VIII. Midwifery & Global Models
NASHP: State Medicaid Approaches to Doula Service Benefits (March 2026)
Doula Medicaid coverage 13x in 6 years, $459-$1,500 labor rate
NASHP state tracker: 26 states + DC cover doulas under Medicaid as of March 2026. Up from 2 states in 2020 and 12 states in April 2024. Labor support reimbursement ranges from $459 to $1,500 across states. At least 17 states cover doula services through 12 months postpartum.
The National Academy for State Health Policy maintains a live state tracker on Medicaid doula service coverage. In 2020, two states (Oregon and Minnesota) covered doulas under Medicaid. By April 2024 the count was 12.
By March 2026 it had reached 26 states plus the District of Columbia. That is a 13-fold increase in six years. The policy shift was driven by the combined evidence from the Kozhimannil cost-effectiveness papers, the Cochrane review on doula effectiveness, and the maternal mortality crisis that has been growing across the same period. Reimbursement rates vary widely.
Labor and delivery doula support ranges from $459 to $1,500 across states, with at least 17 states covering doula services through 12 months postpartum. The expansion is among the fastest policy shifts in US maternal health.
2
States covering doulas in 2020
26 + DC
States covering doulas by March 2026
13x
Expansion factor in 6 years
$459-$1,500
Labor support reimbursement range
Why it matters
When state policy moves this fast in US maternal health, the underlying evidence has to be unusually strong. The doula data is one of the rare cases where it was, and policy is responding.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.