Oregon's Doula & Lactation Promise Stalls: Why Essential Maternal Care Still Isn't Getting Paid

You'd think that a state aiming to broaden access to crucial maternal health services, especially for those who need it most, would be met with resounding success, right? Well, in Oregon, the story isn't quite so straightforward. While the intent was noble—to ensure more birthing people on Medicaid could receive support from doulas and lactation consultants—the reality on the ground is proving to be a frustrating, complex mess for the very professionals meant to deliver this care.

The state made a significant commitment, passing Senate Bill 182. This legislation, along with new rules from the Oregon Health Authority (OHA) taking effect in July 2023, was designed to open doors, ensuring that certified doulas and lactation care providers could bill Medicaid-managed health plans, known as Coordinated Care Organizations (CCOs), for their invaluable services. It was hailed as a win, a step towards more equitable, culturally congruent care for pregnant and postpartum individuals, particularly those from historically underserved communities. Think about it: a trained doula offering emotional, physical, and informational support during one of life's most transformative moments, or a lactation consultant guiding new parents through feeding challenges. These services are priceless.

However, here's where the wheels seem to come off. Despite all the promises and official regulations, a significant number of these dedicated care providers are finding it nearly impossible to get paid. They're putting in the work, delivering invaluable care, but the payment... well, that's another story entirely. Months are passing, bills are going unpaid, and the financial strain is becoming unbearable for many who poured their hearts and resources into becoming certified.

It's a bureaucratic quagmire, to say the least. Providers report a confusing maze of enrollment hurdles, inconsistent information from different CCOs, and outright payment denials or excruciating delays. Imagine dedicating yourself to supporting new families, only to spend countless hours on the phone, sending endless emails, and still seeing no income for the essential services you’ve already provided. It’s not just disheartening; it’s financially crippling. Many are contemplating leaving the profession altogether, or have already done so, simply because they can't afford to continue operating.

And who ultimately bears the brunt of this administrative gridlock? The families who desperately need this support. Medicaid recipients, often those facing systemic barriers to healthcare, are the ones who stand to lose access to the very services Oregon promised. Doulas and lactation consultants are often trusted figures, especially within specific cultural communities, offering a level of personalized, holistic care that can be life-changing. When these providers are forced to stop working, that crucial lifeline is severed.

The Oregon Health Authority acknowledges these challenges, framing it as a "learning curve" for the CCOs and the system at large. They assert that the responsibility for timely payments lies with these health plans and say they are working with them to resolve the issues. While it's true that implementing such a widespread change takes time and coordination, for providers who are facing eviction notices or struggling to feed their own families, a "learning curve" doesn't pay the bills. The frustration is palpable: these professionals followed all the OHA's guidance, invested in their training and certification, and now feel utterly abandoned by the system they trusted.

The vision was clear: better, more equitable maternal care for all Oregonians. The reality, unfortunately, is a system entangled in its own complexity, inadvertently penalizing the very individuals it sought to empower. For the promise of enhanced maternal support to truly become a reality, Oregon must urgently untangle this payment knot, ensuring that doulas and lactation consultants receive timely and fair compensation for their vital work. Only then can the state truly deliver on its commitment to the health and well-being of its most vulnerable families.