As of March 2026, 33 states plus DC have moved to cover doula care under Medicaid or are rolling it out soon. UnitedHealthcare announced on March 16 that by the end of 2027 up to 7.2 million members could gain access to maternal and infant doula support through their employer plans. Insurers see this as a way to reduce costly interventions—studies tie doula care to fewer C-sections and premature births, with particularly strong benefits for Black mothers. Startups are stepping in to smooth out billing and credential hurdles. Pomelo Care, valued at $1.7 billion, bought a national doula network in 2024 and now supports about 350 doulas. The company vets each doula, handles insurance documentation, claim submissions and payments. Before, most doulas worked solo on a cash basis, finding clients and handling all admin themselves. Maven Clinic has offered doula services since 2015 and recently saw demand surge. It screens doulas for certification—often through DONA International—hours logged and cultural competency, then helps them file claims under the varied rules of different Medicaid programs and private plans. Executive Neel Shah points out that doula care lived outside the formal healthcare system until now. With insurers and states picking up the tab, doulas are finally moving from side-gig to integrated benefit.