Medicaid reimbursement for doulas in Ohio started in the fall of 2024, and many entities are involved to ensure a smooth process for both reimbursement and certification. One of the entities is the Doula Advisory Group. Housed under the Ohio Board of Nursing, the Doula Advisory Group performs the following duties:
- Provides suggestions, guidance, and general advice to the Ohio Board of Nursing relating to State of Ohio doula certification and adoption of rules within divisions (D)(3) and (5) of Section 4723.89 of the Revised Code.
- Advise the board of nursing about people seeking to become eligible for Medicaid reimbursement as State of Ohio certified doulas.
- Offers recommendations, general advice, and guidance to the Department of Medicaid about the Medicaid coverage of doula services under section 5164.071 of the Revised Code.
Likewise, the Ohio Department of Medicaid (ODM) tries to help doulas navigate the reimbursement process. Sometimes, a representative from ODM attends the Doula Advisory Group meetings to listen to their concerns about the claim process. They also offered technical trainings in the past.
Major topics of concern among the Doula Advisory Group
The Doula Advisory Group held its first public meeting of the year on January 14, 2026, to discuss challenges navigating the Medicaid reimbursement process and a report due to the general assembly later this year.
Issues with online claim reimbursement and tech support
One of the issues doulas endure is Availity, a platform where providers can submit claims online for Medicaid reimbursement. During the public meeting, a couple of doulas, who are also members of the advisory group, expressed their frustrations about not receiving Medicaid reimbursement in a timely manner. They mentioned that there isn’t a systems administrator that can help them navigate the website if they have any questions or difficulties. A chatbot is available to offer guidance instead, which can pose as a limitation for doulas who are trying to submit Medicaid claims because there isn’t a person present in real time to trouble shoot issues.
Submitting a claim to a managed care organization can take hours
Another challenge in the Medicaid reimbursement process is how long it takes to submit a claim for each managed care organization (MCO). One doula said it took her eight hours to submit one claim for only one MCO. Fortunately, a representative from United Healthcare offered technical assistance/office hours on navigating the Medicaid process. If they haven’t done so already, other MCOs should consider offering office hours to help doulas understand the Medicaid reimbursement process.
Measures to improve health outcomes
One more discussion during the meeting was the creation of a report between ODM, the Doula Advisory Group, and the Board of Nursing. Together, these three entities will present to the General Assembly on the effectiveness of the Medicaid reimbursement program for doulas.
A professional from ODM presented a list of measures they could include to show how doulas help improve health outcomes for their Medicaid patients. Some measures include connecting patients to maternal mental health screenings and lactation supplies.
Members of the Doula Advisory Group suggested that ODM should include other measures, such as low birth weight, preterm birth, and breastfeeding
Members of the Doula Advisory Group suggested that ODM should include other measures, such as low birth weight, preterm birth, and breastfeeding. They expressed that the measures must show how successful doulas are in helping moms and babies remain healthy and in reducing infant and maternal deaths. The report is expected to be completed by April 30, 2026.
How to support the improvement of Medicaid processes for doulas
Doula Advisory Group meetings are open to the public. These are good opportunities for anyone to learn more or to voice their concerns or questions about doula state certification and Medicaid reimbursement. If interested in attending their meetings, the following are dates for 2026:
- April 8, 2026
- August 12, 2026
- November 4, 2026
As noted earlier, doulas are experiencing challenges reimbursing Medicaid claims. If you are a doula in Cuyahoga County and would like to explain your experience navigating the Medicaid reimbursement process, First Year Cleveland recently released a Medicaid Billing Experience Survey for providers. It is open until February 27, 2026. Responding to the survey will help First Year Cleveland to effectively advocate for the enhancement of Medicaid processes for providers.
