Doula care has become a Medicaid-covered benefit in over half of the U.S. states, with research linking it to lower cesarean rates and fewer preterm births. California does reimburse for Medicaid coverage of doula care, and a state law requires health plans to address racial disparities through the use of this care. California's Public Employees' Retirement System (CalPERS) also added doula coverage in 2025. 25 other states and D.C. are currently reimbursing for Medicaid care of a doula. The National Health Law Program has reported that before 2020, only Oregon and Minnesota offered Medicaid coverage for doula treatment. However, expanding doula support could create a catch-22 for the profession as it becomes more regulated.