Increasing commercial coverage of doula services: perspectives from health plans and large employers in California.

Although Medicaid coverage of doula services has expanded since 2014, commercial coverage remains nascent. Little is known about what motivates private payers to cover doula support. Through qualitative interviews with staff members (n = 11) from health plans and employers that operate in California, we aimed to identify factors that could influence commercial coverage of doula services. In our first theme, we describe how a health plan or employer's commitment to birth equity can serve as a catalyst for commercial coverage of doula services. Second, participants noted that when considering new benefits, payers would review evidence related to doula support and weigh cost. The third theme centers on how consumer demand could impact a health plan or employer's appetite for adding a commercial doula benefit. The final theme highlights the operational considerations health plans and employers are contemplating, such as how to prioritize populations that could most benefit from doula support. Our findings suggest that the decision to cover doula support largely hinges on payer priorities. However, we found that health plans and employers interested in advancing birth equity were compelled by evidence supporting doula care, suggesting there may be opportunities to increase commercial coverage of doula services.