The Medi-Cal Doula Benefit
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Doulas provide physical, emotional, and educational support during pregnancy, birth, and the postpartum period. Their support helps reduce complications during delivery, lower C-section rates, and shorten labor.
They also empower people who are pregnant by helping them understand their choices and feel supported through the process. Since most pregnancy-related deaths are preventable, doulas play a key role in improving safety and care outcomes.
Because of their important work, the California Department of Health Care Services (DHCS) added the doula benefit to Medi-Cal through the CalAIM initiative in January 2023.
Today, if you are pregnant or recently gave birth and have Medi-Cal, you can receive doula services at no cost. These services include more than just labor and delivery. This article explains what services are included and how doulas can get reimbursed through Medi-Cal.
Click below to learn more about what services are included, becoming a Medi-Cal Doula Provider, and the reimbursement rates.
Doula Services Covered by Medi-Cal
Medi-Cal covers doula services as a preventive benefit for members who are pregnant or were recently pregnant.
Doulas can provide services in person or virtually. The setting depends on what is best for the client. Medi-Cal reimburses for both types of visits.
Covered services include:
- 1 initial visit
- Up to 8 additional visits, which can be used before or after the birth
- Labor and delivery support, including support for miscarriage, abortion, or stillbirth
- Up to 2 extended postpartum visits, each up to 3 hours
You can only bill for one visit per member per day, unless you are providing labor and delivery support.
If two doulas work with the same member on the same day, only one doula can bill for that day, except when the visit is for labor and delivery, stillbirth, abortion, or miscarriage support.
In those cases, one prenatal or postpartum visit can be billed on the same day as labor and delivery services. The prenatal or postpartum visit may be provided and billed by a different doula than the one attending the birth.
Additional Postpartum Visits
In some cases, members may need more support after giving birth. Medi-Cal allows up to 9 extra postpartum visits, but these require a new written recommendation from a licensed provider.
This recommendation must be documented before services are provided. The doula should keep a copy of the recommendation in their records.
See more information here.
Becoming a Medi-Cal Doula Provider
To get reimbursed, you need to enroll as a Medi-Cal provider. You can apply as an individual or as part of a group. Before you apply, make sure you:
- Are at least 18 years old
- Have a government-issued ID
- Have a Federal Employer Identification Number (FEIN)
- Hold any required local business licenses or permits
- Have a business or administrative address
- Are certified in adult and infant CPR
- Complete HIPAA training
- Finish a Medi-Cal-approved doula training program or qualify through experience
- Have a contract with a Medi-Cal Managed Care Plan (MCP) or a licensed referring provider
You can submit your application through the Provider Application and Validation for Enrollment (PAVE) portal.
Once you're approved, your name will appear in the Department of Health Care Services (DHCS) Doula Directory. You’ll also need to complete at least three hours of continuing education in maternal, perinatal, or infant care every three years.
Medi-Cal Doula Reimbursement Rates
| Service | Code | New Rate |
| Extended initial visit (90 min) | Z1032 | $197.98 |
| Prenatal visit | Z1034 | $162.11 |
| Postpartum visit | Z1038 | $162.11 |
| Extended postpartum support | T1032 | $486.36 |
| Doula support during vaginal delivery | CPT 59409 | $685.07 |
| Doula support during C-section | CPT 59620 | $795.73 |
| Doula support after miscarriage | HCPCS T1033 | $250.85 |
| Doula support after abortion | CPT 59840 | $250.85 |