How to enroll as a Medicaid doula in Pennsylvania
PA Medical Assistance · coverage since January 1, 2025 · last checked July 25, 2026
Pennsylvania's Medicaid doula benefit began January 1, 2025. The published fee-for-service package pays up to $2,200 for labor and delivery plus 12 perinatal visits. Two qualifying specialized support services can raise the total to $2,550. Enrollment requires the Pennsylvania Certification Board credential, Medical Assistance enrollment as a non-traditional provider, and contracts with the HealthChoices plans you intend to bill.
What Medicaid pays
$2,200 standard maximum; up to $2,550 with 2 qualifying support services
- Labor & delivery (T1033): $1,000; in-person and payable when delivery occurred
- Perinatal visits (T1032, minimum 30 minutes): $100 each, up to 12 per year; specialized support services (T1032-U9): $175 each, up to 2 per year
- The standard published maximum is $2,200. A $2,550 total applies only when the member receives both qualifying $175 specialized support services
- Managed care rates are set by contract. Confirm the payment terms with each HealthChoices plan rather than treating the fee-for-service schedule as a payment floor
Up to 12 perinatal visits per year (minimum 30 minutes each, through 12 months postpartum) + up to 2 specialized support services + labor & delivery. A practitioner recommendation must be on file before services.
Who can apply
- Certified Perinatal Doula (CPD) through the Pennsylvania Certification Board: $50 application, 24+ training hours mapped to PCB competencies (including 1 hour HIPAA), current adult+infant CPR, with an experienced-doula pathway for currently-practicing doulas
- Clients need a recommendation from an MA-enrolled licensed practitioner on file (the state's recommendation form)
- Free Type 1 NPI
How to enroll
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Step 1
Earn the PCB Certified Perinatal Doula credential
pacertboard.org/doula, the sole accepted certifier, with an experience pathway for practicing doulas.
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Step 2
Get your free Type 1 NPI
NPPES, taxonomy 374J00000X.
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Step 3
Enroll in MA as Provider Type 13 (Non-Traditional Provider)
Apply through the DHS online portal. After approval, you will receive the PROMISe ID used for billing and plan applications.
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Step 4
Contract with each HealthChoices plan
Most members are in Physical HealthChoices plans: AmeriHealth Caritas/Keystone First, Geisinger, Health Partners (Jefferson), Highmark Wholecare, UnitedHealthcare Community Plan, UPMC for You (varies by zone). Each credential separately; the PA Doula Commission publishes plan contacts.
How you get paid
Most clients are in managed care, and each plan runs its own credentialing and contract process. A contract with one plan does not cover another. The Pennsylvania Doula Commission publishes plan contacts, but payment terms come from each contract.
What to plan for
Each managed care plan has its own application, contract, and payment terms. Doulas must also obtain the Pennsylvania Certification Board credential and keep a practitioner recommendation on file for every client.
Where to get help
- Pennsylvania Doula Commission (FAQs, MCO contracting contacts, and advocacy)
- Pennsylvania Certification Board, Doula (the required CPD credential)
- Pitt CONVERGE PA Medicaid Doula Benefit Toolkit (independent navigation toolkit for the benefit)
Sources and last checked
We checked these details on July 25, 2026.
- MA Bulletin (Dec 23, 2024): coverage of and payment for doula services
- PCB Certified Perinatal Doula requirements
- PA Doula Commission FAQ & MCO presentation
This is general educational information, not legal, billing, or enrollment advice. Rules and rates can change between reviews. Confirm the current provider manual, payment schedule, and health-plan contract before you apply or bill. Junie can create a payment receipt labeled as a superbill, but the current output derives its dates and descriptions from payment records and must be checked against the recipient's requirements. A superbill is not a Medicaid claim. Junie does not currently enroll providers in Medicaid or submit Medicaid claims. Found an error? Email hello@junie.app.