Virginia lawmakers ask for study on requiring insurers to cover doula care

Two bills that would have required private insurers in Virginia to provide coverage for state-certified doula care were unanimously struck down last week by lawmakers in both chambers, who instead requested a study of the proposal.

The bills will now go before the Senate Health Insurance Reform Commission, which is charged with studying mandated health insurance benefits.

Del. Nadarius Clark, D-Portsmouth, and Sen. Jennifer Boysko, D-Fairfax, described their identical bills as a way to help reduce maternal mortality and alleviate some of the disparities in the care received by women of color and white women during and after pregnancy. Studies have shown that doulas—nonmedical professionals trained to provide a broad range of support services during pregnancy, birth, and postpartum — significantly improve outcomes for both parent and child, especially in low-income and minority populations.

In 2020, the General Assembly passed legislation creating a state certification process for doulas, meaning they must complete training approved by the Virginia Board of Health.

Clark and Boysko’s legislation this year would have required private health plans that include obstetrical services to cover at least eight doula visits for pregnant women during and after pregnancy and support during labor and delivery.

The United States has one of the highest rates of maternal death compared to other developed countries, Boysko told the Senate Committee on Commerce and Labor last week. Black women are nearly three times more likely than non-Hispanic white women to die from complications related to pregnancy and childbirth, according to the U.S. Centers for Disease Control and Prevention.

“There are a plethora of data and studies that have shown tremendous benefits and cost savings from providing doula care,” said Galina Varchena, policy director for Birth in Color RVA, an organization focused on providing maternal care for women of color that also worked on Clark’s bill.

Clark said in an interview that he still suffers from complications during his own delivery.

“We know there’s still implicit biases and different things that happen in our prenatal and health care systems,” he said.

In 2020, following the Health Insurance Reform Commission study, the General Assembly passed legislation making state-certified doula care available for Medicaid users.

Virginia currently has 87 state-certified doulas, and around 100 Medicaid members have received doula services so far, said Rebecca Dooley, communications director for the Virginia Department of Medical Assistance Services, in an email.

Douglas Gray from the Virginia Association of Health Plans told a House Commerce and Energy subcommittee last week that “typically in the commercial world, we have licensed people rather than certified people, so there needs to be a conversation about how this would work.”

The State Corporation Commission and the Virginia Bureau of Insurance will do a preliminary analysis of the costs and benefits of private insurance coverage for doulas before the Health Insurance Reform Commission holds public hearings on the proposal, said Dave Wesolowski, chief of staff for HIRC Chair Sen. George Barker, D-Alexandria, in an email.

By “opening up this door to allow private insurance to cover doula care,” Clark said, Virginia can “start giving the people that haven’t had a voice to finally have care.”