Reject House Bill 158
House Bill 158 will allow doulas to be covered by Medicaid and is on it’s way to the Senate after being passed through the Texas House.
“This bill is great! It’s going to help doulas gain credibility and families will be able to afford a doula.”
Nope. This bill does not need to pass the Senate. Here’s why:
While it sounds great on the surface, there are strings attached. If doula care will be covered by insurance, it will have to be defined and regulated. What constitutes a doula? Instead of DONA, CAPPA, or BAI helping to define this, it’ll be lawmakers who don’t understand doula work. It’s not out of the realm of possibility that you will have to have a Texas Doula License, complete with the hoops, fees, CEUs for renewal, and Scope of Practice that limits what you can do. Remember, Texas doesn’t give scholarships or passes for these fees, no matter your life situation.
Say that you serve in Denton and your niche is women who lean more toward deregulation. You draw more women by being well trained but not certified. If this bill passes, you’ll likely have to certify, or you won’t get reimbursed by Medicaid. Oh-and since demand for certification will go up, so will the prices.
Have you ever listened to midwives discuss billing? Do you know about diagnosis codes and clearinghouses? Superbills and HCFA forms? Do you want to pay someone who does to do your billing? Do you assume that just because you’re “non-medical support” you won’t be made to submit bills to insurance like everyone else?
In spite of this, you decide to jump through all the hoops and start accepting Medicaid in your doula practice. Be ready to be paid little and paid late. And, if you need the help of a biller, be prepared to make zero profit on that birth. Actually by the time you pay for parking, childcare, food, doula gadgets, etc., you’ve actually *paid* to attend that birth. Remember, you can’t balance bill Medicaid so there’s nothing more you can do than accept the paltry amount they throw at you. Well, “throw” is too generous of a word. You’ll actually have to pull it from them with loads of paperwork and then wait and wait for your anemic check to come in.
But hey, at least that mom had her birth paid for!
What if you decide you don’t want to be covered by Medicaid? What if you want to keep the government out of your business and find other innovative ways to ensure there’s a doula for every woman who wants one? Well lets imagine…You charge a living wage of $900 per birth and when you tell your potential clients this, they just want to know if you take Medicaid like the other doula in town. Of course you don’t get hired, and the doula down the street gets another client for whom she’ll have to pay to attend her birth. Since you can’t get work, you move into midwifery where the reimbursement rate is so much better (tongue planted firmly in the cheek). The other doula is swamped but since she’s making peanuts (or less) she burns out, and then your area has zero doulas.
Listen, the government is not the answer to making sure everyone gets what they want outside of good safe roads, emergency services and clean water. They even mess that up (do you remember the power debacle of just a few months ago during our winter storm crisis?). Stand against the broken system breaking your career, or families will have even less access to the undeniable benefits you bring to the birth world with your skills. Don’t fall into the trap, doulas!