Mississippi Medicaid has not yet confirmed whether it will begin reimbursing for doula services next year, despite receiving a federal grant that requires it to do so.
Mississippi, along with Idaho and North Dakota, is one of three states that have not implemented or taken steps publicly toward covering the cost of doulas through Medicaid, according to the National Health Law Program.
Doulas are nonmedical professionals who provide emotional, physical and informational support during pregnancy, childbirth and the postpartum period.
In 2025, the federal government awarded 15 states, including Mississippi, a grant to improve maternal healthcare for women enrolled in Medicaid. The Transforming Maternal Health Model gives eligible state Medicaid agencies up to $17 million over 10 years to bolster their maternal health workforce. Guidelines from the Centers for Medicare and Medicaid Services, the agency distributing the grant, say states receiving the federal funding must begin doula reimbursement by the end of 2027.
“There is significant evidence that incorporating doula services in a patient’s care team can improve outcomes across a range of conditions and circumstances,” the guidelines read. “Therefore, participating state Medicaid agencies will be required to cover doula services by the end of Model Year 3 under the TMaH Model.”
Amy Chen, a senior attorney at the National Health Law Program, said she learned through conversations with people at the Mississippi Division of Medicaid that they are “exploring avenues” to provide funding for doula coverage, but they have established no definitive course of action.
Medicaid spokesperson Matt Westerfield did not answer questions about the state’s plan for Medicaid reimbursement of doulas. Mississippi Today followed up with him six times between Oct. 22 and Nov. 2.
In one of the poorest states in the nation, more than half of births are covered by Medicaid. Those mothers rarely have access to doulas, because of Mississippi’s reimbursement policies.
The Mississippi Division of Medicaid is located in the Walter Sillers Building, seen here on Monday, Oct. 16, 2023, in Jackson, Miss. Credit: Eric J. Shelton/Mississippi TodayMeanwhile, Mississippi infants die at a rate nearly twice the national average. In 2024, Black infants died at nearly three times the rate as white ones in Mississippi, according to the state’s 2025 infant mortality report. The state earned an F grade in its latest report card from the March of Dimes, a national nonprofit aimed at improving the health of mothers and babies. For years, the group has urged Mississippi to expand reimbursement options for doulas.
Honour McDaniel Hill, who directs the Infant and Maternal Health Initiatives for March of Dimes, said she believes the growing movement and evidence behind doula care make it a safe investment.
“You’ve got a bunch of states who are doing it, so you’re not doing it alone,” McDaniel Hill said. “It’s an opportunity to join in on something that has shown to improve mom’s experiences, improve mother-baby bonding and being able to have a healthy pregnancy and birth.”
Part of the success of doulas is that mothers confide in them more than doctors, said Kashuna Watts, a Jackson-based doula and founder of the Professional Mississippi Association of Doulas. Watts said doulas tend to spend more time with women and focus on building trust.
“When you pick up a client, you serve that client during pregnancy, birth and postpartum,” Watts said.
That continuity of care can be lifesaving, Watts said. She recalled a first-time pregnant woman she cared for earlier this year. That mother called Watts experiencing hand pain and headaches – symptoms she “didn’t want to worry the doctor with,” according to Watts. But Watts recognized those symptoms as warning signs of preeclampsia, a life-threatening condition related to high blood pressure, particularly during and after pregnancy. Within minutes, she said, she made sure the mother got to the hospital.
“If she hadn’t gone to the hospital, she would have had to have an emergency C-section,” Watts said, referring to a cesarean section. Instead, doctors stabilized her blood pressure and she gave birth without complications, Watts said.
Doulas aren’t interested in taking the place of medical providers, Watts said. Instead, she said they’re interested in filling in gaps in care, providing women with information and connecting them to doctors and resources.
“If every mother had access to a doula,” said Watts, “I know that not only would our maternal mortality rate drop, but (the) infant mortality rate would drop, also.”
Efforts to expand access
Rafia Tchatikpi was 21 when she first gave birth. She said doctors told her she needed a C-section because her baby was large. After the surgical birth, Tchatikpi said, she found out her daughter weighed only six pounds.
That is common, and research suggests many women nationwide undergo C-sections unnecessarily. Studies show that only one in five U.S. women who were told their babies might be large actually delivered infants weighing more than eight pounds, 13 ounces – the standard definition of a large infant.
Tchatikpi believes if she had a doula by her side and advocating for her at the hospital when she gave birth for the first time, she may not have ended up with a C-section.
“My mom passed away on my 21st birthday, so I had to go through that pregnancy alone,” Tchatikpi said. “I was just becoming an adult, I had no idea about any of the birth process.”
Studies show receiving continuous care from a trained doula throughout pregnancy and labor significantly reduces the risk of undergoing a C-section. The problem isn’t unique to Mississippi. But it is worse in Mississippi, where 38% of births are surgical. The state has recorded the highest rate of C-sections overall and particularly among first-time mothers – and experts say hospital culture often makes a difference in shaping those trends.
When Tchatikpi arrived in Mississippi in 2020, she was surprised at the dearth of maternity care – especially after just completing a doula certification program in California.
Now, Tchatikpi hopes to be part of an effort to change that. In 2027, Tchatikpi will begin teaching doula work to other Mississippians through a new doula certification program at Sisters in Birth, a Jackson-based women’s health clinic.
Clinic founder Getty Israel said the 10-month program costs $2,100 per person. Israel said the course aims to take a more comprehensive approach to doula training in which students will also learn the fundamentals of public health. That’s especially important in Mississippi, Israel said, where sexually transmitted diseases and chronic conditions, such as diabetes and obesity, remain maternal health challenges.
Rebuilding maternity care in the state demands more than expanding the doula workforce and reimbursing for doula services, Israel said. Israel said she has tried for nearly six years to open the state’s first birth center, a home-like, non-hospital healthcare facility for childbirth. Israel said she has run into myriad policy obstacles. Despite growing evidence that midwife-led birth centers improve outcomes for mothers and infants, Mississippi remains one of 10 states with no centers.
A birth center may have made a difference for Tchatikpi, who delivered two of her six children at home in Mississippi. She said she would have preferred to use a birth center, but given the choice between the hospital and her home, Tchatikpi chose her home.
“No one wants to do it on their own, but it was something I felt I had to do because I was so traumatized with the doctors and their way of doing things,” said Tchatikpi, who is Black.
While Tchatikpi isn’t sure whether race played a part in her traumatic hospital birth, the majority of Black Americans said they had negative experiences with doctors, according to a poll from the Pew Research Center.
For Tchatikpi, investing in maternity care reflects the spirit of what Mississippi should stand for. Tchatikpi, whose mother was from Mississippi, said she always loved the welcoming nature of the state. But she believes Mississippi’s maternal-infant health woes directly contradict that value.
“What hospitality can we say we’re giving if we’re letting our most vulnerable members of our society – which is infants, babies – have a poor start in life?” Tchatikpi said. “We’re letting their mothers suffer.”
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