MEDI-CAL DOULA BENEFIT ENROLLMENT

FREQUENTLY ASKED QUESTIONS

GENERAL INFORMATION

What is the Medi-Cal Doula Benefit?

As of January 1st, 2023, California’s Department of Health Care Services (DHCS) has added full spectrum doula services as an approved preventive service benefit covered under the Medi-Cal program. Doula’s provide preventative care services that include emotional, educational, and physical support to birthing families throughout pregnancy, childbirth, and the first year postpartum.

What are Full Spectrum Doula Services, as defined by Medi-Cal?

Prenatal and postpartum doula care, presence during labor and delivery and doula support for miscarriage, stillbirth, and abortion. Doula care includes physical, emotional and other non-medical care.

What doula services are approved by the Medi-Cal Doula Benefit?

The initial recommendation, approved by a statewide standing order (Nov. 2024) authorizes the following:

  • One (1) initial visit

  • Up to eight (8) additional visits that may be provided in any combination of prenatal and postpartum visits.

  • Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage.

  • Up to two (2) extended three-hour postpartum visits after the end of a pregnancy.

  • An additional recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice is required for up to nine (9) additional postpartum visits.

Source: DHCS

What is a “Community Doula?”

Community doulas, also known as birth workers, provide trauma informed family centered care. This is to encourage safe and respectful care to historically marginalized birthing communities. As this new benefit is being established, we recognize that there are many seen and unseen barriers to doulas becoming approved Medi-Cal providers. In addition, families seeking doula care through their managed care plans may face challenges in being matched with a Medi-Cal doula due to the lack of approved providers.

What are the Reimbursement Rates?

(as of January 2024)

  • Initial visit (90 min): $197.98

  • Prenatal visit: $162.11

  • Postpartum visit: $162.11

  • Extended postpartum support: $486.36 for a 3hr visit

  • Support during vaginal delivery: $685.07

  • Support during cesarean birth: $795.73

  • Support during or after miscarriage: $250.85

  • Support during or after abortion: $250.48 

Sources: DHCS and The IE Voice 

ELIGIBILITY, REQUIREMENTS, AND HOW TO ENROLL

Am I eligible to enroll as a Medi-Cal Doula Provider?

All doulas must be at least 18 years old at the time the application is submitted, and 

  • Provide proof of an adult and infant cardiopulmonary resuscitation (CPR) certification from the American Red Cross or American Heart Association, and

  • Attest they have completed basic Health Insurance Portability and Accountability Act of 1996 (HIPAA) training. 

Required Documents to Enroll:

  1. Driver’s License or state-issued identification card (issued within the 50 United States or the District of Columbia) of the provider, or person signing the application who has the authority to legally bind the applicant or provider. 

  2. Federal Employer Identification Number (FEIN) or Social Security Number (SS) Note: The legal name of the applicant or provider on the application must match the name on the IRS document. For further information, please visit the IRS or call them at (800) 829-4933.

  3. Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must match the business name and business address on all local licenses and permits. For further information, please contact your city business license office and/or visit the California State Association of Counties​ Web Site and click on the "California’s Counties" link, and select "County Web Sites."

Enrollment Options: Training or Experience Pathway

In addition, a doula must meet requirements for either of the following qualification pathways:

  • Gather the required documents listed below, as applicable, and attach them to the completed application in the applicable field in PAVE. Please ensure the attached documents are legible.

    1. Certificate of Completion for a minimum of 16 total hours of training which includes all of the following topics:

      • Lactation support;

      • Childbirth education;

      • Foundations on anatomy of pregnancy and childbirth;

      • Nonmedical comfort measures, prenatal support, and labor support techniques; and

      • Developing a community resource list

    2. If the Certificate of Completion does not detail the total number of hours completed and topics covered or if the doula applicant does not have a Certificate of Completion, the doula applicant is required to provide a copy of a syllabus from the completed course(s) and complete the applicable attestation provided within the e-Form application attesting that they have satisfactorily completed course(s) covering the required topics above with the name of the organization providing the training course, the total number of hours completed and the date the course was completed.Attestation within the e-Form application attesting that they have provided support at three births in the capacity of a birth doula.

  • Gather the required documents listed below, as applicable, and attach them to the completed application. Please ensure the attached documents are legible.

    1. Attestation within the e-Form application attesting that they have provided services in the capacity of a doula in either a paid or volunteer capacity for at least five years. The five years of experience in the capacity as a doula must have occurred within the last seven years from the date the application is submitted.

    2. Three written client testimonial letters or professional letters of recommendation using the testimonial templates provided within this regulatory provider bulletin from any of the following: a physician, licensed behavioral health provider, nurse practitioner, nurse midwife, licensed midwife, enrolled doula, or community-based organization. Letters must be written within the last seven years. One letter must be from either a licensed provider, a community-based organization, or an enrolled doula.

      Testimonial Templates for Doula Applicants​​​:

Where to Enroll:

Doula applicants may apply to become a Medi-Cal approved doula by submitting an electronic application through the Provider Application for Validation and E​nrollment (PAVE) online enrollment portal, along with all supporting documentation.

COSTS TO BECOME A MEDI-CAL PROVIDER

What is the cost to become a Medi-Cal doula Provider and do I have to pay to become one?

There is no cost to the DHCS PAVE application. However, there are pre-requirements from DHCS to consider before you apply. These “costs” include as needed: a business license or tax certificates (based on your city’s requirements), CPR certification from the American Red cross or The American Heart association, HIPAA training and liability insurance (when contracting with the managed care orgs). Total costs can range from $250 to $600.

Please see the cost breakdown below:

  • This can easily range from $50 - $420+ depending on your city or county. Contact your county office to find out. Also note that there may be additional fees for permits and potentially back taxes if you’ve been operating a business without a license.  Business license fee depends on where you live, how long you have “been in business,” etc.  Call your local Business License office for further information. Consult with a tax professional for support to ensure you know your best options. 

  • Depending on what insurance you decide to purchase, this could range from $80 (for your first year) to $409 per year (for general and professional liability). To meet the minimum requirements of professional insurance CM&F offers a $166/year plan.

  • Red Cross offers a blended model, first portion can be completed online for $37, to receive certification you must complete part 2 within 90 days for an additional $50-$100

    American Heart Association offers in-person only classes through a range of affiliates at a range of prices depending on your location.

  • You may be able to find free trainings online, see our resource guide. You can also find an online or in person training for $25-$50 dollars.

  • Here are two examples/options:

    Simple Practice is HIPPA compliant, has telehealth options, and works with a clearinghouse to submit claims. Price $29-$99 per month for solo practice and starting at $149 + for group practices.

    The Doula Network is contracted with several Managed Care Plans and has a no-cost option. The Doula Network will be introducing a monthly platform fee option $30 + for solo and group practices who already have or who wish to contract directly with Managed Care Plans.

BILLING AND PAYMENTS

  • There are many billing practices and service providers. Here are two options: Simple Practice or The Doula Network

  • Yes you can start your application, but will not be able to begin giving services until all aspects of onboarding and PAVE approval have been completed.

  • There is no cost associated with joining The Doula Network (TDN).

  • No, you can be reimbursed for births that happen in any setting; hospital, birth center, or home.

  • Only the Doula who does the initial intake of 90 minutes can bill for the initial visit of $121.31. If the client transfers to another doula, and that doula starts services with the client, the new doula provider can bill for their intake as a regular prenatal visit.

  • After services are rendered.

  • 6 months is the period of time you have to submit a claim in order to be paid the full amount. For example, if you attend a birth in January, you still have until June to submit a claim to be paid for the full reimbursement. You can still file after, but then you won't get your full amount.

  • Payments may take several days to several weeks.

  • If the beneficiary is enrolled with a MCP it will come from them, if the client is enrolled with straight Medi-Cal, it will come from DHCS/Medi-Cal.

BUSINESS & LICENSING

  • Please check with your local city and or county offices. 

  • No it is not. Some people prefer to separate their liabilities/finances. 

  • If you wish your doula services to be a part of your current business you can use the same EIN number. Please contact your accountant or legal representative to ensure you are fully informed of the options for your business that are in your best interests.

  • If your original business NPI wasn’t doula related then yes, that’s the suggestion, but not a requirement—It depends on your license, personal preference, applicable legal advice, etc.

  • You can still serve other areas, that’s just where you will be listed on the NPI website and if insurances are listing addresses or search features (which we are advocating against).

BAY AREA BUSINESS LICENSE INFO

PAVE

  • Provider Application and Validation for Enrollment - An online provider enrollment portal for DHCS.

  • Yes.

  • Yes, you would need to be approved through PAVE and then be added to the doula group practice through PAVE.

  • You do not have to have worked as a professional doula (for example - you may have worked in a volunteer capacity or within a ministry) but there are requirements that must be met in order to apply. These can be found on the DHCS website.

    There are two enrollment options:

    Training Pathway OR Experience Pathway

    Resource: Doula Testimonial Template for Licensed Providers

  • Yes. In the Training Pathway, there isn’t a specific approved doula training list. You may take any birth doula training that provides a certificate of completion and meets these minimum requirements:

    “Certificate of Completion for a minimum of 16 total hours of training which includes all of the following topics:

    • Lactation support;

    • Childbirth education;

    • Foundations on anatomy of pregnancy and childbirth;

    • Nonmedical comfort measures, prenatal support, and labor support techniques; and

    • Developing a community resource list

    If the Certificate of Completion does not detail the total number of hours completed and topics covered or if the doula applicant does not have a Certificate of Completion, the doula applicant is required to provide a copy of a syllabus from the completed course(s) and complete the applicable attestation provided within the e-Form application attesting that they have satisfactorily completed course(s) covering the required topics above with the name of the organization providing the training course, the total number of hours completed and the date the course was completed.” - Source: DHCS

  • It will be different for everyone depending on how many of the requirements they have completed at the time of application. It may take anywhere from a couple of weeks to a few months.

  • In this case you would use the “Training Pathway” and be able to attest to having supported 3 births. For Doulas with no formal training they would use the “Experience Pathway” which requires 5 years of experience. Please see the Training and Experience Pathways as outlined on this DHCS page.

  • You DO NOT have to be HIPAA certified, you have to attest to completing a HIPAA training. You can become HIPAA trained with organizations that offer the training free of cost. Here is a resource for online HIPAA certification. Please see our HIPAA recommendation here.

NPI

  • Yes.

  • We are not sure, please contact them on the number or email listed below:

    The NPI Enumerator may be contacted Monday through Friday, 9am to 5pm (Eastern Time)* as follows.

    Phone: 1-800-465-3203 (NPI Toll-Free) 1-800-692-2326 (NPI TTY for the deaf, hard of hearing or those with speech difficulties)

    Email: customerservice@npienumerator.com

  • We do not have experience with trusts or trustees to advise on this topic. Instead we can direct you to the website and call center:

    The NPI Enumerator may be contacted Monday through Friday, 9am to 5pm (Eastern Time)* as follows.

    Phone: 1-800-465-3203 (NPI Toll-Free) 1-800-692-2326 (NPI TTY for the deaf, hard of hearing or those with speech difficulties)

    Email: customerservice@npienumerator.com

  • Your National Provider Identifier (NPI). An NPI is a 10 digit permanent numeric identifier that is assigned to a healthcare or preventative care provider for the Centers for Medicare and Medicaid services (CMS). Enrolled medical providers and organizations (doulas etc.) must have an NPI in order to receive payment for the delivery of services.

  • Yes.

  • Yes. Your LLC will have a EIN number which will be different to your SS or EIN for your previous business.

  • No, you need a new NPI number for your doula practice.

  • No, you need a new NPI number for your doula practice.

OTHER

  • At the time of writing this, to our knowledge, it is not mandatory to APPLY or be approved to be a Medi-Cal approved doula provider, however, this is a state benefit and we cannot advise on if vaccines will be mandatory for approved Medi-Cal providers at this time.

  • The CPR certification must be an adult and infant certification from the American Heart Association or the American Red Cross. The training has to be in person, either in its entirety or hybrid (online and in person).

  • Yes, the client chooses their doula by reaching out to a doula of their choice. They can ask questions of the doula that pertain to their personal preferences, identities, or beliefs. It may be beneficial to reach out to community organizations that serve diverse populations and may provide connections to Medi-Cal doulas that are culturally congruent to the client.

  • The benefit is for the client regardless of the birth outcome. They can still receive all postpartum visits through 12 months postpartum.

  • You will need an administrative location.

    “Doula providers are exempted from the established place of business requirements outlined under CCR, Title 22, Section 51000.60. Additionally, doulas may use an “administrative location” for the purposes of reporting a business address in the e-Form application. This may be the same as their mailing address but it cannot be a post office box. This address will appear in directories and in the California Health and Human Services Open Data Portal. For the purposes of this provider bulletin, an “administrative location” is defined as the physical location associated with the doula’s operations, which can include where doulas are dispatched or based. They are not required to provide services at the administrative location.” - Source: DCHS