The Arkansas Department of Human Services missed yet another deadline to extend Medicaid coverage to doula services across the state. But doulas' worry reached beyond these delays. Ozarks at Large's Eva Mundo has the details.
The process to implement this coverage began in February 2025 with the Healthy Moms, Healthy Babies Act. Aaron Pilkington is a state representative for District 45 and one of the co-sponsors of the bill. He says their ultimate goal was to lower maternal and infant mortality rates across the state. And through doulas' work as a bridge for communication between doctors and patients, they wanted to find ways to extend access to their services.
"We wanted to do a comprehensive package. And so, as we had these working groups around the state come together and talk and figure these things out, one thing became clear was that doulas could be a valuable ally in helping us reduce maternal health deaths in Arkansas, especially in rural parts of the state in the Delta."
Pilkington says that there have been frustrations with delays in the implementation and reimbursement rates that doulas will receive, but those complaints have not been as prevalent recently.
"I think a lot of them have understood the process and that's been explained by DHS, and they know they're working on it. So, while they may be frustrated, I think they understand that we're all pulling in the same direction. And for this way, it's not from lack of willingness to get it done. I think it's just been a lack of resources and time to get it done in the proper way."
He also says that there are fears among lawmakers about issues that might not appear until later on, when they are no longer in session.
Liyah Wasson is the co-founder and executive director of the Doula Alliance of Arkansas. Her organization works with providers across the state to increase access to their services. She says that she has been watching Medicaid coverage be implemented for doula care nationwide.
"I’d say we’re doulaing the doulas, so we're standing between the doulas and the state and really supporting the doulas through this shift that's happening right now with legislation, state governments and things of that nature. So we have this standing team of doula leaders meeting each month where I meet with the doulas who are leading what's happening and all of the transforming maternal health state. I did a nine-month IMI doulas and CHWs and Medicaid training long before DA-AR was even an idea. So I've really been following this work for years before Arkansas was even thinking about bringing doulas on the map."
Wasson says that while this new Medicaid coverage will extend the accessibility of doula services to many new clients, providers have concerns about the rise in late or low reimbursement rates, as well as administrative burdens.
"Feelings are mixed, and I am a practicing doula myself, so even as a co-founder and someone who helped create the scope of practice, still, even my own feelings are very diverse on this. There is the excitement about the accessibility for families and what this means as far as who gets to access doula services."
She says that before Medicaid and private insurance reimbursement, these services were all out of pocket costs for clients, and doula packages can cost up to $1,500 in Arkansas, with even higher rates in other states. Doulas focus on quality versus quantity. Wasson says that an individual doula typically will not take more than three clients who have due dates within the same month. But this also means that reimbursement rates of just over $900, with month-long gaps between services and payments, are not sustainable for doulas to continue in full-time positions.
"Because this isn't work that has been designed yet to be sustainable for the doulas to do full time, they're going to go do something else because the bills will still need to be paid in the meantime. So that is where I really worry and have hesitancy that on paper this all sounds great, but then when we're actually looking at implementation and what this means for the doula workforce, is this truly sustainable? And right now, unfortunately, I don't think that's the case."
Wasson says that she has been observing other states implementing Medicaid coverage for doula services with varying success. The outcomes in some states raise concerns about the eagerness that Arkansas' implementation has come about.
"I wish we had written in more time for ourselves, really like a two-year span to get implementation off the ground. I think we just didn't give ourselves enough time. We were too excited. And then of course, the drawback from that is that then people are expecting the benefit and it's not ready, but it has given us a lot of time to prepare ourselves. The doulas, the organization, as well, while the state is preparing at their level so that we can really get processes and procedures and administrative duties in order."
The Arkansas Advocate reports that the Healthy Moms, Healthy Babies Act requires coverage of doula services from Medicaid and private insurance plans. Act 965 was also passed in 2025 and gave the Arkansas Department of Human Services a deadline of Dec. 31, 2025, to implement Medicaid coverage of doula care with approval from state legislators. However, the DHS has still not met these requirements more than five months past its deadline. This has also caused a lag within private insurance companies, who are waiting on the department to proceed with their own doula coverage.
Wasson says that the delay in this implementation could be because of several moving pieces in the legislative side that need to fall into place on the state level, they're waiting for the DHS to move forward with Medicaid rules and regulations, while on the federal level, the Centers for Medicare and Medicaid Services requested a change on a page that needs to be sent back for readjustment.
She says that she is not personally opposed to this extended time, because they could use another year to educate partners and stakeholders in the community on why doulas deserve higher reimbursement rates. However, she says that this delay will harm families unable to access doula services without Medicaid coverage.
"So many families will not receive doula services because without Medicaid and insurance reimbursement in place. It's just not accessible for them. It's not an option."
Wasson said DHS had a deadline of June 1 to begin reimbursements. They missed that deadline. She says they updated the deadline to Aug. 1, but she's skeptical that this will happen. She does hope that this legally mandated coverage will go live sometime this year.
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