Birthing support advocates could receive Medicaid reimbursement if this bill passes

Doulas are trained birthing coaches who help women through pregnancy and childbirth. And if a bill passes through state legislation, this resource could be available to Nebraskans who use Medicaid.

Legislative bill 1258, introduced by state Sen. Terrell McKinney of North Omaha, would make it so the Department of Health and Human Services would reimburse for full spectrum doula services. This bill is not only important for those who may be low-income, said executive director for reproductive justice organization I Be Black Girl Ashlei Spivey. She said more access to doulas could help address the disparities in maternal and infant mortality rates in Black communities.

​“There are accessible interventions that allow for people especially Black people to not only live through their birthing experiences, but thrive," she said. "Doulas specifically full spectrum doulas can disrupt families experiences of harm, mistreatment and adverse health impacts by acting as an advocate while enhancing feelings of agency security and respect."

Data from fiscal year 2020 shows about 12% of Nebraskans were Medicaid recipients. And according to a report from the Nebraska Office of Health Disparities & Health Equity, 28.6% of African Americans in Nebraska live below the poverty level. This is behind American Indians at 32.6% and above Hispanic or Latino and Asian, 22.7% and 19.3%, respectively.

There is an amendment in the works that clarifies the reimbursement would go to the doula as opposed to the individual who uses the service.

Those opposed to the bill said they’re concerned it could add more barriers to doulas by "tying [their] hands" and adding too much government restriction on who can be a doula. They also expressed concern about the why doula is defined in the bill, which they said leaves out some services a typical doula would provide. They did not, however, oppose doulas' roles in addressing maternal and infant health disparities in the state. There are currently no state requirements for who constitutes as a doula, rather doula certification comes from other private organizations.

​​“To access doula services would help to ensure a higher quality of care for low-income women provide culturally appropriate and patient centered care and reduce unacceptable racial disparities in maternal and infant health outcomes in Nebraska," said Sydnie Carraher, program administrator for the Nebraska Perinatal Quality Improvement Collaborative, in support of the bill.

According to the Centers for Disease Control and Prevention, non-Hispanic Black people in the U.S. had a maternal mortality rate of 69.9% in 2021 compared to 26.6% for non-Hispanic white people.

Sen. McKinney said he is willing to make amendments to the bill to account for the concerns in opposition to the proposed legislation.