Full Breakdown
Virginia’s Medicaid Doula Reimbursement Faces Access Gaps
8/11/2026, 9:20:18 PM
Policy Overview
In 2022 Virginia joined three other states by beginning Medicaid reimbursement for doula services. The law requires a physician referral and state certification for doulas to bill Medicaid. Reimbursement is $859 per pregnancy, with an additional $100 if the client attends prenatal and postpartum doctor visits. Medicaid covers up to eight doula visits; only the first visit is unlimited, while subsequent visits are capped at one hour each. The same rate applies statewide, despite higher living costs in areas such as Alexandria.
Implementation Challenges
A review of the Virginia Certification Board’s Doula Registry this June identified just 19 doulas in Northern Virginia who accept Medicaid payments. Doulas report that extensive paperwork, certification fees of $75-$150, and delayed reimbursements deter participation. The low rate—far below private-pay fees of $1,200-$3,000 per pregnancy (up to $6,000 for extensive services)—has resulted in limited provider availability. Desirae Leaphart Mensah’s study of 2022-2024 data found that during the first two years of the program, fewer than 1% of Medicaid births in Virginia used doula services.
Impact on Families and Providers
Parents who do receive Medicaid-covered doula care cite reduced stress and stronger advocacy during birth. Juliana Navia, who connected with a doula at a free prenatal clinic, described how her doula helped her navigate hospital care. For doulas, the reimbursement amount is viewed as insufficient; Kenda Denia, executive director of Birth in Color, notes that midwives and doctors receive higher payments for comparable travel and home-visit work.
Official Statements & Responses
Taja Iglesias, founder of The Momager Co. and co-chair of Virginia’s task force on doula regulations, says the certification process should be faster and less costly, arguing that current requirements limit Medicaid beneficiaries’ access. Denia acknowledges the law’s intent to expand support but highlights “logistics that are not working,” calling for higher rates that reflect the true value of doula services.
Verbatim Quotes
- “We kind of created this to fill the gaps that we realized existed because we had to go through it,” — Taja Iglesias, founder of The Momager Co.
- “The doula is the person that already knows what you want. We know what your dream birth is,” — Taja Iglesias, founder of The Momager Co.
- “If you want to actually build a relationship with this person that you’re going to be standing in with in their most vulnerable moment, it ain’t happening,” — Taja Iglesias, founder of The Momager Co.
- “But now we’re looking at certain logistics that are not working,” — Kenda Denia, executive director of Birth in Color
- “I was stressed giving birth, but my doula helped me,” — Juliana Navia, Medicaid beneficiary.
