Opinion: Why Utah must cover doula services through Medicaid

An effective solution exists for strengthening access to vital health care for vulnerable Utahns, but it has not yet been enacted.

Doulas are individuals who provide support before, during and after childbirth. And while doulas deliver a plethora of benefits to those they assist, the White House recently reported that just 6% of women giving birth do so with the support of a doula.

Legislators in Utah recently looked to address this problem. 2023′s SB192 and 2024′s SB85 , both titled Medicaid Doula Services, were introduced in the state’s two most recent legislative sessions.

These nearly identical bills would have required Utah’s Department of Health and Human Services to develop a state plan amendment that, if approved, would establish Medicaid coverage for doula services in the state.

Despite passing the Senate with bipartisan support and not a single “no” vote, these bills did not pass the House of Representatives and were thus not enacted into law.

These bills’ failure to pass is surprising not just because of their unanimous support in the Senate but also because their aim is supported by a large body of recent research.

A team of researchers led by Dr. Katy Backes Kozhimannil of the University of Minnesota found in a 2012 study that Medicaid beneficiaries with doula coverage and support have 40.9% lower odds of cesarean delivery.

Additionally, a group of researchers also led by Kozhimannil found in a 2016 study that beneficiaries with doula coverage were 22% less likely to experience preterm births.

Doula support was also found by researchers led by Dr. April M. Falconi of Anthem Inc. in a 2022 study to have mental health benefits, including lowering postpartum depression and anxiety rates by 57.5% for beneficiaries.

This is especially relevant to Medicaid coverage as a 2020 analysis conducted by a team of researchers at Harvard and MIT found that those with the lowest incomes in a community, or those who may be eligible for Medicaid, are 1.5 to 3 times more likely than those with the highest incomes to experience depression or anxiety. Thus, doula coverage through Medicaid addresses this problem for vulnerable populations.

So why did Utah not enact these bills? Medicaid financed 17% of Utah’s births in 2022, so this initiative could benefit many Utahns.

Opponents of the bills may cite cost concerns in the program’s execution. However, this strategy may actually save funds for Utah’s Medicaid program.

As shared above, doula support lowers preterm and cesarean birth rates. Kozhimannil’s 2016 study also found that infants experiencing preterm births have 10 times higher medical costs in their first year than full-term infants, while cesarean births are twice as expensive as vaginal births.

The result of these complications is higher costs for payers, which for Utah, is Medicaid 17% of the time.

So, if doula support reduces these complications, doula coverage could potentially reduce Medicaid costs as well. But is this a reality in these programs?

Kozhimannil’s 2016 research found it to be so. Using a cost-effective analysis, doula services reimbursed at an average of $986 were found to yield potential cost savings. In other words, doula services reimbursed at $986 or less could actually save Medicaid program funds. This rate ranged from $929 to $1,047 among states.

And, indeed, 2023′s SB192′s fiscal note shows an average of $691 would be spent on 350 clients annually, while 2024′s SB85 would spend an average of about $989 for 470 clients annually.

SB192′s program could likely lead to cost savings, as it is below the range, while SB85′s would be within the range, meaning it could potentially lead to cost savings. Regardless, either bill has potential to save Utah Medicaid program funds.

Overall, research has shown programs providing Medicaid coverage for doula services are successful, as they give access to vital physical and mental health benefits for vulnerable populations while also potentially saving state funds.

Ultimately, to prioritize its families and reduce spending, Utah must pass a bill covering doula services through Medicaid in the 2025 legislative session. This is a vital and effective step forward to making health care more accessible — and more economic — in Utah.

Max Lepore is a political science student at the University of Utah. He has worked various roles in public service both for the state and federal government and is looking forward to a future career in law.