Additional Considerations
Covering doula services as a preventive service is a medium-term investment. It requires NC Medicaid to submit a State Plan Amendment (SPA) to CMS and receive federal approval. New Jersey, Oregon, and Virginia were approved for their doula-related SPAs, while other states are currently in the SPA submission process. Medicaid reimbursement of doula services may require additional funds from the NC General Assembly to initiate this new benefit; however, doula services can be cost-saving in the long run. Relying upon Medicaid data from multiple states, a team of researchers modeled the cost effectiveness of doula care and estimated an average saving of $986 per birth due to reductions in preterm births and C-sections.377 Encouraging the NC General Assembly to appropriate funds for doula training grant programs may be more difficult given state budget restraints. Yet, given these grant programs would be a minor appropriation amount it may be more feasible. A bill introduced in the NC General Assembly would establish awarding up to five doula training grants ranging from $10,000 to $50,000 annually.378 Alternatively, NC Medicaid could encourage PHPs to privately fund community-based doula programs, similarly to BlueCross NC’s current grant program.
2.2 Group Prenatal Care NC Medicaid should require PHPs to cover group prenatal care. Implementation: • NC Medicaid should add group prenatal care in PHP contracts. • NC Medicaid should work with stakeholders to develop an adequate incentive payment rate for group prenatal care. Background
Group prenatal care differs from traditional childbirth education classes in several ways. In traditional classes, the program is not clinicallybased and provides information on subjects such as newborn care, breastfeeding, and the labor and delivery process. In contrast, in group prenatal care, women with similar due dates meet with a health care provider in a group setting, where group discussions are facilitated by the clinical staff. Women participate in collecting health metrics, such as taking blood pressure and charting, and have the opportunity to meet one-on-one with the medical specialists.379 CenteringPregnancy is a specific evidence-based group prenatal care that has been implemented across the country. As discussed in the background section, Black women experience much higher rates of poor maternal outcomes. Specifically—as it relates to group prenatal care—Black women experience higher rates of depression during the pregnancy and postpartum period.380 Black women also are at higher risk for giving birth to a preterm and/or low-weight baby, which, in addition to causing worse outcomes for the infant, can be associated with increased rate of maternal depression and other maternal health conditions.381 Black women generally experience higher levels of stress in their daily life, which in turn can negatively impact their pregnancy health and outcomes.382
70 Part III. Maternal Health Care Recommendations
