Tahira Ali supports people as they navigate the joys and trials of pregnancy — from giving birth to postpartum, and everything in between.
She’s also helped pregnant patients deal with domestic violence, homelessness, and poverty. It’s exactly the kind of work she hoped to do when she trained to be a doula, a person who assists parents during childbirth.
So, when California’s low-income health insurance program expanded to include doula services in 2023, she signed up. However, Ali claims she is owed thousands of dollars for services she provided to Medi-Cal patients as a result of unpaid reimbursement claims.
She is not alone. Two years after Medi-Cal began covering doula care, a number of those workers say they are constantly fighting for reimbursement for their services. Others claim they have not been paid for any work at all.
“Medi-Cal is the worst thing I’ve ever done in my life,” Ali told me. “I provide services to Medi-Cal clients for free because I am not compensated. When I do get paid, it’s usually months and months and months after I’ve completed the visit.”
The experience also raises concerns that doulas will stop accepting Medi-Cal patients entirely.
Doulas demand changes to Medi-Cal program
Doulas and groups representing them wrote a letter to California’s Department of Health Care Services on Monday, claiming they are being denied and delayed repayment claims and require more clarity and support from Medi-Cal managed care plans to navigate billing.
“These compliance issues are exacerbating distrust among the doula workforce, which severely diminishes the willingness of doulas to participate in the Medi-Cal Doula Benefit,” according to the letter.
Their concern is not only for the doulas, but also for the future of the Medi-Cal program, particularly if providers withdraw.
The benefit was added in part to address racial disparities in pregnancy outcomes for Black and Brown mothers, as well as to provide ongoing support to pregnant people who would otherwise be unable to afford it.
“If we don’t have enough workforce, we don’t have enough doulas to supply the benefit, then those families are not getting the reproductive care that they deserve, and that is their right,” said Khefri Riley, director of community organization Frontline Doulas and director of L.A. County’s Medi-Cal Doula Hub. “That’s what I’m concerned about.”
Frontline Doulas is one of the community groups that has signed onto the DHCS letter, which also states that some doulas are still waiting to be paid new, higher rates for their services after California increased doula pay in 2024.
LAist gave DHCS three business days to respond to a request for comment; a spokesperson stated that they needed more time to get answers. If we receive a response, we will update this story.
LAist also contacted Medi-Cal managed care providers L.A. Care, HealthNet, Molina Healthcare, and Kaiser Permanente. Only Kaiser Permanente responded on time for publication.
“Kaiser Permanente is committed to providing prompt, accurate reimbursement to the doulas who support our Medi-Cal members,” a spokesperson stated. “We are in compliance with Targeted Rate Increase fee schedule rates for doula providers as required by DHCS.”
Why are doulas facing delays with re-payment?
According to state guidelines, managed care plans must pay claims within 30 days or face interest if they do not pay within 45 business days. However, some doulas told LAist that their claims were consistently denied, resulting in long waits for repayment.
“I’m not an expert in medical billing or insurance, so I’m not sure how it works.” This is what’s been difficult for doulas,” said Michelle Brenhaug, a doula in the San Gabriel Valley who believes she’s been paid for less than 10% of the Medi-Cal services she’s provided since June. “A lot of doulas are not super well off or super privileged that they can wait 3, 4, 5, 6 months to be paid.”
According to the letter sent to the Department of Health Care Services, doulas have struggled to obtain assistance from Medi-Cal plans when submitting claims, as well as encountered challenges with billing codes and other aspects of the Medi-Cal bureaucracy.
Amy Chen, who directs the National Health Law Program’s Doula Medicaid Project, stated that these issues are common in other states that have implemented Medicaid coverage for doula care. She stated that incorporating a new type of care into the healthcare system is one of the challenges.
“The work is not medical, it’s not clinical, and so I think that has also been something that has been challenging both for state Medicaid agencies and also for health plans and even for hospitals to kind of wrap their minds around,” Chen told me.
Medi-Cal doula benefit is part of a historic effort
According to doulas, reimbursement challenges must be addressed in order for the Medi-Cal program to continue to function and grow. California’s Medicaid program covers 40% of births in the state, but as of last year, only a small number of Medi-Cal members had access to doula services, and more doulas were needed to meet the demand.
Tahira Ali, a doula in South L.A., is still accepting Medi-Cal patients, but says it’s difficult to pay her rent and live her life.
“This work is very much heart-centered, emotional work,” Ali told me. “We don’t do it for the money, but we do need to be paid.”
