Tricare to Cover Doulas, Lactation Consultants for Some Starting Jan. 1

Expectant moms who use Tricare in the U.S. will have access to the services of a doula and/or lactation consultant under a new program being rolled out by the Defense Department in 2022.

The Pentagon announced Friday that it plans to launch a five-year pilot starting Jan. 1 to examine whether these birthing and breastfeeding consultants can help improve the health outcomes of new moms and babies in the Tricare program.

But the pilot will be only for those who use the Tricare health program at civilian facilities in the U.S. and won't be available overseas until Jan. 1, 2025.

The program, created earlier this year in the 2021 defense policy law, will "study the impact of adding these providers and services on cost, quality of care and maternal and fetal outcomes for the Tricare population," according to an announcement Friday in the Federal Register.

The military health system has significantly lower rates of maternal death and infant mortality than the general U.S. population, according to the Pentagon -- 7.4 maternal deaths per 100,000 births, or 42% lower than in the general population, and 2.51 newborn deaths per 1,000 live births, or 62% lower. But it "continues to actively work to decrease infant and maternal mortality," officials noted.

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The federal register notice does not say whether telehealth visits would be covered under the new program. During the COVID-19 pandemic, many hospitals have been excluding doulas from delivery rooms.

The new program will study the impact of the doula assistance and breastfeeding support separately, weighing their impact to determine whether both should become a permanent benefit under Tricare, according to the DoD.

"The three months immediately following birth, sometimes referred to as the 'fourth trimester,' account for more than half (52 percent) of pregnancy-related deaths in the U.S. ... Doulas and lactation consultants and counselors provide services during pregnancy and the critical fourth trimester, potentially impacting outcomes for both the parent giving birth and the infant," wrote Aaron Siegel, alternate Federal Register liaison officer for the Defense Department.

Labor doulas are non-medical professionals trained to provide guidance and support to birthing moms before, during and after the labor and delivery process. 

Under the program, Tricare will cover up to six pre-birth and postpartum visits by a certified labor doula, as well as assistance through the entirety of a vaginal or cesarean section birth, whether it occurs at a hospital, birthing center or at home under the supervision of a Tricare-authorized provider.

The program will cover only experienced doulas certified by one of the following organizations: BirthWorks International; Doulas of North America International; Childbirth and Postpartum Professional Association; International Childbirth Education Association; and toLabor.

Visits will be reimbursed at $46, while support during the labor will be reimbursed at $690 for 2021, with both figures due to be adjusted annually.

While Tricare historically has supported new moms with lactation counseling through outpatient postpartum appointments and well-child visits and has covered up to six lactation counseling sessions since 2015, the latter program is underutilized, with just 5% of new moms using it in fiscal 2020, according to military health officials.

The new program will broaden eligibility for providers, allowing non-medical personnel who are trained as consultants to participate.

It authorizes coverage of up to six lactation counseling sessions per birth, as well as group lactation classes and counseling sessions.

The pilot will cover lactation consultants who have a certification from the International Board of Lactation Consultant Examiners or are certified as an advanced consultant by the Academy of Lactation Policy and Practice.

The new benefit does not cover those seen at military treatment facilities, nor will it be offered to those who use the U.S. Family Health Plan or Continued Health Care Benefit Program. 

DoD officials noted that some military hospitals have lactation consultants on staff and, while there are no doulas at those hospitals, many "[military treatment facilities] do permit beneficiaries to bring a doula with them during labor, whether that doula be a volunteer, paid for by the family, or reimbursed under another program."

The new program will not be offered to Tricare beneficiaries overseas until Jan. 1, 2025. Officials said that delaying the rollout outside the U.S. will "reduce the administrative burden of the demonstration without having a meaningful impact on the demonstration's results." 

The five-year pilot is expected to cost $51.16 million, with an additional $4.3 million cost for the analysis.

Senate Democrats Kirsten Gillibrand of New York and Richard Blumenthal of Connecticut originally sponsored the legislation, saying they wanted to help service members and military spouses who may deliver their babies alone as the result of deployment or training and are stationed away from family and friends.

"Military moms, either service members themselves or the partners of those who serve, are at a higher risk of stress and isolation during their pregnancies, and they're more likely to give birth alone -- all factors that make doula access especially important," Blumenthal said when introducing the legislation.

The legislation containing the provision became law on Jan. 1, 2021, following a veto by then-President Donald Trump.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

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