Table of Contents

1. Introduction
2. Old Rates (Pre‑2024)
3. New Rates (From January 1, 2024)
4. The 2024 Implementation Problem: Delays, Gaps, Non‑Reimbursement
5. Current State of Reimbursement (as of mid‑2025)
6. What Doulas and Clients Should Know & Do
7. FAQs
8. Resources

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Introduction

In recent years, California’s Department of Health Care Services (DHCS) has expanded recognition of doula services under Medi‑Cal. A key change came with a set of increased reimbursement rates (via the Medi‑Cal “Targeted Provider Rate Increase” or TRI), effective January 1, 2024. However, as often happens with large policy shifts, full implementation has been uneven. Some providers (particularly those contracting through Managed Care Plans, MCPs) have reported not being reimbursed at the updated higher rates, or only after delays or after taking certain actions. This article lays out what changed, what the problems were, and where things stand now.

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What Were the Old Rates (Pre‑2024)

Before the increase effective January 1, 2024, Medi‑Cal paid doulas substantially lower rates for most doula services under the fee‑for‑service (FFS) model.

• Initial visit (90 minutes): $126.31
• Perinatal Visits (Prenatal or postpartum): $60.48
• Extended postpartum support: $180.00
• Support during delivery (via caesarean, or vaginal delivery with or without previous caesarean): $544.72
• Support during caesarian section: $795.73
• Support during or after miscarriage or abortion: $250.85

These lower rates reflected earlier Medi‑Cal policy before the TRI adjustments. Many doulas and advocacy groups argued that these rates were insufficient to cover the costs of service, especially travel, time, overhead, and the emotional labor involved.

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What are the New Rates (From January 1, 2024)

Thanks to the Targeted Provider Rate Increase (TRI) enacted under AB 119 (Chapter 13, Statutes of 2023), which authorized a MCO provider tax to fund this and other rate increases, Medi‑Cal raised doula reimbursement to 87.5% of the lowest statewide Medicare rate for maternal care services. (DHCS)

Here are the newest, and currently active, rates (for services provided January 1, 2024 or after) for doulas under Medi‑Cal FFS (and for contracted MCP providers who are compliant).

• Initial visit (90 minutes): $197.98
• Perinatal Visits (Prenatal or postpartum): $162.11
• Extended postpartum support: $486.36
• Support during vaginal delivery: $685.07
• Support during caesarian section: $795.73
• Support during or after miscarriage: $250.85 (same as before)
• Support during or after abortion: $250.85

These represent a substantial increase in almost every category except miscarriage/abortion supports, which stayed the same. For many doulas and maternal care advocates, these new rates were necessary to make service provision sustainable.

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The 2024 Implementation Problem: Delays, Gaps, Non‑Reimbursement

Despite the policy change effective Jan 1, 2024, many doulas reported not being paid at the new rates, especially under Managed Care Plans (MCPs). Some of the issues:

• Managed Care Plans (MCPs) not immediately attesting that they would pay the updated rates. DHCS required that MCPs attest by December 31, 2024 that they had paid all eligible network providers the 2024 TRI rates for qualifying services.
• Some MCPs missed deadlines or delayed contracting with doulas, or had gaps in their networks. When a doula is not a contracted provider in the chain, the MCP may claim they is not eligible for TRI payments.
• Retroactive payments (for services rendered Jan 1, 2024 onward) were required for those MCPs attesting, but the process of adjusting claims has been uneven and delayed. Some doulas have had to dispute claims or contact MCPs or DHCS to push retroactive payment.
• Another obstacle: requirement of a diagnosis code for doula claims starting November 1, 2024. Since doulas are not medical practitioners, they were given general codes. But adoption of this requirement has been a hurdle for some providers.

So, even though the law changed the reimbursement schedule, the path to actually receiving those higher payments has had friction. Some doulas ended up being reimbursed at old rates for a while, or not at all, until the MCPs complied.

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Current State of Reimbursement (as of mid‑2025)

What is happening now, roughly a year and a half after the rate change?

• Most MCPs have attested (19 of 24) that they are paying the 2024 TRI rates to eligible network providers.
• DHCS has issued All Plan Letter 24‑007 to guide plans about their obligations around TRI, including retroactive payments. (DHCS)
• Claims submitted after November 1, 2024 require a diagnosis code. This is now in effect and is a compliance point. Without the correct diagnosis code, even clean claims may be rejected.
• Doulas who have contracts in good standing and who submitted clean claims with correct billing codes and modifiers should be getting paid at the new rates but many report delays, rejections, or unclear communication from MCPs.

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What Doulas and Clients Should Know & Do

If you are a doula or someone receiving doula services, here are some actionable tips to ensure you’re getting what’s due under the law and policy:

• Check whether you are “in‑network” with the MCP: If not under contract (or in an unbroken chain), the plan may try to pay old rates or deny the higher rate.
• Document everything: Dates of service, what services were provided, codes used, whether modifiers (e.g. XP) and diagnosis codes were included.
• Submit claims correctly: Use the proper billing codes listed in the DHCS Provider Manual: Doula Services.
• Monitor payments: If you notice you’re being paid at older, lower rates for services after Jan 1, 2024, raise the issue with the MCP and/or DHCS.
• Use the provider dispute resolution process if needed. MCPs are required to have these; disputes can be over denied payments or incorrect reimbursement.

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FAQs

Here are some frequent questions (and answers) about the doula reimbursement rate changes and current status:

Was the new rate schedule retroactive to January 1, 2024?

Yes. For providers contracted in MCPs, the new rates apply to services provided on or after January 1, 2024. MCPs were required to retroactively adjust payments for eligible services.

Do all Managed Care Plans currently pay the updated 2024 rates?

No. As of the latest update, 19 of 24 MCPs have attested their compliance. Five still had not, meaning doulas working under those MCPs might still not be guaranteed full reimbursements.

What happens if a doula isn’t contracted or is under a “Letter of Agreement” or a one‑time agreement?

Such doulas may not be eligible for the TRI rate under some MCPs. The law requires an unbroken chain of contracts between the doula and the MCP. Doulas in less stable contracting arrangements may have more issues getting the correct rate.

Is a diagnosis code required now?

Yes. Starting November 1,  2024, claims for doula services require a diagnosis code. This is a federal requirement. DHCS has provided general codes doulas can use since doula providers are not medical practitioners who diagnose.

Do doulas use the same billing codes as licensed providers?

For many services, yes. Doulas use the same service codes as midwives, nurse practitioners, physicians for maternal care (initial visit, prenatal/postpartum visits, delivery support, etc.). They also must use modifier “XP” to indicate the service was provided by a doula instead of a licensed provider.

What about support during miscarriage, abortion, or stillbirth?

Doulas are covered for support during or after miscarriage or abortion under Medi‑Cal; the rate for those services remains $250.85 and did not increase. Support for stillbirth is treated similarly.

What should I do if a claim was denied or not paid at the new rate?

First verify the claim was submitted correctly (proper codes, diagnosis, modifier, etc.). If yes, engage the MCP’s provider dispute resolution mechanism. If still unresolved, contact DHCS at DoulaBenefit@dhcs.ca.gov with all relevant documentation.

Are MCPs required to provide training or assist doulas in billing?

Yes. MCPs must provide training, technical assistance and instructions to doulas to submit “clean claims,” and help with claims, billing, or invoice training.

What is the maximum reimbursement a doula may receive per pregnancy under the new rates?

Under the initial recommendation (prenatal visits, postpartum visits, delivery support), the maximum reimbursement amount has approximately doubled compared to the old schedule. For example, for all initial recommendation visits + vaginal delivery, the old maximum was ~$1,514.87; under the new rate it’s ~$3,152.65.

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Conclusion

The Medi‑Cal rate increase for doula services effective January 1, 2024 represents a major win: much higher reimbursements that better reflect the work doulas do. But as with many policy changes, the implementation has lagged, especially through managed care plans.

The DHCS has laid out requirements and is holding MCPs accountable, but diligence from providers is needed: verify contracts, ensure claims are clean and properly coded, use the dispute resolution process when needed. Over time, with more MCPs becoming compliant and system processes being refined, the expectation is that more doulas will reliably receive the updated rates.

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