The majority of western states now let Medicaid help cover the cost of doulas, the trained professionals who provide emotional support and information to people before, during and after childbirth.
It’s a change from a decade ago, when only two U.S. states allowed Medicaid to reimburse doulas for their work. Now, 28 do, including Arizona, Colorado, Nevada, New Mexico and Utah. That’s according to a map from the National Health Law Program, a healthcare advocacy group for low-income patients.
Montana could join the lineup later this year, and some lawmakers and advocates in Wyoming are considering it.
“I'm seeing way more clients coming in inquiring about doula care,” Colorado postpartum doula Ali Batwin said on Sept. 2 at the Wyoming Maternal Health Summit in Laramie, Wyoming, a first of its kind event organized by the state university’s Rural Health Institute.
In Colorado, Medicaid started reimbursing up to $1,500 for doula care in 2024.
“It really was a thing that only wealthy people could afford,” said Batwin. “Now that Medicaid is covering it, we're seeing better outcomes across all socioeconomic statuses.”
Research has shown doulas can decrease C-section rates by as much as half or more, and at the same time increase breastfeeding rates. While they aren’t medical professionals, they help clients make informed decisions before and during childbirth, and help them get the care they need after birth.
Almost two-thirds of maternal deaths in 2020 happened in the postpartum period, up to a year after birth, according to a U.S. Department of Health and Human Service report. Common causes include cardiac events, hemorrhage, and postpartum depression or anxiety.
The federal Centers for Disease Control and Prevention says more than 80% of pregnancy-related deaths are preventable.
Amy Chen, senior attorney at the National Health Law program, said people became more aware of these statistics when the Covid-19 pandemic hit, illustrating health inequities.
“I think people were kind of both getting more knowledge and understanding about maternal mortality and morbidity, and then also more specifically really understanding the kind of racial disparities in care,” Chen said.
Chen said that supporting doula care is one way to reduce these disparities and that the majority of states have passed Medicaid reimbursement for doulas since the pandemic.
“You're able to provide really individualized attention and support to the birthing person,” she said.
Chen wants to see states like Wyoming follow the model of other rural states in providing reimbursements to doulas. For example, Nevada allows higher reimbursement for certified doulas working in rural areas than urban ones to account for travel costs and larger care gaps.
Medicaid reimbursements for doulas was one of several maternal health solutions explored in a 2025 report prepared for Wyoming lawmakers. Sen. Gary Krum (R-Rawlins) and Rep. Mike Yin (D-Jackson) both expressed interest in the idea at the recent maternal health summit.
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
