How Virginia Families Can Use the Medicaid Community Doula Benefit

Last updated: August 2026 · Sources: DMAS, VCB, Virginia General Assembly HB 838, NASHP

1. Who Is Eligible

Eligibility is broad and does not depend on health status or risk level:

• Any Virginia Medicaid or FAMIS MOMS member who is currently pregnant, or who has given birth within the last six months, is eligible for community doula services regardless of health status. The newest 2026 legislative update extends the postpartum eligibility period further — see the Recent Updates section below.
• FAMIS Prenatal Coverage members are eligible to receive doula services through 60 days postpartum, a shorter window than standard Medicaid/FAMIS MOMS members.
• Coverage begins from the date of confirmed conception, as documented in the member's medical record, and continues through the eligible postpartum window, contingent on the individual maintaining Medicaid or FAMIS MOMS eligibility throughout.
• 91% of pregnant Medicaid enrollees in Virginia receive their benefits through a managed care organization (MCO) — Aetna Better Health, Anthem HealthKeepers Plus, Molina Healthcare, Sentara Health, or United Healthcare — so most families will need to confirm which MCO plan they're enrolled in, since this affects how the doula benefit gets processed.

2. How to Find a VCB-Certified Doula

There are three main starting points for families:

Option A: Virginia is for Doulas Directory

The Virginia is for Doulas website (vaisfordoulas.org) is a public-facing resource specifically built to help Medicaid members understand and access this benefit. It confirms that any Virginia Medicaid member who is pregnant or has given birth in the last six months is eligible for community doula care.

Option B: Ask Your Doctor, Midwife, or Nurse Directly

Since a doula visit requires a licensed practitioner's signature before services can begin, many families start by asking their OB-GYN, midwife, or prenatal nurse directly. Providers can supply the required Doula Care Form and often know local community doulas who already work with Medicaid patients.

Option C: Community Doula Organizations

Several Virginia-based maternal health organizations run doula training and connect Medicaid-eligible clients to certified doulas directly. Urban Baby Beginnings and Birth in Color RVA are two organizations specifically active in this space, both offering doula certification training as well as client-matching services.

Confirming Certification Status

3. What Services Are Covered

The Doula Care Form (Required First Step)

Before any billable services begin, the family or doula must obtain a completed Doula Care Form (formerly called the Doula Care Recommendation Form) signed by a licensed practitioner — a doctor, midwife, or nurse. Key details:

• You can request this form even before you've chosen a specific doula.
• The form is available at dmas.virginia.gov/doula, or your provider's office can supply it directly.
• The doula must secure and retain this practitioner recommendation for each client before starting doula care, and store the record per HIPAA requirements.
• A copy must be submitted to the client's MCO (if managed care) or directly to DMAS (if fee-for-service) before services begin.

Covered Visits and Reimbursement

Services are covered at delivery regardless of whether the birth is vaginal or cesarean. Some MCO-specific policies (e.g., Humana Healthy Horizons) allow additional medically necessary visits beyond the standard limit for conditions such as active behavioral health issues, domestic abuse, homelessness, poorly controlled diabetes, or uncontrolled hypertension — these must be ordered by a treating provider who specifies the number of extra visits requested.

4. How Doulas Bill for These Services (What Families Should Understand)

Understanding the billing side helps families ask informed questions and troubleshoot delays. To bill Medicaid for community doula services, a doula must complete several steps:

1. Complete VCB State Certification — a minimum of 60 hours of VDH-approved training, plus a completed application and $100 initial certification fee ($75 for recertification), submitted to the Virginia Certification Board.
2. Obtain a National Provider Identifier (NPI) — a unique 10-digit number through the National Plan and Provider Enumeration System (NPPES), required for Medicaid enrollment.
3. Enroll as a Virginia Medicaid provider — through the Provider Enrollment Public Portal within the Medicaid Enterprise System (MES), attaching proof of VCB state certification and medical liability insurance ($1M per claim / $3M per year).
4. Sign individual provider agreements with each MCO — doulas must enroll as a Medicaid provider before executing MCO contracts, then separately review and sign agreements with each of the five contracted MCOs (Aetna, Anthem, Molina, Sentara Health, United Healthcare) they want to bill through.
5. Submit the completed Doula Care Form to the relevant MCO or to DMAS directly, before starting billable services for that specific client.
6. Bill using the required codes and taxonomy — claims must include the mother's Medicaid ID, taxonomy code 374J00000X, diagnosis code Z32.2, the HD modifier on every claim line, and the correct place-of-service code.
7. Submit claims within 365 days of the date services were provided (with a 365-day window from the paid date to resubmit any revised claim).
8. Live within Virginia or within 50 miles of the state border — a specific state requirement for Virginia Medicaid doula providers.

5. Tips for Families Navigating the System

• Get the Doula Care Form moving early — even if you haven't picked a doula yet, you can request the form from your OB, midwife, or nurse right away so it's ready the moment you connect with a provider.
• Confirm Medicaid enrollment, not just state certification — a doula can be a fully certified SCD without being enrolled as a Medicaid billing provider; always ask directly whether they can bill your specific MCO plan.
• Know your MCO — since 91% of pregnant Medicaid members in Virginia are enrolled through a managed care plan (Aetna Better Health, Anthem HealthKeepers Plus, Molina Healthcare, Sentara Health, or United Healthcare), confirm which plan you have. The doula's enrollment and the form-submission process differ slightly by MCO.
• Use the postpartum visit incentive structure — because doulas receive extra incentive payments for completing a postpartum visit and connecting you and your baby to follow-up clinical care, most doulas are motivated to actively schedule these visits; don't let them slip if you're offered one.
• If you have other insurance in addition to Medicaid, an Explanation of Benefits (EOB) from that other plan may be required as part of the claims process — ask your doula how coordination of benefits will be handled.
• If services are delayed or a claim issue arises, the DMAS Provider Helpline (1-804-786-6273 or 1-800-552-8627, Monday–Friday 8:00 a.m.–5:00 p.m.) can help verify member eligibility and answer general billing questions. Families or doulas can also contact Baby Steps VA at babystepsva@dmas.virginia.gov with specific questions about the Doula Care Form.
• Recognize this is still a maturing system — only 130 of Virginia's 203 state-certified doulas were actively Medicaid-enrolled as of the most recent data, meaning availability can still be limited in some regions, especially outside major metro areas. Ask early and be prepared to search regionally if your first-choice doula isn't Medicaid-enrolled.

6. 2025-2026 Updates

Virginia's Medicaid doula benefit has expanded meaningfully in the past two legislative sessions:

• Current standard benefit (through 2025): Up to 8 total prenatal/postpartum visits (up to 4 prenatal and up to 4 postpartum) plus attendance at labor and delivery, with services available through 6 months (180 days) postpartum, reimbursed at $859 per completed episode.
• HB 838 (2026 General Assembly) — the newest expansion: This bill codifies and significantly expands the benefit to up to 10 total visits — 4 prenatal and 6 postpartum (an increase of 2 additional postpartum visits) — and extends eligible postpartum coverage from 6 months to a full 12 months after delivery. The bill also formalizes up to two value-based linkage-to-care payments for postpartum maternal care and newborn pediatric care as part of the codified benefit structure.
• State Plan Amendment (SPA) in progress: As of a June 8, 2026 filing, DMAS is submitting a State Plan Amendment to the federal Centers for Medicare and Medicaid Services (CMS) to formally implement the HB 838 changes. Families should watch for confirmation of federal approval and an updated effective date, since a SPA must be approved by CMS before the expanded benefit becomes fully operational statewide.
• Prior 2025 expansion (HB 1614/SB 1418): Before HB 838, an earlier 2025 General Assembly bill had already increased Medicaid-covered postpartum doula visits from 4 to 6, laying the groundwork for the more comprehensive 2026 codification.

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