By Nicole Hall
On March 7, 2023, there was a joint public hearing to receive testimony on how to identify and examine best practices for integrating doulas into New York’s maternal healthcare system. We are sharing Inclusive Alliance's public comment that we submitted in response to the hearing. You can watch the recorded hearing here: Joint - Public Hearing: To receive testimony on how to identify and examine best practices for integrating doulas into New York’s maternal healthcare system | NY State Senate (nysenate.gov)
Written Testimony for Public NYS Senate Hearing Integrating Doulas into New York’s Maternal Healthcare System
Nicole Hall, Network Development Manager
Inclusive Alliance IPA
March 10, 2023
Chair Brouk, Chair Rivera, and distinguished members of these Senate committees: thank you for the opportunity to provide written testimony on the importance of Medicaid reimbursement for Doula services from the perspective of Central New York’s non-profit health & human service providers. My name is Nicole Hall and I am a Network Development Manager for Inclusive Alliance IPA. I am also the mother of 2 young children ages 5 and 3, and a passionate advocate for better maternal mental health care.
Inclusive Alliance is a non-profit community-based organization (CBO) network and independent provider association (IPA) founded in 2017 comprising over thirty diverse health & non-billing human service providers serving Cayuga, Cortland, Herkimer, Madison, Oneida, Onondaga, & Oswego counties. Our network includes agencies that primarily serve individuals with Medicaid and who have unmet medical, behavioral health, and social needs. Several of our member organizations have grant-funded Doula programs.
Maternal and infant health is in a state of crisis right now across the country. New York has much work to do to improve the state of care for mothers and birthing people in this state. This is especially true for Black women and birthing people, who are significantly more likely to die or suffer serious avoidable medical complications than their white counterparts. The rural, less racially diverse counties in our network also face high rates of maternal mortality and morbidity associated with poverty and lack of access to care.
While New York must engage in long term work to address the system that leads to so many unnecessary deaths and injuries, we have the opportunity now to support these families through the services of Doulas. Evidence clearly shows the benefits of Doulas not only in the delivery room, but also in the long-term health outcomes of both mother and child.
Unfortunately, the cost of these services is often out of reach for the women and birthing people who would benefit most. Medicaid coverage of these valuable services offers a window of opportunity to create a safer and more equitable birth experience for all families across New York State. In Central New York, Inclusive Alliance IPA has seen these benefits through our member organization Cayuga Community Health Network and its rural community-based Doula program, as well as through the work and advocacy of independent Doulas serving Black mothers and birthing people in Onondaga County, both making positive impacts in the communities they serve.
Community based Doula networks provide value to their community not only through their direct support of families, but also in the administrative support of Doulas themselves. Administrative support to include billing on behalf of Doulas, ongoing training and supervisory support, community connection and outreach, and peer network support are all necessary to ensure that the Doula workforce can operate sustainably long term. It is critically important that when considering reimbursement rates for Doula services, which we know reduce the need for higher cost medical interventions, that these rates reflect the intensity of work these Doulas are providing, and these ongoing administrative costs.
Doulas can make these incredible impacts on babies and parents with both formal certification from recognized organizations, as well as community-based training programs. While certification does offer more rigorous training and experience than some community-based training programs, it also comes with increased short- and long-term costs that can prevent some from entering the Doula workforce altogether. We hope that New York will support the development of this much needed workforce by recognizing Doulas, both trained and certified, as it implements Medicaid reimbursement for these desperately needed services.
Without adequate reimbursement rates for these services that provides a thriving wage for Doulas, not only will New York State fail to interrupt the current maternal health crisis, but we will see higher burnout of the Doula workforce. Inadequate reimbursements will lead to families with the greatest levels of need unable to be adequately served, and disincentivize the Doula workforce from working with Medicaid recipients altogether.
Inclusive Alliance aims to support our local community-based Doula networks by providing the administrative infrastructure required to bill Medicaid, to make meaningful impacts in the maternal health population across Central New York. We look forward to the inclusion of Doula services as a Medicaid reimbursable service and thank you for the opportunity to provide testimony on this incredibly important topic.