Doula services could soon be covered by Medicaid after racial equity bill passes OH House

Posted at 7:36 PM, Jun 08, 2022

COLUMBUS, Ohio — A bill that is aiming to combat racial disparities in infant and maternal mortality rates passed the Ohio House during a session Wednesday.

Cuyahoga County has one of the highest infant death rates in the country and has for the past 50 years, according to First Year Cleveland. For every white baby that died before they turned one, nearly six Black babies died, the organization reported.

Black families in Ohio face a significant amount of barriers while pregnant.

"I felt railroaded, but I was able to stand up and make my own choices," Chaundra Davis said. "I remember thinking, 'I know I can make my own choices, but how many women and birthing people don't know.'"

This is why Davis became a doula — so she could help others, specifically Black and Brown parents, feel like their voice is being heard.

"I do see rates of racial disparities in regards to care," she said. "There are a myriad of people out there who need this service for one reason or another, there is an underserviced community of women."

Restoring Our Own Through Transformation (ROOTT), an organization dedicated to addressing the needs of Black, Brown and women of color, said doulas, specifically perinatal support doulas, can help combat structural racism.

"They can save lives," Dorian Wingard, partner and COO of ROOTT, said. "They can prevent the death of mothers, they can prevent the death of children."

Between 2008 and 2017, Black women died during birth about two and a half times more than white women, according to the Ohio Department of Health. Black women also have twice the amount of birth complications.

That number isn't as high as new data, according to Jessica Roach, CEO of ROOTT, said. It also keeps growing.

"Most of the time it has to do with how our institutions approach not only access to prenatal care but really a receipt of respectful prenatal care," she said.

The pair added their perinatal doula program has a 0% maternal and infant mortality rate.

"We have opportunity to be able to work with our families, not only through preconception, the family planning phase but throughout the entire prenatal period," Roach said. "Also there for labor and delivery and then for extended postpartum services."

Doula services can result in lower rates of preterm births, as well as help save money for families, Wingard said.

The problem is — doula services can be costly.

"That's a service that's needed, and I shouldn't have to scrimp and save to save for it," Davis said. "I should be able to have that service, in the same way, I would if I fell and broke my arm."

Republican state Rep. Tom Brinkman, from Mt. Lookout, agreed, introducing and then getting House Bill 142 to pass the House. The bill was also introduced by former state Rep. Erica Crawley, a Democrat from Columbus, who then took a job as Franklin County commissioner.

Their bill would provide Medicaid coverage for licensed doula services.

"Access to continuous labor support from a doula is especially vital for birthing people of color," Crawley said in her initial testimony. "Black women experience higher rates of poor birth outcomes, including higher rates of cesarean, preterm birth, low birth weight, and infant death."

None of the above have to do with factors like the pregnant person’s income, education, marital status, tobacco or alcohol use and insurance coverage, the Dept. of Health showed.

"In other words, health and social factors alone can’t explain the higher rates of poor birth outcomes among Black people," the former Rep. said.

Brinkman had to convince his fellow Republicans to vote for the bill, he said.

"The hardest thing was to talk to my colleagues and say, 'look, we are going to expand Medicaid, which we don't necessarily want to do because we're trying to restrain costs, but what it's going to do is result in overall savings because we won't be paying for [as many complications]."

He explained that it could allow Ohio to save some money since doula services lead to fewer preterm births, which are expensive for the state.

"That'll be a better outcome not only for the moms but for the babies, too," he said.

To be eligible for payments under the Medicaid program's coverage of doula services, a doula must have proof of a valid certificate, evidence that they completed that includes numerous types of training and proof of attendance of at least one breastfeeding class, two childbirth classes and two births.

"I'm 100% pro-life from conception to natural death and so we have a Roe v. Wade decision coming down here soon," the Republican said. "We want to make sure that if we're eliminating abortion in the state of Ohio, we want to make sure that having a child is not a death sentence.

"We do have a high infant mortality rate and we want to have better outcomes for moms and babies. Let's put some money behind this and try to have those better outcomes."

But, there are some major concerns.

"You have to, unfortunately, fall under some of these particular terms in order to be able to be reimbursed by Medicaid based upon some of these training models," Roach said.

Roach points out that yes, specific services can be reimbursed, but reimbursement rates aren’t clarified. The bill also has a level of training doulas have to go through from specific organizations to become eligible, which could put up additional barriers.

"It's not a simple light switch, 'Medicaid reimburses all black babies, the mothers are going to stay alive now,'" Wingard said. "That's not what we're talking about. What we're talking about is yet another small step in a ocean of steps that need to be made."

H.B. 142 provides an opportunity to structure and fund this critical service for Black families but doesn't hit the mark completely.

"Given the disproportionate impact of infant and maternal mortality on Black communities for a variety of institutional and systemic reasons caused by racism, it is counterintuitive to expect that solutions that ignore this fact will be effective," Roach said. "Therefore, Medicaid reimbursement must be comprehensive and reflective of the value of the range of services delivered, with an understanding that a singular approach or rate will not answer the needs of diverse Black families."

That being said, getting it passed is still important.

"It is something that is necessary and I hope that it comes to fruition definitely," Davis said. "Black, brown women who are not only not able to have this support but are dying or are losing their lives because they don't have adequate support because their voices aren't heard."

Each wants the bill to go through the senate, but says that institutional and structural change is needed to truly save the lives of Black families.

Follow WEWS statehouse reporter Morgan Trau on Twitter and Facebook.