Pritzker Administration Announces New Medicaid Coverage for Certified Doula and Lactation Consultant Services

New coverage intended to improve maternal and infant health outcomes across Illinois

Certified doulas are trained professionals who provide a range of physical, educational and emotional supports to pregnant and birthing individuals throughout their pregnancy, birth and postpartum experience with a goal of improving health outcomes for birthing people and infants. Lactation consultants are healthcare professionals who provide breastfeeding education and support and can assist parents with any questions or challenges with breastfeeding.

 "Here in Illinois, we're committed to ensuring every mother, regardless of race, income, or zip code, has access to the care they deserve," said Governor JB Pritzker. "By expanding Medicaid to include doula and lactation consultant services, we're closing gaps in maternal healthcare and improving outcomes for mothers and infants."

"Expanding Medicaid coverage to include the full spectrum of reproductive care is an investment in public health," said Lt. Governor Juliana Stratton. "We're widening the scope of protection for Illinois families to ensure that every new mother, regardless of race or zip code, has access to the support her unique body needs -- and that every new baby is delivered into a world that supports healthy development."

"Expanding coverage to include new maternal health provider types will make available new services for expectant and birthing parents and will provide a wide range of supports during the critical perinatal period," said Acting HFS Director Elizabeth M. Whitehorn. "This new coverage will continue to strengthen maternal and child healthcare in Illinois and improve equity - an essential part of the Department's mission to improve the lives of Illinois families."

"The Illinois Department of Public Health is proud to support this innovative effort to improve birth outcomes in Illinois," said IDPH Director Dr. Sameer Vohra. "IDPH's recent Illinois Maternal Morbidity and Mortality Report documented unacceptable racial disparities in maternal health outcomes.  Increasing access to maternal supports, like doulas, has been tied to improved outcomes for Medicaid recipients and those living in historically excluded communities. Our Office of Women's Health and Family Services is actively partnering with HFS to support this critical effort and ensure we are doing all we can to make Illinois the safest place to give birth."

The Medicaid coverage for lactation consultant services includes the entire perinatal period through infant weaning. Covered lactation support services include perinatal education about breastfeeding and human lactation; comprehensive maternal, infant, and feeding assessments related to breastfeeding and human lactation; and evidence-based lactation counseling and the provision of support and encouragement to promote successful attainment of breastfeeding goals. Services may be delivered individually or in a group setting and may be provided in person or via telehealth.

The coverage for certified doula services includes the entire perinatal period and up to one year postpartum, regardless of how the pregnancy ends. Covered doula services include perinatal counseling, education and supports, including newborn care; development of a birth plan and support during labor and delivery; care coordination with available community-based services; attendance at clinician visits; emotional and physical support; and visits to assist with basic infant care. Prenatal and postpartum services may be provided in person or via telehealth. Support during labor and delivery must be provided in person. The expanded coverage for doula services was included in the Illinois Legislative Black Caucus healthcare pillar bill, which Gov. JB Pritzker signed into law in 2021.

"Illinois has taken major steps to address the challenges mothers face in pregnancy, childbirth, postpartum and newborn care. That includes recognizing the higher rates of morbidity and mortality that women of color face, ensuring everyone can choose a birth plan that works for them, and now providing additional resources for new families" said House Majority Leader Robyn Gabel (D-Evanston). "Every new family needs quality care and support during pregnancy, in childbirth, and after they leave the hospital; expanding Medicaid coverage for lactation specialists and perinatal doulas ensures cost is not a barrier to that care."  

"Doulas and lactation consultants provide vital support that helps improve the overall health of mothers and their babies," said State Senate Assistant Majority Leader Mattie Hunter (D-Chicago). "By expanding coverage of these services, we are making essential care more attainable for families."

"Today Illinois is taking a needed step forward to support mothers with doula and lactation services that will improve equity, strengthen healthcare options and deliver better outcomes across our state," said House Assistant Majority Leader Camille Lilly (D-Chicago). "It's critical that we complement and build on this progress to ensure that every mother and child receives the care they deserve, especially the most vulnerable women in Illinois. I appreciate the Illinois Department of Healthcare and Family Services' continued leadership and commitment to this cause, they have worked alongside the General Assembly and its leadership to get us to this point."

"Having doula and lactation services covered through Medicaid can be a lifeline for women at risk of complications," said State Sen. Cristina Castro (D-Elgin). "This important coverage is a significant step toward building supportive systems of care where parents have the tools and support they need to keep themselves and their babies healthy."

The State of Illinois is also issuing a standing recommendation for lactation services and doula services so that Medicaid customers can receive coverage for these services without having to obtain a referral from their physician. This standing recommendation meets a federal requirement that preventive services provided by certified doulas and certified lactation consultants be recommended by a licensed provider. It removes a potential access barrier for Medicaid customers and removes an administrative burden from lactation consultants and doulas.

"Eliminating obstetric harm and racism has to be a collective effort to ensure the reduction of maternal and infant mortality," said BA NIA Inc. Co-founder and Executive Director Mekazin Alexander. "BA NIA Inc. supports the progressive strides that HFS has taken to expand the services of doulas and lactation consultants for Medicaid and private insurance users across the state of Illinois.  We commend HFS for recognizing the importance of organizations that are community-based, culturally congruent and offer certification and mentoring.  We would like to see the state continue to move quickly for reimbursement rates set at a livable wage so doulas are able to work at the fullest extent of their practice."

"The work required to support improved outcomes for families in Illinois is a heavy undertaking and will require the keen collaboration of everyone across the healthcare landscape," said Tayo Mbande of Chicago Birth Works. "Medicaid expansion towards doula support, and lactation support is a step towards a more inclusive and community-centered healthcare landscape. Healing the communities that are most impacted by maternal mortality, morbidity and longstanding health inequities must involve care that is centered in those communities. We are excited for this win and to continue building partnerships with the many stakeholders involved in the struggle toward birth equity in Illinois."

To enroll as an Illinois Medicaid provider, lactation consultants must be at least 18 years old and certified as an International Board Certified Lactation Consultant (IBCLC) by the International Board of Lactation Consultant Examiners, certified as a Certified Lactation Counselor (CLC) by the Academy of Lactation Policy and Practice, Inc., or certified as a Certified Lactation Specialist (CLS) by the Lactation Education Consultants.

To enroll as an Illinois Medicaid provider, doulas must be at least 18 years old and certified by the Illinois Medicaid-Certified Doula Program, a partnership between HFS and the Sothern Illinois University (SIU) School of Medicine. This Illinois certification, developed in partnership with HFS and a workgroup of community doulas, leverages an extensive list of existing national and Illinois-based doula training programs and includes a training-based pathway as well as a legacy pathway for doulas with significant experience. Questions regarding certification can be directed to the SIU School of Medicine at doulacertification@siumed.edu.

To provide enhanced Medicaid provider onboarding and support for these new maternal health provider types, the Medicaid Technical Assistance Center (MTAC), a partnership between HFS and the University of Illinois Office of Medicaid Innovation, will provide live training, on demand training, and one-on-one support via phone and email. This support includes a Medicaid-specific overview for each provider type, how to obtain National Provider Identifier (NPI), and how to enroll in IMPACT, the Illinois Medicaid provider enrollment system.