24-610m Let Pregnant and Postpartum Medi-Cal Members Know About the Benefits of Doula Services

Date: 06/20/24

Doulas offer assistive and supportive services before, during and after childbirth

Research shows that pregnant people who have doula support have a decrease in their cesarean section (C-section) rates and an increase in prenatal and postpartum visit rates.

To help close the gap in C-sections and postpartum care, Health Net sponsors and supports the new Medi-Cal community doula benefit. We view doulas as an integral part of health and wellness for pregnancy, delivery and postpartum care.

Doula services are preventive

Effective January 1, 2023, physicians and other licensed practitioners 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.¹

• 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.

Eligibility requirements

The member must be active and enrolled in a Medi-Cal plan with Health Net.

• Doulas must verify eligibility for the month of service by contacting
  Health Net.
• The member must be pregnant or have been pregnant within the past year and would benefit from doula services or requested doula services.

Initial coverage 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 services include the following:

• One initial visit.
• Additional visits – up to eight given in any combination of prenatal and postpartum visits.
• Labor and delivery support – including a miscarriage, a 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.

Additional visits during the postpartum period require a recommendation: 

• Up to nine postpartum visits can be added.
• Cannot be established by a standing order for doula services. A recommendation can be provided to the member or the doula.

Assistive services during visits

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.    

Coordinating services

Doulas should work with the member’s primary care physician (PCP) or contact Health Net 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).
• Transportation.
• Medically appropriate Community Supports services.

Note: If a doula teaches classes, the classes can be offered at no cost to a member receiving services from the doula.

Non-covered doula services

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)
• Photography
• Placenta encapsulation
• Shopping
• Vaginal steams
• Yoga

Questions about doula services

Providers and other physicians can refer members to contact Member Services about available doula services. The number is on the back of their medical identification card.

Mahmee wraparound maternity care

More maternal support services are available to Medi-Cal members through Mahmee. Those who enroll in Mahmee have greater access to a range of health services and support tools at no added cost. Support is available from conception to one year postpartum.

Examples of available support/services include, but are not limited to:

• Registered nurses – remote patient monitoring, high-risk pregnancy support and child and newborn education.
• Lactation consultants.
• Doula care – virtual support for stillbirth, abortion or miscarriage. In-person services available in some counties.
• Mental health and nutrition coaching.
• Care coordination.

It’s easy for members to register.

1. Go to Mahmee website.
2. Call 818-431-1118 to speak to a Mahmee representative.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone 800-675-6110 or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.

¹See All Plan Letter (APL) 22-031, Doula Services, dated December 22, 2022.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, including Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.