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Horizon Partners with the State to Help Close Health Disparities for NJ’s Moms and Babies



How an innovative policy pairing at-risk mothers with doula caregivers will save lives, especially in New Jersey’s underserved populations.

The mother going into labor only spoke Haitian Creole. But her doctor and nurses didn’t, and the hospital didn’t have a translator. Fortunately, the patient knew someone who did: her doula.

“By joining a conference call in the birthing room to bridge the language gap between the clinical staff and the mom, the doula calmed the mother and helped to ensure a safe delivery,” said Dr. Roberta McNeill, Medical Director for Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ).

A doula is an advocate for an expectant mother, from early pregnancy to post-delivery. Dr. McNeill is Horizon BCBSNJ’s ambassador to a unique public/private workgroup seeking to match doulas – who are shown to contribute to better health outcomes – with expectant mothers in New Jersey’s Medicaid program.

Backed by NJ First Lady Tammy Murphy, the workgroup has a mission to train and credential community-based doulas for Medicaid patients to reduce disproportionately high rates of death among Black and Brown mothers and infants in New Jersey.

According to Health Affairs, low-income mothers of color are at the highest risk of poor birth outcomes in the United States. New Jersey ranks among the worst in the nation for maternal mortality (47th out of 50 states), with more than 46 deaths per every 100,000 live births. In New Jersey, a Black mother is seven times more likely to die than a white mother because of maternity-related complications. To help address these disparities, New Jersey enacted legislation in 2019 to bring doula care into the NJ Medicaid system, and Governor Murphy’s budget funded $1 million in doula services for Medicaid members.

Doulas are a critical part of mother and newborn care

Doulas aren’t midwives or physician assistants. “Their role is to be a coach and companion for the mom during her journey, from accompanying her to doctor visits and the birthing room, to supporting her and her baby after she brings the newborn home,” said Dr. McNeill.

Although doulas’ services are not typically covered by commercial insurance, many expectant moms still seek them out. A number of them are being supported through government grant programs in New Jersey, New York and other states.

Connecting parents to community resources and better outcomes

Like community health workers, doulas are a familiar face from the neighborhood, who know the local organizations providing a wide range of services and can connect those services to people in need, Dr. McNeill said.

Because poor medical outcomes for both mom and baby can happen anytime during the pregnancy, a doula’s advocacy role is critically important. “For too many nervous mothers – many of them teenagers – doctor visits can be an intimidating experience. It’s important for moms to ask questions, share information about symptoms and be as prepared as possible to make their OB/GYN visit a successful one,” said Dr. McNeill.

A doula with community ties can work with moms to acquire the baby’s necessities, such as clothes, cribs, baby formula and a stroller. Doulas can also help moms access mental health services if signs of postpartum depression are present or connect them to public assistance programs, like WIC, that help ensure maternal and newborn nutritional needs are met.

Creating a statewide network of doulas to close gaps in care

Developing a community doula benefit for New Jersey’s Medicaid program has been a collaborative effort spearheaded by the workgroup created by New Jersey’s Medicaid office and Assistant Commissioner for the Division of Medical Assistance and Health Services, Jennifer Langer Jacobs. Stakeholders from the doula industry, the NJ Department of Health and regional non-profits, including the Burke Foundation and the Nicholson Foundation, are all working together to put the intricate pieces in place.

“First Lady Tammy Murphy has challenged us to make New Jersey the safest place in the nation to give birth,” said Jacobs. “Across the state, we are taking bold, evidence-based steps to improve maternity care. Research tells us this will contribute to better birth experiences and better health outcomes.”

The group is finding common ground on training, certification, background checks, billing/compensation and other technical details, with the goal of having the framework completed in time for implementation on January 1, 2021.

If successful, New Jersey will soon take a leap forward in closing health disparities and helping women of color and their children live safer, healthier lives.