Q: What information is required from doulas during the enrollment or application process?

Doulas will be required to provide an EIN/TIN and NPI, along with any required supporting documentation, during the enrollment process. This information will also be required on the claim form. 

Q: Are there specific documentation requirements for doula services?

Additional details regarding documentation requirements for doula services will be shared as they become available. More information is expected to be published in the Women's Services and Family Planning Provider Manual in May 2026. For updates, please visit:
medicaid.utah.gov/utah-medicaid-official-publications/

Q: How long does the provider enrollment process take?

Enrollment for Healthy U, Health Choice Utah, and PRISM generally takes approximately 30–45 days. PRISM is a separate enrollment completed through the State.

Q: What are the reimbursement rates and details for doula services?

T1032 (Prenatal/Postpartum Support) is reimbursed at $11.59 per 15 minutes, and T1033 (Labor Support) is reimbursed at $834.28 per diem. For additional details, please refer to the Medicaid Coverage and Reimbursement Code Lookup Tool.

Q: Does the doula have to be present for all 4 stages (Cervical Dilation, Delivery of the Baby, Delivery of the Placenta, and Recovery/Postpartum) of labor to be reimbursed for labor support?

No. The doula does not need to be present for all four stages in order to be reimbursed for labor support.

Q: Can two doulas support a patient during a long labor?

Due to the limit of one unit of T1033 per rolling year, that code can only be reported once per member per rolling year. It is the responsibility of the doula to discuss expectations and processes should the labor and delivery exceed the time that the doula is able to assist. If the doula reporting services decides to share the per diem reimbursement with another doula, it is their responsibility to coordinate that care and reimbursement. The code may only be reported once, per rolling year, per member. 

Q: Can doulas balance bill Medicaid members if reimbursement is lower than their fees?

No, balance billing Medicaid members is not allowed.

Q: Will my personal email address be publicly visible?

No, your personal email address will not be publicly displayed.

Q: If a birthing person is looking for a doula who is covered, is there a link we can send them?

You can search for participating providers using both plan directories. Access the U of U Health Plans Provider Directory or the Health Choice Utah Provider Directory to view participating providers.

Q: Will there be additional training or informational sessions?

ASCENT and U of U OBGYN are planning to host an “open house” to support doula Medicaid enrollment at the end of April. For additional information, please contact Jessica.Sanders@hsc.utah.edu

Q: How many hours are covered for prenatal and postpartum services?

Up to 8 hours may be used for prenatal or postpartum services, depending on eligibility. Units are billed in 15-minute increments. 

Q: How should doulas handle situations where Medicaid eligibility changes from month to month during ongoing care?

If the member is not Medicaid eligible or does not have any other coverage for one or more months, payment may be collected privately, or support may be discontinued for those months.

Q: What are the certification requirements for doulas, and are specific certifying bodies required?

Doulas seeking to contract with U of U Health Plans and Health Choice Utah must hold a Basic Life Support (BLS) certification and be certified through one of the following approved agencies: DONA International, CAPPA (Childbirth and Postpartum Professional Association), the National Doula Certification Board (NDCB), ProDoula, Childbirth International (CBI), the International Childbirth Education Association (ICEA), Birth Boot Camp, or Health Connect One. Organizations interested in becoming a Utah Medicaid‑approved doula training program may apply by submitting their curriculum and supporting materials to dmhfmedicalpolicy@utah.gov.

Q: If a member loses Medicaid eligibility, can doulas still bill for services provided while the member was covered?

You may bill for the supported hours while the member had coverage.

Q: If there are multiple births (e.g., twins), will it be counted as one birth?

This is currently under review. Please check back for updated guidance.

Q: Can you share what your commercial rates are?

If interested in contracting, you may contact U of U Health Plans to obtain commercial rate information.

Q: If a precipitous birth occurs (e.g., unplanned home birth, car, parking lot) and the baby is born before hospital admission, but the doula is present, can the doula bill for labor support?

Yes, you can bill for labor support in those instances. 

Q: Are doula services covered for surrogate pregnancies?

No, surrogate motherhood is excluded from Medicaid coverage.

Q: Who should I contact if I’m interested in contracting?

If you are interested in contracting, please reach out to the appropriate provider relations team for next steps.

Q: If a provider enrolls but determines the compensation is not sufficient, are they required to maintain enrollment or update it annually?

Providers are recredentialed every three (3) years. If the compensation is not sufficient, you may terminate your contract with U of U Health Plans and Health Choice Utah.

Q: How often are providers recredentialed?

Providers are recredentialed every three (3) years. Notification will be provided when recredentialing is required.

Q: How do providers determine which insurance to bill for a member (e.g., Medicaid vs. Healthy U or Health Choice Utah)?

You would check the member’s eligibility in PRISM and bill the insurance carrier listed.

Q: Are Molina and SelectHealth also accepting doula services?

Please check directly with Molina and SelectHealth for information on doula services.

Q: Is certification required before contracting?

Yes, certification is required prior to contracting with U of U Health Plans and Health Choice Utah.

Q: How do doulas enroll with Utah Medicaid?

Enrollment will occur through PRISM once the doula provider type is available (expected late April). When the Medicaid Information Bulletin (MIB) is published, doulas must follow the instructions included in the MIB to complete PRISM enrollment.

Please subscribe to the MIB to receive updates as they are released!