- Physicians (does not apply to Cal MediConnect)
- Participating Physician Groups (PPG)
(does not apply to HSP)
This section contains general member benefit information on nurse midwife services.
APL 22-031, a physician or other licensed practitioner must recommend doula services to an eligible Medi-Cal member. The physician or licensed practitioner that provides the recommendation does not need to be enrolled in Medi-Cal or be in-network.
Doula services are considered preventive and offer support before, during and after childbirth. Doulas do not diagnose medical conditions, provide medical advice, or clinical assessment, exam, or procedure.
Select any subject below.
The member must be active and enrolled in the Medi-Cal Plan.
- Doulas must verify eligibility for the month of service by contacting the Plan.
- The member must be pregnant or have been pregnant within the past year and would benefit from doula services or requested doula services.
Initial recommendation – the physician or licensed practitioner can use one of the following methods:
- Member’s record – written recommendation added.
- Standing order for doula services.
- A signed standard form that the member can give to the doula.
Second recommendation – Additional visits during the postpartum period require a second recommendation:
- Up to nine postpartum visits can be added.
- Cannot be established by a standing order for doula services.
Members can receive doula services virtually or in-person in any setting, such as home, office, hospital, or an alternative birthing center. All visits are limited to one per day, per member.
The initial recommendation authorizes the following:
- One initial visit.
- Additional visits – up to eight given in any combination of prenatal and postpartum visits.
- Labor and delivery support – including miscarriage, stillbirth and abortion.
- Postpartum – up to two extended three-hour visits. These visits do not require the member to meet any criteria or receive a separate recommendation.
Doulas can also give assistive or supportive services during an in-home prenatal or postpartum visit. This support provides face-to-face interaction while helping with emotional or educational support, such as folding laundry or drying dishes with the pregnant member. An assistive or supportive activity with the member cannot be billed to the member.
Doulas should work with the member’s primary care physician (PCP) or contact the Plan to refer a member to a network provider for the following services:
- Behavioral health services.
- Belly binding after cesarean section by clinical personnel
- Clinical case coordination.
- Health care services related to pregnancy, birth, and the postpartum period.
- Childbirth education group classes.
- Comprehensive health education including orientation, assessment, and planning (Comprehensive Perinatal Services Program services).
- Hypnotherapy (non-specialty mental health service).
- Lactation consulting, group classes, and supplies.
- Nutrition services (assessment, counseling, and development of care plan).
- Medically appropriate Community Supports services.
If a doula teaches classes, the classes can be offered at no cost to a member receiving services from the doula.
The following are not covered under doula services:
- Belly binding (traditional/ceremonial)
- Birthing ceremonies (i.e., sealing, closing the bones, etc.)
- Group classes on babywearing
- Massage (maternal or infant)
- Placenta encapsulation
- Vaginal steams