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What happened with doulas in the state budget?

July 6, 2023
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Community Solutions has been working for several years with the legislature and both the Kasich and DeWine Administrations to improve women’s and maternal health in Ohio. One key element of this work is expanding access to doulas. When we learned that one of Governor DeWine’s budget vetoes was related to doulas, we had to dive in and figure out what happened.

 Doulas are professionals trained to provide non-medical, emotional and physical support throughout a woman’s pregnancy, childbirth and postpartum.

First, a quick description of why doulas are so important. Doulas can play a vital role in the lives of people who give birth and their families. Doulas are professionals trained to provide non-medical, emotional and physical support throughout a woman’s pregnancy, childbirth and postpartum. While a doula may work alongside medical staff to create a comfortable environment, a doula’s primary role in the medical setting is to serve as an advocate for the family he or she works for. This is especially important for women of color who have significantly higher rates of maternal mortality and morbidity compared to white women. Having an advocate in health care settings is literally an issue of life and death.

Doulas in the state budget

There have been efforts, now spanning three General Assemblies, to create a certification process for doulas and require that Medicaid pay for doula services. This certification is necessary for Medicaid payment of doulas as a provider type. Legislation in the 133rd and 134th General Assemblies to achieve this stalled out, so we looked to the budget in the 135th General Assembly, House Bill 33, as a vehicle to finally get this done! It was a windy path to get here (the House added in language to expand access to doulas, the Senate removed it, it was added back in in the Conference Committee. Trace the entire budget process.)  

Ultimately the legislature passed the budget on June 30, 2023 with language that creates certification for doulas through the Board of Nursing and includes Medicaid coverage of doula services.  

Here’s where the confusion starts…one of the Governor’s 44 vetoes deleted SOME of the text in the section of the bill where the doula certification process and Medicaid coverage are created. We know this has created a misunderstanding by some in the media, and likely beyond, that the Governor vetoed the entire section of the bill that expands access to doulas. This is not the case. In a nutshell, here’s what is in versus out from the budget language:

  • Language that establishes doula certification and specifies that the rules for issuing certificates to doulas will be developed through the Board of Nursing IN
  • Medicaid coverage of doulas IN
  • Language that made doula services a 5-year pilot program OUT  
  • By vetoing the pilot, this program is now permanent
  • Language that named specific organizations that could certify doulas OUT  
  • Certifying entities will be determined by the Board of Nursing
  • Language naming specific organizations that needed to be represented on the doula advisory board within the Board of Nursing OUT  
  • The advisory board will be comprised of at least 13 members spanning maternal/infant health organizations, public health, current doulas, a consumer and with a goal of including people who represent areas with higher rates of maternal and infant mortality and greater disparities.
  • Language that required a report on outcomes OUT  
  • The Governor’s veto message cited this as duplicative of other reporting requirements.We are hopeful that this is helpful in understanding what happened during the budget process, as it relates to doulas (we’ll certainly explore more in the coming weeks and months). This is an issue that Community Solutions has been working on for many years now and we are eager to work with the Board of Nursing, the Department of Medicaid, organizations and people across the state who know how important it is to expand access to doulas.
 At the end of the day, Ohio is on a path to permanently cover doula services.

At the end of the day, Ohio is on a path to permanently cover doula services which will lead to healthier outcomes and expand access to a service that we know can help to reduce maternal and infant mortality.

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