LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6316 NOTE PREPARED: Nov 17, 2020
BILL NUMBER: HB 1350 BILL AMENDED:
SUBJECT: Coverage for Doula Services.
FIRST AUTHOR: Rep. Bauer M BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: X GENERAL IMPACT: State & Local
DEDICATED
FEDERAL
Summary of Legislation: The bill requires a state employee health plan, a policy of accident and sickness
insurance, and a health maintenance organization contract to provide coverage for services provided by a
doula to an insured before, during, and after childbirth. It also requires a hospital to allow a doula to
accompany a patient at the hospital, including attending a live birth, at the request of the patient.
Effective Date: July 1, 2021.
Explanation of State Expenditures: Doula services are not covered under the current state employee health
plan design. Routine prenatal visits, delivery, and postnatal visit costs are bundled in the maternity global
fee. To the extent that doula services are separate from routine care and may be provided by practitioners not
in the obstetric practice providing maternity care, the addition of doula services may affect health insurance
premium amounts. An increase in premium costs may be mitigated with adjustments to other benefits, or
through the division of premium costs between the state and state employees. Improved birth outcomes or
reduced maternal mortality would mitigate the direct costs of doula services.
Additional Information - Indiana does not require licensure of doulas; however, private organizations offer
training and certification within Indiana. Doula fees range between $350 and $1,200 for delivery, while
hourly rates pre- and postpartum range between $27 and $35 per hour. Improved birth outcomes and reduced
maternal mortality with a doula present have been documented in the literature most often among the
Medicaid population. A cost benefit analysis from the Oregon Health and Science University demonstrated
cost savings when the doula costs are below $159.73 per delivery.
Explanation of State Revenues: If total insurance premiums were to increase as a result of increases to
HB 1350 1
maternity coverage, revenue to the state General Fund could increase from either corporate adjusted gross
income tax or insurance premium tax collections. Any impact is anticipated to minimal.
Explanation of Local Expenditures: The bill potentially impacts local units of government who offer health
insurance coverage for employees through a nonERISA plan. Added local health coverage costs may be
mitigated with adjustments to other benefits or to the total employee compensation packages, or through the
division of costs between the local unit and employees.
Explanation of Local Revenues:
State Agencies Affected: State Personnel Department, all state agencies.
Local Agencies Affected: Local units providing health insurance coverage.
Information Sources: Platt, Taylor and Kaye, Neva, Four State Strategies to Employ Doulas to
Improve Maternal Health and Birth Outcomes in Medicaid, NASHP, July 6, 2020; Strauss, Nan, Giessler,
Katie, McAllister, Elan, How Doula Care Can Advance the Goals of the Affordable Care Act: ASnapshot
From New York City, J ournal of Perinatal Education, 2 01 5 , 2 4(1): 8-15;
https://www.dona.org/become-a-doula/birth-doula-certification/;
https://www.ecommunity.com/services/womens-care/pregnancy-and-planning/discover-doulas;
https://www.franciscanhealth.org/health-care-services/doula-services-475;
https://www.whattoexpect.com/pregnancy/hiring-doula#:~:text=The%20cost%20of%20a%20doula,post
% 2 D d e l i v e r y % 2 0 f o l l o w % 2 D u p ;
https://www.oregon.gov/oha/oei/reports/Using%20Doulas%20to%20Improve%20Birth%20Outcomes%2
0for%20Underserved%20Women%20in%20Oregon%20-%20Appendices.pdf, Appendix H: Cost Benefit.
Fiscal Analyst: Karen Rossen, 317-234-2106.
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