HLS 25RS-329 ORIGINAL
2025 Regular Session
HOUSE BILL NO. 454
BY REPRESENTATIVE MILLER
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Requires Medicaid coverage for certain doula services
1 AN ACT
2To enact Part V of Chapter 8 of Title 46 of the Louisiana Revised Statutes of 1950, to be
3 comprised of R.S. 46:977.41 through 977.43, relative to Medicaid insurance
4 coverage for doula services; to provide for legislative findings; to provide for
5 definitions; to require Medicaid coverage for maternity services provided by doulas;
6 to provide for enrollment qualifications; to assign certain duties to the Louisiana
7 Department of Health; to provide for applicability; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. Part V of Chapter 8 of Title 46 of the Louisiana Revised Statutes of 1950,
10comprised of R.S. 46:977.41 through 977.43, is hereby enacted to read as follows:
11 PART V. MEDICAID COVERAGE FOR DOULAS
12 §977.41. Legislative findings
13 The legislature hereby affirms all of the following:
14 (1) Leading professional societies, such as the American College of
15 Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, and
16 federal agencies, such as the Centers for Disease Control and Prevention, the Health
17 Resources and Services Administration, and the Centers for Medicare and Medicaid
18 Services, have recognized the well-established benefits of doula services.
19 (2) In January 2025, Louisiana was selected as one of the states to participate
20 in the Centers for Medicare and Medicaid Services Transforming Maternal Health
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1 Model. The model is designed to focus exclusively on improving maternal
2 healthcare for people enrolled in Medicaid and the Children's Health Insurance
3 Program. The model supports participating state Medicaid agencies in the
4 development of a whole-person approach to pregnancy, childbirth, and postpartum
5 care that addresses the physical, mental health, and social needs experienced during
6 pregnancy. The goal of the model is to reduce disparities in access and treatment.
7 The model aims to improve outcomes and experiences for mothers and their
8 newborns, while also reducing overall program expenditures. This model urges
9 states to address gaps in maternal healthcare using doulas.
10 (3) Research has demonstrated that support from a doula is associated with
11 lower cesarean section rates, fewer obstetric interventions, fewer complications
12 during and after childbirth, decreased use of pain medication, shorter labor hours,
13 and higher scores on the Appearance, Pulse, Grimace, Activity, and Respiration, or
14 APGAR, test, which indicates how well the baby is doing outside the womb.
15 (4) As a state, Louisiana consistently ranks in the top five states for maternal
16 and infant mortality and morbidity in the United States, which is indicative of a
17 maternity healthcare crisis. It is well established that the use of doulas in maternal
18 healthcare makes a difference in improving outcomes and lowering healthcare costs
19 for the mother and infant.
20 §977.42. Definitions; health coverage; policy provisions
21 A. For purposes of this Section, the following definitions apply:
22 (1) "Doula" means an individual who has been trained to provide physical,
23 emotional, and educational support, but not medical or midwifery care, to pregnant
24 and birthing women and their families before, during, and after childbirth.
25 (2) "Doula treatment or care" means any maternal healthcare services
26 rendered by a registered doula in this state.
27 B. Any Medicaid coverage plan delivered or issued for delivery in this state
28 that provides benefits for maternity services shall include coverage for services
29 provided by a doula before, during, and after childbirth as provided in R.S.
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1 46:977.43. The coverage scope of services and rates shall be determined by the
2 Louisiana Department of Health using market benchmarks and comparisons to
3 similar state rates.
4 C. Doula services shall include but not be limited to all the following:
5 (1) Support and assistance during labor and childbirth.
6 (2) Prenatal and postpartum support and education.
7 (3) Breastfeeding assistance and lactation support.
8 (4) Parenting education.
9 (5) Support for a birthing woman after the loss of a pregnancy.
10 D. At minimum, each Medicaid plan shall comply with the provisions in
11 R.S. 40:977.43 and provide coverage for all of the following services:
12 (1) Five prenatal visits for up to ninety minutes.
13 (2) Three postpartum visits for up to ninety minutes.
14 (3) Assistance and attendance during labor and birth including cesarean
15 deliveries.
16 E.(1) The requirements established by Medicaid managed care plans to
17 ensure the services provided by a doula before, during, and after childbirth shall not
18 be construed to preclude a doula from practice in this state.
19 (2)(a) A doula may opt to practice in this state and forego any eligible
20 reimbursement via a health coverage plan.
21 (b) Doulas opting for reimbursement via a Medicaid managed care plan shall
22 have approved registration by the Louisiana Doula Registry Board.
23 F. All doulas with approved registration with the Louisiana Doula Registry
24 Board shall have acceptance as a provider of such services with all Louisiana
25 Medicaid plans in accordance with Medicaid rulemaking.
26 G. Terminology in any Medicaid managed care plan or contract deemed
27 discriminatory against doulas and doula services is void and unenforceable.
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HB NO. 454
1 §977.43. Required Medicaid coverage for doulas
2 A. The Louisiana Medicaid program shall cover inpatient and, if deemed
3 appropriate, outpatient coverage for doula treatment or care when such care or
4 treatment is used for a medically accepted indication and administered in any
5 healthcare facility by any healthcare professional appropriately registered in this
6 state to provide doula treatment or care in accordance with state and federal
7 guidelines or certifications.
8 B. Any healthcare facility appropriately providing doula treatment or care
9 in accordance with state and federal guidelines or certifications that participates in
10 the Louisiana Medicaid program shall provide doula treatment or care to an
11 individual who is eligible for such enrollment as defined in Subsection C of this
12 Section.
13 C. A prospective enrollee shall be considered eligible for doula treatment or
14 care enrollment if the individual satisfies all of the following qualifications:
15 (1) The individual is enrolled in the Louisiana Medicaid program.
16 (2) A licensed healthcare provider has certified that the individual is
17 pregnant or in the postpartum period.
18 (3) Doula treatment or care is administered in any healthcare facility
19 appropriately providing doula treatment or care in accordance with state and federal
20 guidelines or certifications. Doula care within the scope of services to provide
21 support to the individual shall be eligible for coverage to meet minimum coverage
22 standards external to the healthcare facility.
23 (4) The pregnant or postpartum woman requests or consents to the use of
24 doula services.
25 D. Pursuant to this Section, the secretary of the Louisiana Department of
26 Health shall do all the following:
27 (1) Submit to the Centers for Medicare and Medicaid Services all necessary
28 state plan amendments.
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HB NO. 454
1 (2) Promulgate and adopt all necessary rules in accordance with the
2 Administrative Procedure Act.
3 (3) Take any other actions necessary to implement the provisions of this Part.
4 Section 2.(A) The provisions of Subsection B of R.S. 46:977.42 as enacted by
5Section 1 of this Act shall apply to any new Medicaid managed care plan issued on and after
6August 1, 2025.
7 (B) Any Medicaid managed care plan in effect prior to August 1, 2025, shall convert
8to conform to the provisions of this Part on or before the renewal date, but no later than
9January 1, 2026.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 454 Original 2025 Regular Session Miller
Abstract: Requires Medicaid reimbursement for maternity services provided by doulas.
Proposed law provides legislative findings.
Proposed law defines applicable terms.
Proposed law requires Medicaid coverage for maternity services provided by doulas before,
during, and after childbirth.
Proposed law outlines doula services to be covered by Medicaid and other policy provisions.
Proposed law also provides that coverage must include 5 prenatal visits up to 90 minutes in
length, 3 postpartum visits up to 90 minutes in length, and assistance during labor and birth.
Proposed law requires the La. Medicaid program to cover inpatient and outpatient doula
treatment or care.
Proposed law provides for qualifications for prospective enrollees.
Proposed law requires the La. Dept. of Health to submit all necessary state plan amendments
to the Centers for Medicare and Medicaid Services, promulgate and adopt all necessary
rules, and take any other necessary actions.
Proposed law provides for application of proposed law.
(Adds R.S. 46:977.41-977.43)
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