Birthing Families Require Immediate Support.
Qualified doulas are ready and willing to serve. Families are being denied the right to choose one.
Managed Care Plans are relying on a narrow definition of "lack of demand" for doulas that doesn't align with the need of the majority of California families who haven't been empowered to exercise their right to a doula. Too many families remain unaware of the improved birth outcomes doulas provide, or have not fully utilized the Medi-Cal Doula coverage they are entitled to.
We want the maternal health crisis to end, to improve birth & postpartum outcomes, and increase doula access. Doulas are a vital part of the solution and families need access now — with a statewide goal to reduce health disparities for the hardest-hit populations by 50% by 2025 (last year). California has failed to reach that goal. Now we need to act.
Every year, more than 40,000 families in LA County — and over 150,000 across California — give birth through Medi-Cal. Each one has the right to a doula of their choice. Particularly, in communities that are experiencing the highest rates of maternal morbidity and mortality, having a doula who comes from their cultural or linguistic background to advocate for them becomes crucial.
Health plans are allowed to define their network as "adequate" for the demand and declare they have "enough" doulas. But that math is broken at the root: most families don't know that the doula benefit exists, so measured demand stays artificially low. Plans use that suppressed number to justify turning away qualified providers who are ready to serve families.
PAVE-approved Medi-Cal doula providers wait months and even years for contracts. Claims go unpaid. Families who do find a trusted doula are told that the doula can't be contracted in time. The need is real and the doulas are ready. The barrier is the system in between — and it's one the plans and DHCS can fix.
Doula care itself isn't in question: ACOG (American College of Obstetricians and Gynecologists) and the Society for Maternal-Fetal Medicine recognize continuous doula support as one of the most effective strategies for improving birth outcomes. Families have a right to care that is proven to work.
Families may choose a doula of their choice — including offering a Letter of Agreement so a trusted, not-yet-contracted doula can serve them in time. Don't cap the network before every family has access.
Contract more doulas to meet families' real needs, and stop delaying or denying contracts for doulas already PAVE-approved to serve high-risk communities.
Cover administrative costs and process claims promptly. End the payment delays and denials that make this work financially unsustainable for an independent, non-clinician workforce.
Eliminate insurance requirements — like umbrella and cyber coverage — that are financially out of reach and don't fit the doula profession. Bring transparency to billing and claims.
Who signed
The people who signed are exactly the community this benefit was built for: the families who receive care and the doulas who provide it, in every region of the state.
Individuals and organizations who put their names on the record in support of families' right to doula care.
The very members plans say aren't asking — adding their own names to the demand.
In their own words
Signers were invited to share why this matters. Here are a few of their voices.
Standing together
Doulas, birth collectives, community health organizations, legal advocates, and care providers across the state added their names alongside individual signers.
Add your name
The letter is still gathering signatures. Add your name to urge California's Medi-Cal managed care plans to remove the barriers between families and their right to a doula of their choice.
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