for how doula care is delivered and funded. On the surface, it sounds like a huge win for both doulas and families. More families could access doula support. More doulas could get paid for their work. Win-win. 

But whenever reimbursement enters the picture, regulation usually follows.

The state has to define who qualifies as a doula what training counts, what services are allowed, and how care is delivered.

That may sound reasonable. But history shows us what can happen when community-based care gets absorbed into the medical industrial complex.

Historically, birth support has always been rooted in relationship and community. It was women caring for women, with knowledge passed down through mentorship and lived experience.
Birth and perinatal care was personal, intuitive, and deeply connected to community.

Over time, midwifery was pulled into regulatory systems. The role became legally defined, bound by rules, documentation, and institutional oversight.

Now we’re watching something similar unfold with doulas.

Doulas are one of the last truly community-based care providers left.

We are chosen by families. We provide continuous, relational support that doesn’t belong to a hospital or an insurance company. We work for the family only, without any boards or licenses or hospital policies to answer to. 

That independence is what makes doula care so powerful, especially in a world where 98% of births are occurring within the medical industrial complex. 

And please here us when we say - we want more families to have access to support.
Truly. We totally get why there are so many people excited about having wide-spread funding for doulas. 

But expanding access cannot come at the cost of losing the community-based model of care that makes doulas so effective in the first place.

Because if doulas are pushed out by requirements that don’t reflect the reality of community care, families lose options.

And once community-based care disappears, it’s incredibly hard to rebuild. (We see this painful truth in the midwifery world). 

So we must ask the question - are we truly increasing access, or just increasing regulation? 

Always in your corner, 

Kayla & Leslie