Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”January 14th, 2016
As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release:
“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”
“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”
The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).
- Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
- The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
- State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
- The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
- Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
- State legislatures should mandate private insurance coverage of doula services.
Lately I have been bombarded with messages and e-mails from Mamas on Bedrest seeking for financial help. I hear you and I so wish that I could help. Unfortunately, Mamas on Bedrest & Beyond was never designed to provide financial assistance to families in need.
This is not a new issue. Mamas on Bedrest & Beyond has been a staunch advocate of paid family and maternity leave since its inception. We have traveled to the halls of congress with other family leave proponents to petition legislators to pass a paid family leave bill without success. To date, The National Partnership of Women and Families, MomsRising and others continue to press for paid leave, and while we have gotten close, there still remains no uniform, national paid family leave for new parents. Thus the United States has the dubious distinction of being the only industrialized nation on the planet not to offer paid family/maternity leave to its citizens. In terms of countries with medical leave benefits, we rank approximately 168th out of 172 nations that offer medical leave benefits. The only other countries without paid leave policies are Lesotho, Swaziland and Papua New Guinea. Thus the United States, one of the richest nations on the planet, the nation that spends more for health care than any other nation on the planet continues to have birth outcomes and overall health outcomes that rival those of developing nations without technological resources. It is a sad state indeed.
The Family Medical Leave Act is the best that we have and that has its restrictions. Passed in 1993, FMLA allows an employee to take up to 12 weeks of unpaid leave to care for a family member or for the employee to undergo treatment for illness and continue to have healthcare coverage during this time as an employee benefit. But there are some caveats. First, FMLA does not apply if you work for a small company with less that 50 employees. For companies larger than 50 employees or electing to enact FMLA, if an employee is out beyond the 12 weeks, the employers is not obligated to keep them as employees and many people have lost their jobs due to prolonged illness and absence. Additionally, while employers may be required to keep you on as an employee, they are not required to keep you in your same position or at your same salary. So after your leave, you may return to your place of employment but not to your same position.
Some individual companies have elected to offer their employees paid medical leave. This is a very individual decision and one that is not at all regulated. If your employer offers a paid leave benefit, you need to contact the human resources office to see what the rules and stipulations are regarding the paid leave. You will want to ask if there is a minimum amount of time you have had to be with the company in order to be eligible for the benefit as well as ask if you have to be a full time, salaried/exempt employee.
What else can Mamas on Bedrest do? How is a mama supposed to go on bedrest, rest, relax and calmly gestate her baby when she is filled with anxiety about her family’s finances? There are a few things that mamas can do that may help their financial situations. We offer these suggestions:
- Learn the laws and regulations governing paid leave for your state. Three states, California, New Jersey and Rhode Island, offer paid family and medical leave. All three states fund their programs through employee-paid payroll taxes and are administered through their respective disability programs. Other states and counties have various medical leave laws, so visit your state, county and local webpages to see what your area offers in the way of medical leave.
- Check with your state’s labor office. Some states have a disability program and take a portion out of your paycheck for this program. If this is the case, you may be eligible to apply for benefits. Often the benefit is a percentage of your pay, say 60%, but isn’t 60% of your salary better than nothing? These programs also have various rules and regulations so check with your state labor office for complete details and to learn how to apply if there is a program for which you are eligible.
- Speak with your employer. Some employers are willing to make allowances for your absence. In some cases, if you are able to work from home, they will set you up with equipment to continue working while on bedrest. In other situations you may be able to job-share; a co-worker covers for you now and you cover for them when you are able. Many employers are more amenable to being flexible than losing an employee and having to find and hire a replacement which actually represents a substantial cost to the employer.
- Consider Work from Home options. If you aren’t eligible for any sort of paid leave, your state/county doesn’t have a disability program and your employer/job won’t allow for you to work from home, you may want to consider work from home options. Some mamas have started businesses while on bedrest, working as virtual assistants, bookkeepers, medical transcriptionist and other jobs that have nominal equipment requirements and flexible hours. If you aren’t sure what types of work from home opportunities are available, I strongly suggest that you visit Theworkfromhomewoman.com. This website is run by my friend and colleague Holly Hannah and offers tips and advice for moms who want to find legitimate work from home opportunities.
I realize that adding to the stress of being placed on bedrest and worrying about how you are going to make ends meet you may not feel like looking for a job, but I have to say that many a mama has created a wonderful business out of her bedrest experience. (i.e. Mamas on Bedrest & Beyond, the Bedrest Concierge, The Sleep Whisperer just to name a few! Also, check out our podcasts! There are several mamas there who have taken their pregnancy/bedrest experiences and turned them into satisfying and profitable businesses!). While being placed on bedrest may not seem like an opportunity, it may in fact be the start of something wonderful for you! Check out your options. Look at the resources available to you. Ask those around you if there is something that you can do to pass the time that would help them. You may be surprised at what opportunities come your way!
If you have found a way to stay financially solvent while on bedrest, or if you have started a business while on bedrest, please share your story in our comments section below. You truly are an inspiration and other mamas will greatly benefit from your wisdom and savvy!!!
If you missed our most recent tele seminar, you really missed a treat! “Former” Mama on Bedrest Parijat Deshpande moderated a panel discussion between Me, Angela Davids (Owner of KeepEmCookin.com) and herself. We not only had a great time together, we shared some great information on Busting Bedrest Blues. I know that I learned a lot and added some great tips and techniques I’ll use when working with mamas. There were some technical difficulties with the original recording, but after some editing, here it is. Enjoy!