New Doula Services for Expecting Mothers Overseas under TRICARE Pilot Program
Starting January 1, 2025, expectant mothers living overseas can now take advantage of the TRICARE Childbirth and Breastfeeding Support Demonstration.
This program provides coverage for services delivered by certified labor doulas, lactation consultants, and lactation counselors, and the benefits extend to U.S. territories as well.
Initially launched in the United States in January 2022, the pilot program has already engaged over 14,000 participants, according to the Defense Health Agency.
Spanning five years as authorized by Congress, the initiative will wrap up in 2026, at which point TRICARE officials will evaluate the possibility of making these benefits permanent.
The goal is to assess how maternal and child health outcomes compare between beneficiaries who utilize these support services and those who do not.
Eligibility and Coverage Details
To qualify for doula services under this program, expectant mothers must be a minimum of 20 weeks pregnant, plan to deliver outside military medical facilities, and work with a TRICARE-authorized provider.
The recent updates also revamp how coverage for doula services is measured.
TRICARE now permits up to six hours of support from a certified labor doula, allowing this time to be divided into 15-minute increments.
This represents a significant change from the prior model, which only covered six separate visits along with attendance during labor.
Karen Ruedisueli, who serves as the director of health affairs at the Military Officers Association of America, highlighted that these revisions provide families with increased flexibility, which could lead to better compensation for doulas.
By enabling families to tailor support according to their specific needs, the program becomes more user-friendly.
Guidelines for Expectant Mothers
For those living overseas, it’s essential to register with the TRICARE overseas contractor, International SOS, before seeking services.
Within 14 days, expectant mothers should receive confirmation regarding the availability of a TRICARE-authorized provider, though it’s important to note that availability isn’t guaranteed.
In the United States, expectant mothers do not need referrals; however, for those enrolled in TRICARE Prime, a referral from their primary care manager is necessary to access non-network providers without incurring extra charges.
It’s recommended that beneficiaries check their eligibility with their regional TRICARE contractor.
U.S.-based doulas must meet certain criteria, including signing a participation agreement.
They can’t charge beneficiaries for covered services once the deductible is met nor ask beneficiaries to submit their own claims.
It’s crucial for labor doulas to maintain current certification from accredited organizations, including the National Black Doulas Association.
Breastfeeding Support Services
Overseas doulas, however, aren’t required to sign a participation agreement but must still meet specific standards.
For breastfeeding support, mothers need to be at least 27 weeks pregnant and must fall under TRICARE’s breastfeeding support guidelines.
Even if they don’t qualify for the demonstration, they may still access other existing TRICARE support benefits.
The ongoing demonstration continues to offer six sessions of breastfeeding support, which is already a standard benefit within TRICARE.
This allows mothers to connect with either lactation consultants or lactation counselors through various formats, from individual to group sessions.
Additionally, it permits lactation counseling services from trained professionals who might not hold TRICARE certification.
While lactation counselors provide guidance for typical breastfeeding practices, lactation consultants specialize in resolving more complex breastfeeding issues.
Source: Militarytimes