Vt. bills would expand Medicaid childbirth coverage

BURLINGTON, Vt. (WCAX) - Two bills at the Vermont Statehouse would expand Medicaid coverage for new mothers by including coverage for the costs of qualified doulas and breast pumps prior to birth.

Mary Kate Shanahan helped start the Vermont Doula Company in 2021. Now they have 10 team members.

Doulas are traditionally known for their coaching during labor, a painful and life-changing event that can carry trauma when things go wrong or feel out of control.

“What a doula can do is kind of help to shift that, help to the birthing person and whoever else is in the room -- partner, caregiver -- feel present. It’s a service Shanahan says truly helps provide better health outcomes.”There’s a reduced rate of c-sections for people -- or surgical births -- for people who work with a continuous support person. There’s a decreased rate in pitocin used -- or augmentation of labor -- and just better birth outcomes for both newborn and birthing person.”

But it’s not just about birth. The Vermont Doula Company offers continual care from pregnancy to postpartum. That includes going to homes after birth, when the baby is crying, no one has slept, and parents are stressed out. “There have been times after an overnight where people don’t want us to leave. They’ll be like, ‘Can you please stay? That was the best night’s sleep, I can’t believe the baby slept well,’” Shanahan said.

But doulas can be pricey. Nationally, one-on-one care from a professional can cost anywhere from a couple of hundred dollars to a couple thousand.

The Vermont Doula Company has a standard birth package but talks with families about what they can afford, including pulling from a donation fund, or finding other resources in the community. “Access to care is a whole big question and I hope that as professionals we can work together as a team -- both in Vermont and across the nation -- to get it so that that isn’t a barrier,” Shanahan said.

Most private health insurance companies don’t cover the cost of doula services. Vermont House Bill 154 would require Medicaid to reimburse the cost of a qualified doula.

Meanwhile, Vermont House Bill 356 would require Medicaid to cover the cost of a breast pump before the birth of a child.

“I had a child in early 2022 and had a really difficult time breastfeeding myself,” said Rep. Ashley Bartley, R-Fairfax. She says it was her own struggles postpartum that prompted her to sponsor the measure. She says Medicaid currently covers a pump after a baby is born.

“That leaves out any parent who might struggle or there might be a mother/child separation. So, in terms of NICU, premature babies often have a hard time feeding, any sort of anatomical issues that might happen that, obviously, doctors might not know about prior to birth.”

The bill also requires Medicaid to provide a pump per child instead of one every three years.

Ginger Irish with the Department of Vermont Health Access says Vermont Medicaid is evaluating breast pump coverage policies to ensure equitable, medically informed access to breast pumps and that they are expanding postpartum coverage from 60 days after birth to 12 months.

Bartley says bills like these show a change in the Vermont Statehouse. “There’s this whole kind of subject of legislation that we haven’t seen before, but because we are seeing those younger voices -- especially younger voices of families come through -- they understand what our growing needs of young Vermonters need,” she said.

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