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SALT LAKE CITY — The Utah Senate's top Democrat argued that authorizing Medicaid to cover doula services for pregnant women would result in long-term savings. Her Republican counterpart agreed.
This bipartisan understanding was reached Friday during a hearing led by Sen. Mike Kennedy, R-Alpine. A bill, SB85, requiring the Department of Health and Human Services to apply for a Medicaid state plan was brought back to life by Senate Minority Leader Luz Escamilla, D-Salt Lake City.
While a similar bill passed the Senate with unanimous support in 2023, it came to a halt in the House upon being labeled a "Medicaid expansion," Escamilla and Kennedy said. But, the bipartisan duo noted, this slight expansion would actually result in a decrease in Medicaid spending coinciding with better maternal and infant health outcomes.
"There is a direct correlation related to the cost of care of who was getting all that experience by using doulas just because you have more preventive care," Escamilla said.
A doula is a trained professional, usually not an obstetrician, who is employed to provide support, comfort and advice during pregnancy, labor, childbirth and, sometimes, postpartum, Escamilla said. This care can include providing information about pregnancy, teaching breathing exercises for labor and crafting birth plans that the doula can advocate for during delivery.
"They help navigate women through this process," which, Escamilla said, is often filled with unknowns, particularly for first-time mothers.
Escamilla and Kennedy, who works as a family physician and urgent care doctor, both referenced numerousstudies that found significant positive effects of having a doula on healthy birth outcomes, including the rate of cesarean sections.
Kennedy said his wife, the mother of eight children, is a trained doula, and that he can testify to both their utility for mothers and their fiscal sense.
"Many of these efforts that we are on small levels expanding Medicaid; actually we're saving money with Medicaid by, in this case, allowing doulas to be covered by Medicaid," he said.
By decreasing the chances of medical emergencies, either by reducing a woman's anxiety during childbirth or by catching indicators of high-risk pregnancies early on, the inclusion of doula services under Medicaid coverage will "shrink Medicaid, not expand Medicaid," Kennedy said — a claim also supported by at least one study.
This was a point made by Holly Richardson, the editor of Utah Policy who attended the hearing as a former doula and doula trainer herself.
"I just wanted to speak to the cost savings. Doulas help reduce complications, so it saves Medicaid money," Richardson said.
The complications that become less frequent with the help of a doula include C-sections and intensive care unit admissions, Richardson said.
Escamilla's bill would open the door for certified doulas, who have received approved trainings, to receive Medicaid reimbursements if they contract with Utah Medicaid members.
Under the legislation, the Department of Health and Human Services would be required to develop a state Medicaid plan amendment. If approved, Medicaid will be required to provide coverage of doula services.
Utah has one of the highest fertility rates and out-of-hospital birth rates of any state. But it has the lowest rate of births financed by Medicaid in the country.
The cost of hiring a doula currently ranges from about $1,200-$2,500 in Utah, according to Doulas of Utah and Doulamatch.net.
Escamilla's bill, SB85, passed through committee with unanimous support and will now head to the full Senate for a floor vote.
