Only six D.C. doulas were paid through Medicaid from October 2025 to September 2026, even though the District made doula care free for Medicaid patients in 2022.

The data, which the D.C. Department of Health Care Finance (DHCF) shared with The 51st, paints a stark picture. The 51st first reported on the program's failures Wednesday, Oct. 14. Between fiscal years 2024 and 2026, just 64 Medicaid beneficiaries used the doula benefit. D.C. Medicaid covered 3,416 births in 2024 alone, according to the 2025 March of Dimes report card.

The numbers matter. D.C. ranks 45th out of 52 states and territories for preterm birth, with an 11.8% rate in 2024, the March of Dimes found. Black women in the District experience significantly worse pregnancy and childbirth outcomes, The 51st reported.

The D.C. Council funded the Maternal Health Resources and Access Act in 2021, covering transportation to prenatal appointments and adding doula services to Medicaid. At-Large Councilmember Christina Henderson called it "a critical set of investments to reduce our extraordinarily high maternal mortality rates" in a press release that year.

Doulas told The 51st that paperwork barriers, denied claims and a confusing credentialing process have kept the benefit from reaching low-income families. Crystal Jackson, owner of A Queen Momma Doula Services, has served only three Medicaid families since enrolling as a provider. She reported $8,000 in denied claims tied to limited instructions on how to submit them to the District's managed care plans.

Gina Valo, owner of BirthingKind, said one managed care plan accidentally left postpartum care out of her contract. She discovered the error only after thousands of dollars in claims were denied. The mistake forced her to stop postpartum services for months, she told the D.C. Council in September 2025 testimony.

"I'm appalled at how hard it has been, and how some of these challenges are so solvable," Valo told The 51st.

To serve Medicaid families, doulas must first enroll with DC Medicaid, then get credentialed separately with each of the District's managed care plans: MedStar Family Choice, AmeriHealth Caritas D.C., and Health Services for Children with Special Needs. Wellpoint DC left the District's Medicaid managed care program on Aug. 1, with its enrollees moved to AmeriHealth Caritas.

DHCF Medicaid director Melisa Byrd acknowledged at a July roundtable that progress was "still really slow and incremental," The 51st reported. A DHCF spokesperson said the agency should have provided more tools before the benefit launched. DHCF published a provider manual in August and is developing a credentialing checklist for each plan.

A bill before the D.C. Council could address the biggest bottleneck. The Streamlining Medicaid Credentialing Amendment Act (B26-0523) is set for discussion Wednesday, Oct. 14. If passed, providers enrolled with DHCF would be automatically credentialed with all contracted managed care plans, potentially ending the plan-by-plan process that doulas say takes years.

D.C. also received up to $17 million from the Centers for Medicare & Medicaid Services in January 2025 to improve maternal health care for Medicaid recipients over 10 years, according to DHCF. Increasing doula access is a central goal of that grant.

The D.C. Council's Oct. 14 discussion of B26-0523 is the next opportunity for residents and providers to weigh in on fixing the program.