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Primary Submission Category: Reproductive health

Community-Engaged Evaluation of Maryland’s Medicaid Doula Program: Policy Lessons and Pathways Forward

Authors:  Shelby Wyand, Teneele Bruce, Leigh Goetschius, Karey Sutton, Sana Ghafoor Rahman, Asli McCullers, Kelsey Lyons, MaryAnn Mood, Melissa Eckroade, Jessica Galarraga,

Presenting Author: Shelby Wyand*

Objective: This study, led by MedStar Health Research Institute, The Hilltop Institute, and community advocates, evaluated the impact of Maryland’s Medicaid Doula Program (MMDP), which offers doula services at no cost to beneficiaries using a mixed-methods, community-engaged design. 

Methods: Quantitative analysis tracked MMDP utilization, while qualitative thematic analysis of 28 key informant interviews (policy leaders, health care providers, managed care organizations (MCOs), perinatal health equity advocates, and community-based doulas) identified strengths, barriers, and actionable recommendations. A community co-investigator and advisory board (CAB) ensured that those most affected guided the evaluation, fostering trust and relevance. Member checking and CAB feedback validated qualitative findings. 

Results: Doula services were used throughout the perinatal period, primarily by Black birthing individuals in urban areas with high social vulnerability. The MMDP improved birthing experiences, increased access to doula care, and fostered collaboration among MCOs and community-based doulas. Policymaker responsiveness led to iterative improvements, though challenges remained, including doula shortages, low reimbursement rates, administrative burdens, and gaps in obstetric care integration. The limited inclusion of doula input in the initial program design contributed to barriers, highlighting the importance of meaningful community engagement and interdisciplinary collaboration. 

Conclusions: The MMDP demonstrates how Medicaid-funded doula services can advance maternal health equity by increasing access for low-income birthing individuals. Maryland’s leadership set a national example, influencing policy changes such as new billing codes to streamline reimbursement. Moving forward, interdisciplinary collaboration is essential to reduce administrative barriers, ensure competitive reimbursement, and integrate doula care into maternity services to strengthen perinatal health outcomes.