Doulas assist with nonmedical techniques during active labor such as massaging, breathing, and positioning. Additionally, doulas offer emotional support and, in some instances, provide advocacy for mothers during the birthing process. There are two types of doulas: birth doulas and postpartum doulas.

Midwives are medical professionals that are trained to provide prenatal, birth, and postpartum care. There are several types of midwives, but Certified Nurse-Midwives (CNMs) are registered nurses with additional training in midwifery. Midwives can provide care in hospitals, clinics, birth centers, and even homes.

Across health plans, and especially in the Medicaid line of business, coverage for doulas and midwives is expanding. To date, more than half of all states are providing coverage for doulas, are in the process of implementing coverage for doulas, or are developing statewide action related to Medicaid coverage for doula care. Every state currently reimburses CNMs in Medicaid, but only 18 states provide reimbursement for midwives without a nursing degree. More states are pursuing reimbursement for midwives with different licensures and trainings.

Counties across the United States are limited in providers who can offer prenatal and postpartum care since some counties are without a traditional obstetrician-gynecologist (OB/GYN) provider. As the maternal health crisis holds strong, increasing the pool of providers who provide care to pregnant people is imperative to expanding access and improving outcomes.

Studies have shown that doulas and midwives can reduce racial disparities, drive down overall perinatal spend, and improve birthing experiences and outcomes. One study compared Medicaid recipients who utilized doulas to those who did not. Outcomes showed that patients who were provided doula support had lower C-section rates and pre-term birth rates among subgroups that included Black women, suggesting doulas play an active role in reducing racial disparities.

Doulas and midwives not only improve maternal health outcomes, but also contribute to cost containment related to pregnancy and birth complications. Recent research has estimated that by 2027, if midwives were leading care for 20% of births, savings would reach $4 billion.

• Ongoing interest and investment in doulas and midwives at the federal level. The Biden Administration has voiced its commitment to expanding maternal health programming.
• New policies at the state level that aim to diversify the workforce for maternal health care and advance health equity practices.

Blue Cross Blue Shield of California

Blue Cross Blue Shield of California is working with community-based organizations to train doulas and provide more mothers with access to doulas. The organization has also invested in the Futures for Black Moms & Babies Initiative to address ongoing racial health inequities impacting maternal health outcomes.

Blue Cross Blue Shield of Minnesota

Blue Cross Blue Shield of Minnesota partnered with Everyday Miracles to offer a free, four-day training for doulas. The training focuses on recruiting doulas of color to help pregnant people of color who have been marginalized. Blue Cross Blue Shield of Minnesota also doubled doula reimbursement for births that were covered by Medicaid.

Humana

Humana created HumanaBeginnings™ for their pregnant members and new mothers. This program allows members to work with a care manager and access useful resources and benefits, like a free portable crib. The program also provides pregnant members with services from a doula that includes prenatal and postpartum assistance.

UnitedHealthcare

UnitedHealthcare¹ is increasing access to doulas for its Medicaid members by partnering with The Doula Network to provide comprehensive doula support in five states: Texas, Washington, Arizona, Kansas, and Kentucky. The organization has also invested in two other organizations: Birthing Advocacy Doula Training (BADT) and Cornerstone Doula Training. These partnerships will create scholarships for doulas, aiming to increase access to holistic support to improve birth outcomes.

The postpartum period is considered the time following the birth of a child, but it’s often debated when the postpartum period ends. This confusion has contributed to the limited coverage available to new mothers, especially those with Medicaid, until recent years. U.S. federal law requires states to provide Medicaid coverage through 60 days postpartum. Through the Consolidated Appropriations Act 2023, states were provided the option to extend Medicaid postpartum coverage through up to 12 months following the birth of a child. Prior to this legislation, states who wanted to extend postpartum coverage had the option to utilize 1115 waivers. Following the Consolidated Appropriations Act, most states are extending postpartum coverage or planning to implement extended coverage. Health plans in other lines of business are also adding additional postpartum benefits, including mental health coverage for postpartum care.

During the postpartum period, new mothers are assessed for how well they are recovering after childbirth. Postpartum visits typically address mental health, assessing for postpartum depression, which is a common condition following the birth of a child. Providers can also assist with family planning, providing options for contraception. Because this is often a fragile period and varies in complication and recovery, ensuring adequate care is essential to the health of the mother. Lack of care could have long-term repercussions.

A study analyzing Medicaid claims found that women who were postpartum, and other people who had extended coverage, benefitted from three times the number of mental health and substance use disorder services. These individuals were also more likely to get preventive care.

Other studies have shown that patients with extended coverage in the postpartum period are able to continue to fill prescriptions for chronic conditions, obtain mental health services, and receive assistance with family planning. Estimates show that approximately 45% of patients whose Medicaid coverage ends 60 days after pregnancy become uninsured, putting them at higher risk for complications and without access to care.

Further, individuals without insurance after 60 days have less access to contraceptive resources, putting them at risk for short interval pregnancies. Short-interval pregnancies are at higher risk of poor maternal health outcomes and infant health outcomes. Extending postpartum coverage can reduce long-term costs and improve overall maternal health.

• Postpartum care benefit design and coverage: How states and MCOs are extending coverage through behavioral health initiatives and preventative care.
• New policies at the state or federal level that impact how postpartum care must be delivered across all lines of business.

Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Illinois leads the Special Beginnings program, this program helps pregnant members until post-delivery and assists them with managing their pregnancies. Members have access to online educational resources, incentives for going to prenatal and postpartum doctor visits, and free cribs and car seats.

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan expanded their maternal healthcare benefits to be more inclusive of the childbirth and child-rearing journey. The program includes prenatal and postpartum resources, NICU support, and care management for pregnancies that are high-risk. Benefits also include a parenting and pediatrics program where parents can access coaching and support for childcare and for children with special needs.

Centene

Centene leads the Start Smart for Your Baby program (SSFB) across several health plans and states. There are four pillars within the program: early identification, health education, care coordination, and equitable access. The program offers a postpartum guide, breastfeeding support, weekly text and email programs, and assistance with feelings of depression or anxiety following childbirth.

Artificial intelligence (AI) is growing in usage in the healthcare industry given the potential to enhance patient care and reduce administrative burden. Artificial intelligence encompasses a wide-range of technology and has a variety of applications for maternal healthcare, such as identifying high-risk patients and perinatal complications. Although AI usage is growing, other non-AI applications are also making strides. Technology-based tools, such as pregnancy tracking apps and prenatal education platforms, are becoming widespread to increase prenatal and postpartum education and to assist people with tracking important pregnancy information. Health plans are incorporating AI and other technology-based tools to drive better maternal health outcomes and increase engagement with their pregnant and postpartum population.

Preconception

• Genetic compatibility
• Fertility
• Fertility tracking
• Communication

Artificial reproductive technologies

• Embryo quality
• Assessment of disease risk
• Method of implantation
• Egg quality

Preconception

• Genetic compatibility
• Fertility
• Fertility tracking
• Communication

Preterm birth

• Contraction pattern
• Cervical properties
• Prediction of perinatal outcome

Perinatal care, Birth/Delivery

• Estimated date of delivery
• Mode of delivery
• Perinatal complications

Postnatal and Postpartum care
 

• Maternal morbidity
• Placental functioning
• Medication safety
• Gestational disease

Studies have shown that artificial intelligence has the potential to perform as well or even better than humans at some tasks, including those in the healthcare field. AI and other technologies have the potential to reduce pregnancy complications and poor maternal health outcomes, while reducing bias and disparities that result from human decision-making.

A recent study focused on AI algorithms that analyze patterns of change during labor to identify risk for adverse birth outcomes. The study found that the algorithms provided individualized alternatives to conventional labor charts and can be used to monitor labor progress in real time. Using AI like this can inform treatment and interventions and reduce birth complications. 

• Health equity concerns and other issues that may arise due to barriers some patients may experience with accessing and using technology-based tools.
• The risks associated with using artificial intelligence, like bias and perpetuation of inequities.
• Protecting patient information and other data. Health plans will need to ensure ethical and responsible processes and access to sensitive information.

Aetna Better Health of Maryland

Aetna Better Health of Maryland launched a pilot maternal health program with Mae. Mae is a digital health company that works with health plans to reduce disparities for Black women. Through this partnership, Aetna members have access to the app which includes virtual weekly check-ins, personalized recommendations that consider an individual’s lifestyle, and curated tips for stress management, nutrition, and exercise.

Blue Cross Blue Shield of North Carolina (BCBSNC)

Blue Cross Blue Shield of North Carolina’s Healthy Blue plan offers My Advocate. My Advocate is a technology-based application and health program that personalizes care. The program offers health screenings to inform care, tracks pregnancy, and provides a checklist for expectant mothers.

Capital District Physicians' Health Plan (CDPHP)

CDPHP partnered with Ovia-Health, a digital health platform that is clinically backed, to support healthy parenthood. The collaboration brings personalized care through digital applications with access to a team of virtual coaches and other educational tools. The program provides maternal and postpartum care through customized programs and data feedback to guide parental transitions.

Elevance

Elevance partnered with Happify Health to create Happify Health Pregnancy Sequence, a digital-first solution that provides maternity education, case management, and care coordination. Through the program, members will have access to Happify Health’s online pregnancy community, allowing them to connect virtually with mental health experts, obstetricians, and gynecologists.