Wyoming Medicaid Doula Gap Persists

Wyoming remains one of the few states that does not reimburse doulas through Medicaid.

The state lags behind 28 other states that have added doula services to their Medicaid benefits. This gap leaves many low-income pregnant individuals in Wyoming to pay for this support out of pocket. The lack of coverage creates a financial barrier for families who might otherwise benefit from professional childbirth assistance.

Liz Alva Rosa, a doula with 23 years of experience, charges $1,800 for her services. She offers sliding scale options but notes that clients typically pay directly. Sarah Heatherton of Jackson Hole recently gave birth to her son Jonathan with Alva Rosa's help. Heatherton described feeling out of control when her water broke in the car, but her doula helped her stay grounded. Alva Rosa explained that doulas do not make medical decisions but help calm the mother, which can reduce the need for interventions like C-sections.

Amy Chen, senior staff attorney at the National Health Law Program, noted that state Medicaid doula reimbursement expanded from two states to 28 in five to six years. She cited growing awareness of maternal mortality rates, which are higher in the U.S. than in other high-income nations. Chen also pointed to a shift toward doulas and home births during the pandemic. In Colorado, doulas have received up to $1,500 per Medicaid birth since 2024, leading to increased client hours and caseloads for practitioners like Ali Batwin.

Wyoming lawmakers face a difficult path to adopting similar coverage. The state is one of the few to reject Medicaid expansion under the Affordable Care Act. Jenn Lowe, who leads the advocacy group Healthy Wyoming, views doula care as a nice-to-have rather than a necessity. She argued that the state should prioritize expanding access to medical care, noting that almost half of Wyoming counties lacked a practicing OB-GYN as of 2024. Lowe suggested using funds for transportation or lodging for women who need to travel for care.

Lowe also highlighted the impending sunset of a current Medicaid provision on March 31, 2027. This provision currently extends coverage for new mothers for a year after birth. Without extension, mothers would only receive coverage for 60 days post-birth, a period advocates say is insufficient for addressing late postpartum complications. Britt Boril, executive director of WyoUnited, agreed that doula reimbursement alone would not solve the state's maternal health crisis. She described it as one piece of a larger puzzle that includes recruiting more physicians.

Faithe Dell, a doula in Cheyenne, uses a kit containing items like diapers and a wide-tooth comb to help clients manage pain. She said doulas can bridge communication gaps when patients have limited access to their OB-GYNs. Dell offers discounts to low-income and military families and sometimes works for free, but she must cover the costs of replenishing her supplies. If Medicaid were to reimburse doulas in Wyoming, she said this support could reach more families without forcing providers to absorb the financial cost of their tools.

The issue sits against a backdrop of changing birth preferences and persistent health disparities. Rural, Black, and Indigenous populations in the U.S. experience higher rates of pregnancy-related deaths. While private insurers often follow Medicaid in covering doula services, specific certification requirements and low reimbursement rates can still complicate payment for doulas. Wyoming's decision on doula reimbursement will be weighed against competing priorities in its limited healthcare budget.

The state's legislative session next year will likely address the postpartum coverage sunset. Advocates continue to push for both the extension of that coverage and the addition of doula benefits. For now, families in Wyoming must navigate the cost of professional childbirth support without state insurance assistance. The gap between Wyoming and its western neighbors remains a focal point for maternal health advocates in the region.