State intends to expand Medicaid to doula services, official says

The state Department of Social Services plans to extend Medicaid reimbursement to doula services for prenatal, delivery and postpartum care for pregnant South Dakotans this year.

Efforts are underway nationwide to expand Medicaid coverage, the joint federal-state health insurance program for low-income and disabled people, to doula services as a way to counter maternal and infant mortality rates. Doulas are non-medical trained professionals who provide physical, emotional and educational support to pregnant clients.

South Dakota’s infant mortality rate is 7.4 deaths per 1,000 births – significantly higher than surrounding states and steadily increasing in the last five years. South Dakota also leads surrounding states for maternal mortality with 25.9 deaths per 100,000 live births, slightly higher than Montana and also increasing over the last five years, according to data from the state Department of Health.

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About half of all births in South Dakota are covered by Medicaid, and about 37% of Medicaid-covered people are Native American, according to DSS. Infant mortality is three times higher among Native Americans than white South Dakotans.

South Dakota Department of Social Services Secretary Matt Althoff told lawmakers on Thursday during a House Health and Human Services Committee hearing at the Capitol in Pierre that the state hopes to include doula services in Medicaid coverage by the time it opens its Pregnancy Health Home program in April.

The Legislature appropriated $3.1 million toward the initiative during the 2023 legislative session, which aims to provide better care management and participation among South Dakota Medicaid recipients for prenatal, postpartum and well-child care.

The announcement came in response to a bill that would instruct the department to expand coverage. Prime sponsor Rep. Mellissa Heermann, R-Brookings, requested the committee table the bill so the department could handle the matter through administrative rule.

Supporters of the bill included doula and OB-GYN professionals as well as South Dakota Right to Life. Professionals told legislators that expanding access to doula services is crucial to addressing health disparities in South Dakota.

“Continuous support by a doula is one of the most effective tools to affect labor and delivery outcomes,” said Michelle Sand, obstetrics director at Brookings Health System, citing a report from the American College of OB-GYN and Society of Maternal-Fetal Medicine.

A 2013 study reported that pregnant people using doulas were two times less likely to have birth complications. A 2016 study found that doula services can be cost-effective for state Medicaid programs, with patients experiencing lower rates of preterm and C-section births when using a doula.

“We’re going to take a very close exam and do all we can to expand coverage for doula services in our normal protocols and procedures posthaste — before even the end of the fiscal year,” Althoff said.