Understanding the Medi-Cal Doula Program

California’s Medi-Cal Doula Benefit is a transformative effort to increase access to quality maternal care and reduce birth disparities. Through this program, eligible Medi-Cal members can receive full-spectrum doula services—support that spans from pregnancy through postpartum, and even during experiences such as abortion, miscarriage, or stillbirth.

The core goal is to increase support during the birthing experience, improve mental and physical outcomes for parents and babies, and ensure that emotional and informational support is never a luxury—but a right.

Doulas play an essential role by helping people prepare for birth, cope during labor, recover emotionally postpartum, and navigate health care systems. This benefit is especially impactful for communities disproportionately affected by maternal morbidity, including Black, Indigenous, and people of color (BIPOC).

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Eligibility Requirements for Doula Services

To qualify for Medi-Cal doula services, both clients and providers must meet specific criteria:

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For Clients:

• Must be currently enrolled in California’s Medi-Cal program.
• Must be experiencing or have recently experienced a pregnancy-related event, such as:
  • Live birth (vaginal or cesarean)
  • Miscarriage
  • Stillbirth
  • Abortion
• Postpartum clients are eligible for up to 12 months after their pregnancy ends.

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For Doula Providers:

California uses a broad and inclusive approach to authorize doula providers:

• Must be at least 18 years old.
• Required to have a valid NPI (National Provider Identifier) and TIN (Taxpayer Identification Number).
• Must complete CPR certification (infant and adult) and HIPAA training.
• Enroll via the PAVE system on the Department of Health Care Services (DHCS) platform.

This inclusive framework encourages community-based doulas, especially those who represent underserved populations, to participate without needing clinical licensure or traditional medical degrees.

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Types of Covered Doula Visits

The Medi-Cal doula benefit includes a wide array of visit types structured to provide meaningful support at every step of the perinatal journey:

• Initial Intake Visit (1)
  
  • A foundational meeting between the doula and client where expectations, preferences, and care plans are established.
• Prenatal and Postpartum Visits (up to 8 combined)
  
  • These hour-long sessions offer emotional guidance, educational support, and preparation for childbirth and early parenting.
• Labor and Delivery Support (1 per event)
  
  • Doulas offer hands-on and emotional support during labor. This support may include breathing techniques, positioning help, and comforting the client throughout delivery—whether vaginal or cesarean.
• Extended Postpartum Visits (2 visits, 3 hours each)
  
  • These longer sessions accommodate more complex postpartum needs, such as mental health support, feeding challenges, or recovery from surgical births.
• Additional Postpartum Visits (up to 9 with referral)
  
  • Clients with high needs or special circumstances can receive extra visits if another licensed provider recommends it.

These visit types aim to make sure clients are fully supported from pregnancy to recovery, with enough flexibility to adapt to individual family needs.

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‍Specific Covered Doula Services

Covered doula services under Medi-Cal are non-medical, yet they significantly impact maternal and infant health outcomes. Doulas provide:

• Emotional support through each stage of the perinatal experience.
• Birth and postpartum planning to align care with the client’s preferences.
• Educational assistance, including evidence-based resources about labor, delivery, recovery, and infant care.
• Lactation support during prenatal and postpartum visits.
• Healthcare system navigation, helping clients understand their rights, options, and schedules.
• Referrals to other professionals such as therapists, lactation consultants, nutritionists, or housing assistance agencies.
• Telehealth flexibility with services available via secure video or phone, especially useful for rural or transportation-challenged communities.

The emphasis is on continuity, compassion, and cultural alignment. For many, a doula becomes a trusted companion through some of the most vulnerable moments in life.

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What Is Not Covered by Medi-Cal Doula Benefit

While the benefit is generous and inclusive, there are limits to what Medi-Cal will pay for. Doulas must understand what’s excluded to avoid compliance issues:

• Clinical or medical services
  
  • This includes taking vitals, checking fetal heart rates, or providing any form of diagnosis or treatment.
• Alternative wellness or luxury services
  
  • Examples include massage therapy, aromatherapy, sound healing, belly binding, vaginal steams, yoga, reiki, and ceremonial services.
• Physical product or over-the-counter items
  
  • Medi-Cal doesn’t reimburse for breast pumps, herbal supplements, or postpartum care kits provided by the doula.
• Artistic or commemorative services
  
  • This includes birth photography, journals, or crafting rituals.
• Unassisted home birth attendance
  
  • Doulas may accompany a client during home birth, but if the birth is not attended by a licensed clinical provider, it is not eligible for Medi-Cal reimbursement.

Doulas offering these non-covered services must use separate private contracts, clearly outlining costs and ensuring clients consent to pay out-of-pocket.

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Total Visit Limits and Frequency Rules

To ensure appropriate service usage and billing, Medi-Cal enforces strict limits on the number and type of doula visits.

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Initial Intake Visit

• 1 visit allowed
• These visits must be 90-minutes or longer

Prenatal/Postpartum Visits

• Up to 8 allowed, in any combination of prenatal or postpartum

Labor & Birth Support

• 1 per pregnancy event
• Includes support during or after vaginal delivery, cesarean section, miscarriage, abortion

Extended Postpartum

• 2 allowed, for up to 3-hour each

Additional Postpartum visits

• Requires a second provider's written recommendation

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The timing of these visits can vary based on the needs of the client, and doulas are encouraged to schedule strategically to offer maximum benefit.

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Doula Support for Different Outcomes

This program goes beyond just full-term birth. Medi-Cal recognizes the need for emotional and logistical support in all pregnancy outcomes, including those often overlooked:

• Miscarriage
  
  • Doulas provide comfort, guidance on recovery, and referrals to grief counseling or support groups.
• Abortion
  
  • Clients receive non-judgmental support, education, and space to process their emotions.
• Stillbirth
  
  • Doulas walk with clients through one of the most devastating experiences, helping with memory-making, hospital navigation, and bereavement resources.

The acknowledgment that doulas are essential not only during birth but during loss and recovery is a huge step toward reproductive justice in the state.

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Where Doula Services Can Be Delivered

Flexibility in care location is one of the strengths of this program. Doula services can be delivered:

• In the client’s home—ideal for postpartum support or prenatal visits for those with transportation barriers.
• In hospitals or birthing centers—primarily for labor and birth support.
• In clinical settings—such as OB/GYN offices or community health clinics.
• Via telehealth—whether through secure video platforms or phone

Doulas must document location and mode of delivery for each session and ensure that services are still client-centered, even when virtual.

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Compliance and Documentation Best Practices

Proper documentation is not only a requirement but a safeguard for both the client and the doula’s practice. Here’s how to stay compliant:

• Use the Standing Order
• Since November 2023, California has implemented a standing order for doula services—no longer requiring each client to obtain a separate provider referral.
• Maintain Accurate Logs
• Include session date, time, location, duration, services provided, and client feedback.
• Separate Covered from Non-Covered Services
• Doulas should create different invoices and session notes for any private-pay services offered.
• Retention Period
• Keep records for at least 10 years in case of delayed audits or reviews.

Failure to comply could lead to repayment demands or disqualification from the program—so attention to detail matters.

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Charging for Non-Covered Doula Services Ethically

Many doulas offer premium services that fall outside Medi-Cal’s covered scope. It’s perfectly legal to charge for these, but it must be done ethically and transparently.

Best Practices:

• Separate Contracts: Clearly distinguish between Medi-Cal-covered visits and private-pay offerings.
• Transparent Invoicing: Give clients receipts for what they’re paying for outside of insurance.
• Avoid Bundling: Never include a private-pay item in a Medi-Cal claim.
• Client Consent: Use written agreements to make sure clients understand what’s covered and what’s extra.
• Maintain Boundaries: Never bill Medi-Cal for non-covered services or charge clients for services Medi-Cal already covers.

Being both service-focused and compliance-minded helps build client trust and sustainable business.

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Frequently Asked Questions (FAQs)

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Q1. What services are covered under California’s Medi-Cal Doula Benefit?

Medi-Cal covers non-clinical support including prenatal, birth, and postpartum visits, education, emotional support, and telehealth.

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Q2. How many visits can a client receive?

Up to 8 prenatal/postpartum visits, 1 labor support, 2 extended postpartum, and 9 more with a provider’s referral.

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Q3. Are doulas reimbursed for abortion or miscarriage support?

Yes. Doulas can receive payment for supporting clients during loss events, including abortion and miscarriage.

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Q4. Can doulas offer yoga or massage through Medi-Cal?

No. These services are considered non-covered and must be billed separately through private contracts.

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Q5. Is there a copay for doula services under Medi-Cal?

No. Medi-Cal beneficiaries pay nothing out-of-pocket for covered services.

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Q6. Do doulas need to work under a doctor to bill Medi-Cal?

No. The standing order removes the need for a physician’s referral, simplifying the process for both client and doula.

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Conclusion: Make the most of the Medi-Cal doula benefit

California’s Medi-Cal Doula Benefit is more than a reimbursement program—it’s a recognition of the powerful role doulas play in shaping healthier, more equitable birth outcomes. With the right knowledge, documentation, and approach, doulas can support clients in every stage of the perinatal experience while building a fulfilling and sustainable career. Staying compliant ensures your practice is not only profitable but ethically sound and deeply impactful.

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