New York Medicaid for doulas: how to enroll, bill and get paid

What New York Medicaid pays doulas

New York pays a set rate for each visit, with a higher rate in New York City. These are the fee-for-service rates in effect since March 1, 2024.

Who can enroll as a Medicaid doula in New York

You don't need a specific certification. To enroll, you need all of these:

• A National Provider Identifier (NPI). It's free from CMS.
• Age 18 or older.
• Current adult and infant CPR certification.
• Current doula-specific liability insurance.
• The New York State Medicaid Fee-for-Service Doula Directory form, completed.
• Familiarity with HIPAA.

You also qualify through one of two pathways:

• Training Pathway: at least 24 hours of training (20 hours of core doula competencies and 4 hours of broader ones such as cultural humility and trauma-informed care), your training certificate, and an attestation that you've supported at least 3 births.
• Work Experience Pathway: an attestation of 30 births or 1,000 hours of doula work in the last 10 years, paid or volunteer, plus 3 client or professional recommendations on the state's forms.

There's no application fee. You can enroll as an individual doula, or as a doula-only group whose doulas are each enrolled. Every 5 years you revalidate with 6 hours of continuing education, current CPR and liability coverage.

How to get paid: step by step

1. Get your NPI. Apply online with CMS. It takes about 20 to 30 minutes.
2. Complete the Doula Directory form for New York Medicaid fee-for-service.
3. Enroll with New York State Medicaid through eMedNY as an individual doula or a doula-only group.
4. Contract with each Medicaid managed care plan your clients use. Since April 1, 2025, those plans pay for doula care for their members, and each plan has its own contract and credentialing.
5. Check each client's coverage before the first visit, so you know whether to bill a plan or fee-for-service.
6. Document every visit with the date, time, duration and what you did, then bill with the right code.

Managed care is where doulas get stuck

Most New York Medicaid members are in a managed care plan, and since April 1, 2025, those plans pay for doula services. Enrolling with the state doesn't give you a contract with any plan. Each one has its own paperwork, portal and timelines.

In one survey of New York doulas, 36 were fully enrolled in Medicaid, but only 12 had a contract with even one managed care plan. For clients you were already seeing before April 1, 2025, plans must keep paying you at the fee-for-service rate through 12 months after the pregnancy ends, even without a contract.

Billing rules that cause denials

• Perinatal visits must last at least 30 minutes of direct time with the client. Missed appointments can't be billed.
• Labor and delivery must be in person, and a licensed provider must be in attendance for you to be paid.
• One visit per day, except a perinatal visit and a labor and delivery encounter on the same day.
• Use the right diagnosis code: Z32.2 for prenatal visits and labor, Z32.3 for postpartum visits.
• Don't send duplicates, and bill on time. eMedNY expects claims within 90 days of the visit. By July 31, 2025, New York had paid 6,590 doula claims and denied 823, and duplicate and late claims were among the most common reasons.
• Medicaid is payment in full. You can't charge the client extra, including for your travel.
• Not covered: group classes, childcare, shopping, placenta encapsulation, vaginal steams, photography, birthing ceremonies and medical services that need a license.

You don't need a doctor's note for each client. Since June 10, 2024, a statewide standing order from the Commissioner of Health covers the required recommendation.

New York doulas by the numbers