Bill Overview
Title: Mamas First Act
Description: This bill requires state Medicaid programs to cover doula and midwife services, including prenatal, delivery, and postpartum services, in a variety of settings.
Sponsors: Rep. Moore, Gwen [D-WI-4]
Target Audience
Population: Women who are Medicaid recipients and may be pregnant or planning to become pregnant
Estimated Size: 5000000
- Many pregnant women rely on Medicaid for their prenatal, delivery, and postpartum care.
- The bill targets pregnant women, especially those considering or needing doula and midwife services.
- Doulas and midwives may be utilized in various settings, including hospitals, birthing centers, and homes.
- Medicaid is a public health insurance program in the United States that covers low-income individuals and families, and it covers a significant portion of births in the U.S.
- It will also indirectly impact families of these women, as the health and affordability of maternal care have wide-reaching effects on family wellbeing.
- The inclusion of doulas and midwives could enhance maternal health outcomes by providing more personalized care and support.
Reasoning
- Under the Mamas First Act, many women covered by Medicaid will receive enhanced support for pregnancy, labor, and postpartum care, likely improving maternal and child health outcomes.
- The policy will primarily impact low-income, pregnant women who are Medicaid recipients and interested in holistic, personalized care options such as that provided by doulas and midwives.
- Budget constraints will limit the scope of services, particularly in underserved areas where the need may be greatest.
- Some Medicaid recipients may not notice any change if they are not pregnant or not choosing doula/midwife care.
- Cultural, geographic, and individual preferences will affect how widely these services are taken up.
Simulated Interviews
Student (Atlanta, GA)
Age: 25 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 15/20
Statement of Opinion:
- I think having a doula will help me feel more prepared and supported during childbirth.
- My community health center currently doesn't offer doula services, so this could improve my access.
- I'm worried about whether my specific doula will be covered under Medicaid.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Retail Worker (Rural Kentucky)
Age: 32 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Doula services are beneficial but aren't readily available in my area.
- Having extra support would greatly benefit my mental health during pregnancy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Unemployed (Los Angeles, CA)
Age: 28 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 12/20
Statement of Opinion:
- I'm considering a midwife for my pregnancy; this policy could support my choice monetarily.
- It's crucial to feel at ease during pregnancy, and having more options helps.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
Part-time worker (Chicago, IL)
Age: 22 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- More options are always good, but I'm not sure this will affect me immediately.
- I like the idea but doubt I'll use it soon.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
Healthcare Administrator (Phoenix, AZ)
Age: 38 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 11/20
Statement of Opinion:
- I would prefer a midwife for my next birth, based on past experiences.
- This policy feels like a positive change in maternal care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Freelancer (New York, NY)
Age: 30 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- The additional support of doulas and midwives would give me peace of mind.
- I'm slightly concerned about potential bureaucratic delays in accessing these services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Teacher (Denver, CO)
Age: 45 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 9/20
Statement of Opinion:
- Great for current and future Medicaid mothers.
- Better late than never; I wish I had these options available to me before.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Stay-at-home mom (Miami, FL)
Age: 27 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- Having a doula could ease the stress of expecting twins.
- Twins might present more challenges, so more support is appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Cashier (Houston, TX)
Age: 21 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 6.0 years
Commonness: 12/20
Statement of Opinion:
- This policy could lessen my anxiety about healthcare access during my pregnancy.
- Midwife and doula services can make a big difference.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 4 |
Barista (Seattle, WA)
Age: 24 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 16/20
Statement of Opinion:
- A doula would make me feel less alone during pregnancy and postpartum.
- It's reassuring to know more options are available, even if I don't choose them all.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Cost Estimates
Year 1: $450000000 (Low: $300000000, High: $600000000)
Year 2: $495000000 (Low: $330000000, High: $660000000)
Year 3: $544500000 (Low: $363000000, High: $726000000)
Year 5: $601950000 (Low: $400000000, High: $800000000)
Year 10: $726000000 (Low: $484000000, High: $968000000)
Year 100: $900000000 (Low: $600000000, High: $1200000000)
Key Considerations
- Coverage of doula and midwife services under Medicaid is expected to improve maternal outcomes but may require adjustments in state budgets.
- Cost variations arise from regional differences in Medicaid coverage and healthcare costs.
- Efficiency gains may occur through preventive care reducing the need for expensive medical interventions.
- Training and scaling of doula and midwife services will be critical factors in adoption speed and cost-effectiveness.