You can Become a Medicaid-Eligible Doula Provider

Becoming Medicaid-ready means preparing to meet your state’s requirements so you can apply for approval as a doula provider and bill Medicaid for covered doula services. This means you can get paid to help people as a doula who cannot otherwise afford your services. In some states, that starts with state doula certification. In others, it starts with a direct Medicaid provider enrollment pathway. Either way, the goal is the same: to become an approved doula provider who is eligible to serve Medicaid clients and receive reimbursement for doula care. 

States Use Different Models

There is no single national model. Some states use a state certification pathway that doulas must complete before they can enroll with Medicaid. Virginia is one example. Virginia’s public materials explain that a doula must first become a state-certified community doula, and then may participate in the Medicaid program. 

Other states use a more direct Medicaid eligibility pathway. California is one example. California’s Department of Health Care Services says doulas may enroll as Medi-Cal providers if they meet the state’s qualification requirements, including CPR, HIPAA, and one of the state’s qualification pathways. 

Some states also combine training, experience, and enrollment requirements without a separate state certification credential. Delaware, for example, sets Medicaid qualification standards around training, CPR, HIPAA, and birth experience as part of the Medicaid provider qualification structure. 

What Most States Commonly Require

Although details vary, many states ask for some combination of the following:

Business and provider setup

After state certification or Medicaid provider approval, a doula must complete some basic provider and business setup steps. One of the most important of these is obtaining an NPI. NPI stands for National Provider Identifier. It is a unique 10-digit number issued by the federal government to identify healthcare providers in billing and administrative systems. Doulas who plan to bill Medicaid must have an NPI.

To apply for an NPI, you will typically need:

• Your full legal name 

• Date of birth 

• Tax ID Number (SSN or EIN)

• Mailing address and contact information 

• Business name (if you are operating under one) 

• Business address (can be your home address if applicable) 

• Taxonomy (provider type - Most doulas use a taxonomy related to doula or non-clinical support services )

• A valid email address

Onboarding with a Managed Care Organization

After getting an NPI, many doulas must take an additional step by onboarding with a Managed Care Organization (MCO), or with another Medicaid billing structure used in their state. A Managed Care Organization is a health plan that contracts with the state to provide Medicaid-covered services to enrolled members. In many states, this means a doula must not only become Medicaid-eligible, but also complete plan onboarding before she can begin billing for services provided to Medicaid clients. Because Medicaid managed care is now the predominant delivery system in Medicaid, this step is a common part of becoming Medicaid-ready.

Filing a Claim and Getting Paid for Service

Once a doula is approved and onboarded, she must keep clear records of the services she provides. This is often called charting or documentation. One important document many states require in order for a doula to bill for services is called a referral or authorization for doula services. Good charting matters because claims must be supported by accurate service records, and doulas must also follow HIPAA and other privacy rules to protect client information. States and plans also use specific billing codes for doula services, and a claim is essentially the formal request for payment submitted for a covered service. Most plans or billing systems provide training so providers can learn how to document services properly, use the correct codes, and submit claims through the required system.

How BAA Can Help You Get Started In Business

For BAA certified doulas who do not want to manage the administrative side of billing on their own, Born Again Perinatal may offer another path. Born Again Perinatal is the agency side of Born Again Academy. When a doula works with Born Again Perinatal as a contract doula, the agency can help with administrative steps such as Managed Care Organization registration where applicable, liability insurance coverage, background check requirements, use of the agency’s electronic health record system for charting, and claims submission. In this model, the doula focuses on serving families, documents her services in the agency system, and Born Again Perinatal handles claim filing and pays the doula after the claim is processed. This can be a helpful option for doulas who want to maintain their own work identity while having another business manage much of the administrative burden.

5 Steps to Medicaid-Ready

In summary, to become Medicaid-ready, most doulas need to do three things:

1. Complete training or certification that meets their state’s standards.

2. Gather the extra requirements their state asks for. 

3. Apply for state certification or Medicaid provider approval.

4. Get a Medicaid NPI number.

5. Contract with a Managed Care Organization and bill Medicaid for doula services. 

That process varies by state, but the purpose is the same: to become an approved doula provider who can lawfully serve Medicaid families and be reimbursed for the care they provide. 

Next Steps

If the idea of building a self-sustaining ministry serving pregnant families covered by Medicaid resonates with you, and you appreciate having training designed with these real-world pathways in mind, we invite you to take the next step. 

• Visit our State Approved Pathways page to see whether Born Again Academy is an approved or qualifying trainer or certifying organization in your state. 

• Sign up for our Prospective Student Orientation so we can answer your questions and help you determine whether BAA training is the right fit for your goals.