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Doula services at risk amid review of state Medicaid roll

A doula assists a pregnant person in a doctor's office.
Marcus Ingram
Courtesy Birth in Color
Birth in Color RVA — a doula care provider and nonprofit advocacy group based in Richmond with clinics across the state — was instrumental in the state adopting Medicaid reimbursement for the service.

More than 350,000 Virginians are at risk of losing Medicaid coverage as state officials review the program’s rolls for the first time since the COVID-19 pandemic began. The process, which had previously been annual, will also affect people receiving doula care. Medicaid is the only healthcare plan in Virginia that covers the service.

The Medicaid roll review process was halted at the start of the pandemic as part of the federal Families First Coronavirus Response Act. The section of the law pausing the audit expired March 31 and began a year-long review process for states.

Birth in Color RVA — a doula care provider and nonprofit advocacy group based in Richmond with clinics across the state — was instrumental in the state adopting Medicaid reimbursement for the service.

Kenda Sutton-EL, executive director of Birth in Color, said doula care is about developing relationships and care plans with patients; doulas provide emotional, physical and informational support to pregnant people.

“With [patients] getting that focus from us, and us spending time giving them different options and different things that they can be doing, we've seen where people are becoming a lot healthier and just adapting to a healthier lifestyle,” Sutton-EL said.

Birth in Color is working with about 300 of its patients on Medicaid to help with the process of reenrollment, Sutton-EL said. They’re also looking to help patients who will lose coverage craft a plan for the future. That might include free doula care, but private grants would be needed to fund the services.

An effort to require doula coverage in commercial health plans failed in the General Assembly this year. Instead, Virginia lawmakers ordered the Senate Health Insurance Reform Commission to study how mandated benefits would impact health plans and access to care. Currently, the only state requiring doula care to be covered by private insurance plans is Rhode Island.

According to the Department of Medical Assistance Services website, Virginia was the fourth state nationwide to establish a Community Doula Program, which allows state-certified doulas to be reimbursed for their services by Medicaid. A 2022 U.S. Department of Health and Human Services report found that investing in doula care — particularly in Black, Native American and Alaskan Native communities — could reduce disparities in birth outcomes.

Reasons for disenrollment

Freddy Mejia, of the Commonwealth Institute for Fiscal Analysis, said last week that many people could lose coverage due to administrative issues like outdated addresses — in addition to those being removed due to other eligibility requirements.

“In fact, [72]% of children who lose coverage nationally are expected to be disenrolled, despite remaining eligible for coverage,” Mejia said, referencing HHS data.

Mejia said the Commonwealth Institute would monitor loss of coverage throughout the process using data provided by the state's DMAS. He also thanked the agency for sharing the data, which he said is an important tool to monitor disenrollments and direct resources to those in need in real time.

Del. Mark Sickles (D- Fairfax) said local social services departments often see high turnover in the positions responsible for reviewing the rolls. He’s “worried that mistakes might be made,” but said the state is working with healthcare providers and managed care organizations to help cover gaps.

Birth in Color is doing some of that work.

Sutton-EL said the nonprofit has held community conversations on how to check coverage status and make a plan for those losing access to doula care covered by Medicaid.

Additional sessions are currently being planned.

DMAS is in the process of sending out reenrollment packages to current Medicaid recipients. It said people should return the form even if they think they no longer qualify because the department might be able to identify other subsidized coverage options.

According to the Richmond Department of Social Services, the city has about 77,000 Medicaid enrollees, about one-third of the city’s population. A spokesperson told VPM News the department is unable to estimate how many people could lose their coverage.

To check Medicaid eligibility status, apply for coverage or update other info, visit or call (855) 242-8282.


Patrick Larsen is VPM News' environment and energy reporter, and fill-in host.