Oregon health plans must cover doula and lactation help

The Oregon Health Authority and coordinated care organizations must ensure medical assistance recipients can get doula services. This applies to people receiving medical assistance. Services must include at least 12 visits, 24 hours, or a comparable mix, beyond labor and delivery, regardless of birth outcome. Additional hours may be approved based on need. Providers must come from the recipient’s community when available; otherwise, they must have had cultural competency training within the past three years. These terms apply to coordinated care contracts entered into, amended, or renewed on or after January 1, 2028. Earlier contracts may allow the same coverage.

The Oregon Health Authority and coordinated care organizations must ensure medical assistance recipients can access lactation counselor services. This applies to people receiving medical assistance; the authority reviews and, if needed, revises reimbursement rates for lactation counselors every even-numbered year. A provider referral is not required. Coordinated care organizations must share access information online and in printed benefit explanations when those are available. These requirements apply to coordinated care contracts entered into, amended, or renewed on or after January 1, 2028.

Health benefit plans covering pregnancy and childbirth must cover services from certified and registered doulas and lactation counselors. Doula services must be provided by a doula certified and registered by the Oregon Health Authority. Lactation counselor services are also covered. Doula coverage is limited to $3,760 per plan period or calendar year; plans may approve more services when needed, subject to reasonable medical management. Covered doula services must relate directly to medical services covered by the plan. Plans may apply the same deductibles and coinsurance as for other benefits. Plans may not require prior approval or a provider referral for doula services, except when deciding whether to approve additional services. They may not require these steps or provider supervision for lactation counselor coverage. These terms apply to plans issued, renewed, or extended on or after January 1, 2028. Starting in 2029, the state must adjust the required doula coverage limit each year for inflation.

The Traditional Health Workers Commission must adopt rules for voluntary lactation counselor registration. Registration is for lactation counselors. The rules must address continuing education, practice standards, registration requirements, and services for clients who were pregnant regardless of birth outcome. The registration provisions take effect January 1, 2028.