Health care bill approved by Missouri House includes expansion of doula services

A wide-ranging health care bill that includes a provision expanding doula services for low-income families across the state passed out of the Missouri House on Thursday.

The legislation, sponsored by state Rep. Tara Peters, a Rolla Republican, would expand coverage of doula support for women enrolled in the state’s Medicaid program from six to 16 visits covering pregnancy, birth, postpartum and lactation support.

State Rep. LaKeySha Bosley, a St. Louis Democrat who urged her colleagues to support the bill, said she’s confident the doula provision will save women’s lives. Doulas advocate for the physical and emotional wellbeing of mothers and families. They do not deliver babies.

“This will assist women who are going through one of the proudest moments, potentially, of their lives, is becoming moms, make sure that they have an advocate with them as they’re going through their birthing plan and doula services,” she said Thursday.

In late 2024, the Missouri Department of Social Services issued an emergency rule authorizing Medicaid to reimburse doula services, citing “an immediate danger to the public health, safety or welfare of pregnant women in Missouri.”

Since the program’s inception, more than 625 participants insured through Medicaid accessed doulas during their pregnancy and postpartum, Baylee Watts, a spokeswoman for the Department of Social Services, said in March.

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Doulas have increasingly been cited as part of the solution to Missouri’s poor maternal and infant birth outcomes. 

On average, around 70 women die each year in Missouri during childbirth or in the first year postpartum. Of those deaths, 80% were deemed preventable by the state. 

In 2024, a year after Missouri expanded Medicaid coverage through the first year postpartum, 38% of births were covered by Medicaid. Several years ago, the state’s Pregnancy-Associated Mortality Review board assessed maternal deaths from 2017 to 2021 and found that women insured through Medicaid were seven times more likely to die within one year of pregnancy than their counterparts with private health insurance. 

The board also found that Black women in Missouri were three times more likely to die within a year of pregnancy than white women. A recent March of Dimes report gave Missouri a D- for preterm births, and also pointed to doulas as a solution.

The bill would also add coverage of childbirth education classes for families enrolled in the state’s Show Me Healthy Babies program.

The legislation, Peters said Thursday, “is about getting government out of the way and letting our health care providers do what they do best: taking care of patients across the state of Missouri.”

The legislation also aims to allow local hospitals to expand investment opportunities; 

• Expand delivery devices of epinephrine products; 
• Expand some telehealth services; 
• Target hospital workplace violence; 
• Increase inspections of long-term care facilities; 
• Address foodborne allergies in child care centers; 
• Allow dentists to practice in correctional facilities; 
• Expand insurance coverage of some anesthesia services; 
• Expand insurance options for small businesses; 
• Track cases of alpha-gal syndrome; 
• Allow for the over-the-counter sale of ivermectin.

It also establishes January as Blood Donor Awareness month; September as Brain Aneurysm Awareness Month; the last full week of April as “Infertility 2 Awareness Week; and March 26 as “Pediatric Acute- 2 Onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric 3 Disorder Associated with Streptococcus (PANDAS) Awareness Day.”

The bill passed with 129 in favor and 20 Republicans opposed. It now goes to the Senate.