Medi-Cal Coverage – Doulas & Donor Milk

Doula care in California is a covered Medi-Cal service as of January 1, 2023
Details are still being worked out, so it is unclear exactly when local doulas will be authorized to accept Medi-Cal payments. There is paperwork to be filed and hoops to be jumped through before the program is fully off and running, but the gears are turning.

The Medi-Cal Doula care will include emotional and physical support, provided during pregnancy, labor, birth, and the postpartum period. These preventive services simply need to be recommended by a doctor, midwife or other licensed member of the healing arts. Once recommended, the doula would be authorized to provide:
• one initial visit
• up to eight 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 extended three-hour postpartum visits after the end of a pregnancy

Doula care is generally an out-of-pocket expense rarely covered by insurance. This leads to inequities in care where those with more disposable income receive beneficial care out of reach for those with limited resources. Those qualifying for Medi-Cal will now be eligible for birth and postpartum doula care.

Most currently practicing doulas are eligible to apply to become Medi-Cal providers, and Cabrillo College is set to begin offering a course to train new doulas beginning this fall. These classes will be offered at no cost to students and will result in a certificate, the opportunity to complete hands-on practice situations, and assistance with the paperwork involved in applying to become a Medi-Cal provider.

Medi-Cal will pay doulas well below the current going rate that independent doulas received. It will be interesting to see how doulas accepting Medi-Cal might make this viable; perhaps working in teams to help minimize the stress of being on-call.

Birth doulas can be on-call for up to 4-5 weeks for each doula client. That means being ready to go at a moment’s notice, day or night for a birth that often lasts much longer than an 8 hour shift. Being on-call is a challenging lifestyle.

Plans are always prefaced with “if I’m not at a birth,” and doulas with young children need a variety of possible childcare arrangements in place to cover a full month – every time they have a birth booked.However it plays out – Medi-Cal recommending and paying for doula care is definitely a step in the right direction.

Better Medi-Cal coverage for Human donor milk for babies as of December 2022
According to the California Breastfeeding Coalition’s December newsletter, a new Medi-Cal policy:
• specifies pasteurized donor human breast milk (PDHM) is billable with Healthcare Common Procedure Coding System code T2101
• identifies Mothers’ Milk Bank San Jose and UC Health Milk Bank in San Diego as “licensed and approved” providers of donor human milk under all Medi-Cal plans
• provides clear criteria for the circumstances in which prescriptions for donor human milk will be approved by Medi-Cal

Medi-Cal providers can now arrange for the provision of donor human milk for outpatient newborns when:
• infant has a documented birthweight of less than 1500 g
• a congenital or acquired condition places the infant at risk for necrotizing enterocolitis (NEC) and/or infection
• infant has a qualifying condition determined by the neonatologist or pediatrician*
• mother has a condition making their own milk insufficient in quantity or medically unsafe
• mother’s milk must be contraindicated, unavailable (due to medical or psychological condition), or available but lacking in quantity or quality to meet the infant’s needs

Authorized providers who can prescribe Pasteurized Donor Human Breast Milk are expanded to include: physicians, advance practice nurses, (Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives), and Physician Assistants, not just neonatologists or pediatricians.

This means Medi-Cal must cover pasteurized donor human milk in situations where there is a low milk supply, problems latching, an infant is not thriving, or medical situations of the parent or infant prevent breastfeeding.

Medi-Cal families can request a prescription for pasteurized donor human milk from their provider and take that prescription to either Mothers’ Milk Bank San Jose to receive milk for their infant. When HCPCS billing code T2101 is used, Medi-Cal will honor the prescription and reimburse the milk banks for the milk prescribed.

This information on doula coverage and expanded donor milk prescriptions is new, so it may be up to parents to share with providers.

By Laura Maxson, LM