Kansas Medicaid doesn’t cover birth doulas, but one contractor is paying to help moms | Kerkool

Janice Ingram wasn’t always a doula, but she always had a helpful heart.

This led to her quitting her criminal justice job four years ago to pursue a career that aligned with her career of helping disadvantaged people, and earning a master’s degree in business and leadership. That’s when she heard about doulas.

“Do I need to go back to school?” Ingram said. “What do I need to do? “I just want to help moms. “

Ingram jumped into the labor force at a critical time for Kansas moms. A study by the Kansas Maternal Mortality Review Commission showed that the rate of severe maternal morbidity, which refers to a person experiencing severe complications during labor and delivery, increased by 6.4% annually between 2016 and 2020. affect their long-term or short-term health.

One Medicaid provider in Kansas is trying to address the problem by offering doula services to clients, but Ingram and other doulas say there are still hurdles to overcome around issues like timely payment.

Doulas are pregnant women’s biggest cheerleaders and coaches, providing support to moms during the birth process. Services vary on a case-by-case basis, but generally, doulas provide advice before and after birth.

“You’re kind of like a counselor,” Ingram said. “You’re a therapist. “Sometimes, if they’re young, you may need to be their mother. “

Ingram said women of color are often not heard in clinical settings. This was another reason she felt the need to become a doula. As a black woman and mother of five, Ingram has had her fair share of childbirth experiences. Now as a doula, she has helped at least 40 mothers.

Ingram said she considers herself an advocate for all her clients and Black moms, and she has to step up to the next level.

“For a lot of them (moms of color), if they don’t have advocates in this space, things can get really bad, really fast,” Ingram said.

Kansas moms of color and women on Medicaid or from low-income zip codes are especially vulnerable to these pregnancy complications. Maternal morbidity rates are 83.5% higher among non-Hispanic black women than among non-Hispanic white women.

Research shows doulas can help. A report from the National Institutes of Health found that moms who used a doula were twice as likely to have birth complications and four times less likely to give birth to an underweight baby.

Tear down the “wall”

To help combat Kansas’ alarmingly high maternal morbidity and mortality rates, one of the state’s three private Medicaid providers stepped in. In 2022, UnitedHealthcare began providing doula services to Black mothers on Medicaid in Wyandotte County, Kansas.

The first project was developed by Lucia Jones Herrera, associate director for social determinants of health and director of maternal strategies for UnitedHealthcare. Jones Herrera said doulas play an important role in the birth field and can improve clinical outcomes.

“That doula was a great partner,” she said. “Mom may need less medication and she’ll feel safer.”

Jones Herrera, who was an emergency room nurse before becoming a community health worker, said people like doulas are being pushed to the margins as the health care system modernizes.

“We’ve sort of evolved … to have a wall between what’s going on inside the clinical system and what’s going on outside,” she said. “So I had to do a lot of work trying to integrate those worlds.”

“It’s as simple as it sounds”

Jones Herrera recruited Ingram into Wyandotte County’s 2022 program. Ingram recruited the help of two other area doulas, who began accepting UnitedHealthcare Medicaid clients.

One of the doulas Ingram helped recruit was Jaima Saunders. Sanders started working as a midwife in the spring of 2021. But a few years before that, several events prompted her to enter the field of childbirth and become an advocate.

First, in 2019, Sanders was struggling with her youngest daughter’s pregnancy. She said she did a lot of journaling and reading during her pregnancy.

“I came across an article about Serena Williams,” Sanders said.

Sanders read about Williams nearly dying after giving birth to her daughter, which illustrates the challenges even famous black tennis stars face.

“Simply because her nurse didn’t listen to her,” Sanders said. “It’s really shocking.”

Sanders said the history of black women being overlooked in health care has deep roots. The man credited with inventing the speculum and known as the “Father of Gynecology” experimented on black slave women.

“I tell this story because I really think that’s where it comes from,” Sanders said. “As people of color, their voices are not listened to in health care. “I think that just stems from history. “

Earlier this year, UnitedHealthcare’s national team contacted Jones-Herrera to ask if she thought Kansas would be a good state to expand doula coverage for all of UnitedHealthcare’s Medicaid clients. Kansas became one of five states participating in the pilot.

UnitedHealthcare partners with the Doula Network, a national program to help with billing and administration.

this is not an easy task

On a cold day earlier this month, Ingram drove to Overland Park, Kan., to visit one of her clients. Anna Ferguson had just given birth a few weeks ago and had some health complications. Ingram was there to check on her and make sure she was taking care of herself.

Ferguson is the mother of seven daughters. Ferguson is a midwife herself and this was her first time using a doula. Ingram’s services are covered by her UnitedHealthcare Medicaid.

Ferguson said that with Ingram’s help, her most recent birth was the most peaceful despite everything she was facing in her personal life.

“My husband left about five months ago and I just didn’t have the support,” Ferguson said through tears. “It was nice to have someone who could validate my preferences and how I wanted to be born. “

For some providers, accepting UnitedHealthcare Medicaid clients hasn’t been easy. Ingram, who works full-time as a doula, said she struggled to get paid during the original Wyandotte County pilot program. Ingram temporarily stopped accepting Medicaid clients while it waits for payment issues to be resolved before UnitedHealthcare expands the program throughout Kansas.

Ingram resumed seeing Medicaid clients when the statewide pilot program began in 2023. But she said payment remains an issue. She and other midwives must complete at least five prenatal and postnatal visits and are not paid until the services are completed.

Ingram said that in some cases, especially if the doula is involved early in the pregnancy, it can take nine months or more to get paid.

“As doulas, they feel like we can wait and eventually get paid for our work, but I don’t think that’s fair,” she said. “Because we’re putting in the work throughout the entire pregnancy.”

For Ingram and many other doulas, their work doesn’t stop after regular business hours, nor is it limited to a five-visit window. Ingram said she receives calls and text messages throughout the day from anxious mothers-to-be. Many times, these extra hours are unpaid.

“Lawyers are paid by the hour every time they go to court to file. They’re counting those hours,” Ingram said. “The time came when I had to leave my children and my family.”

There is more work to be done

Jones Herrera of UnitedHealthcare said there is still work to be done to improve midwifery programs.

“Both sides still need to be able to make this work more smoothly,” Jones-Herrera said.

As of August 2023, 10 states and Washington, D.C., covered doula services through their state Medicaid programs, according to the National Institute for Health Policy. Supporters hope that number will grow.

In Wichita, Kansas, Birth Justice Kansas, a nonprofit organization led by Black and brown women, is pushing for all health insurance providers to cover doula care.

On Monday, the organization announced the formation of the Kansas Doula Alliance in a press release. The organization will advocate for equitable and adequate coverage and work with hospitals to make clinical settings more doula-friendly.

Sanders said she was encouraged by the progress being made.

“It’s motivation, because it’s the difference. So if moms are dying… the least you can do is give them this companionship,” she said.

Ingram couldn’t agree more. Moms on Medicaid are often the ones who need doula care the most, she said. But it’s hard work, and payment delays mean she has to carefully plan to accept Medicaid clients.

“It turned into a lot of running. It became difficult just to make a decent, livable wage,” Ingram said.

Bek Shackelford-Nwanganga covers health care disparities and access for The Kansas News Service.You can email her at r.shackelford@kcur.org.

The News Service of Kansas, a partnership of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio, focuses on health, the social determinants of health and their connections to public policy.

Kansas News Service stories and photos may be reproduced free of charge by news outlets with appropriate attribution and linking ksnewsservice.org.