ODA Medicaid Reimbursement Announcement

and FAQ's:  

OHP Client Doula Services

The Oregon Doula Association (ODA) is excited to share with you pertinent information needed to successfully provide birth doula care (and receive reimbursement for Oregon Health Plan (OHP) clients. HB 3650 was a landmark house bill that mandated the reimbursement of doula care by state Medicaid systems, with doulas being one of five Traditional Health Workers (THW’s) designated for Oregon.  ODA’s Speaker’s Bureau will be contacting each county’s Community Care Organization (CCO), the local doulas, and the ODA members at-large servicing each region to help facilitate these processes in each community. The ODA has assisted Oregon’s THW Commission, and the Systems Integration Subcommittee in creating presentations for both doulas and care providers on how to implement doula services.  

Each CCO and their contracted providers are responsible for specifying how to provide funds for the reimbursement of doula care.  This allows for flexibility so that each county may work out methods that work best for them. The ODA is recommending that the doula care package include pre- and post- natal visits, as well as continuous labor and birth support as standard inclusions in reimbursement rate of $600. 

Learn more by reading the ODA White Paper, “Reimbursement for Doula Care: Processes and Potential for Oregon State”

As reimbursement pathways are specified for each county, birth doulas interested in serving OHP clients should apply to be on the state registry if they are not already.  Requirements for state certified birth doulas, as well as application processes can be found here:   http://www.oregon.gov/oha/oei/Pages/thw-certification.aspx

Use our handy checklist to insure your application is complete, found here: Checklist for Birth Doula State Registry Certification

All OHP clients are eligible for this covered service by OHP. The primary purpose of this law is to improve birth outcomes, lower health care costs, increase the quality of care, and reduce health care disparities that exist with certain groups of clients. Priorities for services include:

(a)    A woman with a racially or ethnically diverse background including, Black/African American, Asian, Pacific Islander, Native American, Latino, or multi-racial;

(b)   A homeless woman;

(c)    A woman who speaks limited to no English;

(d)   A woman who has limited to no family support;

(e)   A woman who is under the age of 21;

(f)     Women who are medically high risk.

These groups are typically underserved and have limited to no access to doula care.  A primary goal of the Diverse Communities Committee of the ODA is to better diversify the doula workforce. We encourage you to reach out to any connections you have to doulas and women in your communities from the priority groups defined and support them in getting involved with the ODA and on the state registry. Contact: Chair of the Diverse Communities Committee, Kimberly Porter, at kimberly.porter@thebpi.org

 

Medicaid Frequently Asked Questions: 

 

How do I apply to get on the registry? 

Fill out the application and send it in by mail to the Traditional Health Worker Program at OHA Office of Equity and Inclusion. Remember to include documentation such as a government issued ID, and proof of training hours, current CPR card, and a food handlers card.  

Do I need to do a criminal background check? 

Once they receive your Traditional Health Worker application and supporting documents, you’ll get an email from their Background Check unit so make sure you check your email! You have a limited amount of time respond, so make sure you don't let it expire. You will then have to complete the background check application and return it. If you’ve lived outside of Oregon in the past 5 years, you’ll also need to submit fingerprints. The background check is required even if you have had one in the past. This process will take about 4-8 weeks and all costs are covered by the Oregon Health Authority. If you meet all the requirements and pass the background check, we’ll notify you by mail and add your information to the Authority’s registry of certified traditional health workers.

How long does it take to get on the registry? 

Currently the process time is approximately three months. Please be patient and remember that Oregon is creating a whole new system from scratch  and is still working on the process. This is one for the history books and you are a part of it!

Are my postpartum services covered? 

Currently only the services you provide for the labor and birth are covered by medicaid once you are on the registry. The ODA is advocating for prenatal and postpartum services to be reimbursed as well, and will keep you updated on the development and expansion of covered services. Join the ODA policy and advocacy committee and help us do this work!

How do I get reimbursed? 

After the House Bill passed, the State needed to develop the actual pathway for registered doulas to be reimbursed. Currently the rule dictates that a registered doula will receive her funding through a medical provider (OB, CNM). The ODA is working directly with the state to create a document to clarify this process which will be posted here soon! 

Can I receive medicaid reimbursement without being on the state registry?

No, you must be on the state registry in order to receive reimbursement. 

How much will the reimbursement be? 

Currently the set reimbursement from Medicaid is $75 for fee for service clients. There are other types of Medicaid clients, though there is no set reimbursement fee for these yet. This is the first step in the beginning of a historic process.

Will private health insurance be routinely reimbursing doulas now? 

We are not there quite yet but the ODA hopes so! Working with the state and receiving Medicaid funding is an important step towards setting a standard, being recognized and integrating as professional members of a family's care team in the Maternity Care System. The ODA's policy and advocacy committee has reimbursement for private health insurance on their agenda.