The Office of Professional Regulation wants to create a new certification process for doulas as the state inches closer towards qualifying doula services for coverage under Medicaid, the federal low-income health insurance program.
Doulas are non-medical professionals who provide support during pregnancy and childbirth, as well as in postpartum care.
About half the states, and Washington D.C., already allow Medicaid coverage for doula care or are in the process of making the change.
And as support grows in Vermont to establish rules for Medicaid reimbursement for doulas, the state wants to set up a certification program to better regulate the practice.
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“Essentially, across the country, doulas have never been regulated in any kind of overarching way. There’s no accreditation that’s codified,” said Sarah Teel, a doula who lives in the town of Washington and is a founder of the Doula Association of Vermont. “It’s a non-clinical role. We’re not part of the health care system, and so it hasn’t been a regulated profession.”
But as more states have recognized the advantages of qualifying doulas for Medicaid, which would open up the services to more low-income individuals, Teel said there needs to be some oversight of the profession.
“What has happened over the years with many, many states coming on board and implementing Medicaid coverage is there obviously needs to be some mechanism for the state Medicaid agency to have the assurance that this is a Medicaid provider that can meet the needs of the Medicaid population,” Teel said.
A 2022 report from the U.S. Department of Health and Human Services found that labor support offered by doulas significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia.
We’re not entirely sure how or why it works, but there’s really good evidence that it does reduce things like C-section rates and postpartum depression in other states that have started to cover doula services under Medicaid.
Bronwyn Kenny, OB-GYN at the University of Vermont Medical Center
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Vermont lawmakers last year asked the Office of Professional Regulation to look into the most appropriate way to regulate the industry, as the state contemplates qualifying doula services for Medicaid.
OPR was looking for the “least restrictive” form of regulation, according to a recent report, and it does not recommend registration or licensure at this time.
In the end, the office settled on a voluntary certification of what it calls “community-based perinatal doulas,” which are doulas who “provide doula services to under-resourced and marginalized populations at low- or no-cost, most often through community-based agencies.”
Marti Churchill is a certified nurse midwife, and founder of the volunteer doula program at UVM Medical Center.
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Churchill’s program provides free doula care to patients who don’t have the ability to pay for the service.
In the rest of the world of medical care if it were a medicine or a pill it would be definitely recommended and prescribed regularly. So this is something that’s really needed.
Marti Churchill, UVM Medical Center volunteer doula program
She said data across the country show that people from low-income backgrounds suffer more complications during pregnancy, and at the same time those populations have trouble accessing doula care.
So opening up Medicaid coverage, Churchill said, would benefit those who most need the service.
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“In the rest of the world of medical care if it were a medicine or a pill it would be definitely recommended and prescribed regularly,” Churchill said. “So this is something that’s really needed.”
“We work with doulas all the time during labor and delivery,” said Bronwyn Kenny, an OB-GYN at the University of Vermont Medical Center and a member of the Vermont Medical Society. “We’re not entirely sure how or why it works, but there’s really good evidence that it does reduce things like C-section rates and postpartum depression in other states that have started to cover doula services under Medicaid.”
The Office of Professional Regulation will work with stakeholders to determine the most appropriate certification requirements.
The office also said it will stay in contact with the Department of Vermont Health Access to make sure the new certification program aligns with federal Medicaid requirements.
Have questions, comments or tips? Send us a message.
A person holds a giant penny at a mock funeral for the coin, which was discontinued in 2025, in front of the Lincoln Memorial in Washington. AP Photo/Julia Demaree Nikhinson
What good is a penny at this point? Penny candy is a thing of the past, and a modern-day penny-pincher wouldn’t get very far if this were their get-rich strategy.
(This newsletter, though, costs you less than a penny. Chip in if you can.)
U.S. mints no longer make pennies, a decision that saves taxpayers an estimated $56 million annually. When the U.S. Treasury Department announced the country would stop minting them, it marked the end of an era — sorta.
Though those pesky copper-colored coins remain in circulation, some businesses, both in Vermont and nationwide, have begun experiencing penny shortages.
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Enter H.837. The bill outlines a plan that could allow retailers to phase out the penny by rounding up or down cash transactions to the nearest nickel.
Other states, including Arizona and Indiana, have passed rounding legislation, and a handful of others are considering it. As written, Vermont’s bill wouldn’t require rounding, a similar approach favored in other jurisdictions.
Some Vermont businesses have already adopted rounding. But lobbyists for Vermont businesses say some of their members fear the practice — without explicit state blessing — could open a business up to a lawsuit over alleged unfair and deceptive practices.
Worried or not, rounding will likely become more necessary as pennies get harder to find, Maggie Lenz, a lobbyist for the Vermont Retail and Grocers Association, told the House Commerce and Economic Development Committee Tuesday. She encouraged the state to create a rounding framework, but discouraged lawmakers from making such a program mandatory.
Rep. Tony Micklus, R-Milton, agreed that rounding should be optional, but said the state should mandate a specific rounding framework for the businesses that choose to round.
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H.837’s approach, which would round down totals ending in 1,2,6 and 7 cents, and round up totals ending in 3, 4, 8 and 9 cents, would seem to be the fairest to consumers and businesses, those who testified agreed.
But the change is likely not net neutral. Zachary Tomanelli, a consumer protection advocate for the Vermont Public Interest Research Group, cited a Federal Reserve study that indicated rounding could cost consumers $6 million annually nationwide. That’s because businesses price goods in ways that tend to lead to rounding up.
He called the cost modest and said he generally supported the bill.
Despite H.837 not making it past the crossover deadlines, there’s still hope that pennies might make it into Vermont’s currency cemetery. Rep. Michael Marcotte, R-Coventry, the commerce committee’s chair, said his committee could stick the rounding legislation in the Senate’s economic development bill.
That said, you might not want to ditch your pennies quite yet.
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In the know
Here are some numbers for you: Between 2012 and 2022, Vermont’s primary care workforce declined by 13%. In that same time period, the specialist workforce grew by 23%. That’s according to testimony Jessa Barnard, with the Vermont Medical Society, gave to lawmakers in the House Health Care Committee Tuesday. She said the numbers are reflective of a trend in medicine nationwide, attributed to the fact that primary care docs often make less but pay the same high cost for medical school as their peers in more specialized roles.
In Vermont, Barnard said that this widening gap is leading to a particularly acute shortage. According to a report her organization put out in 2022, the state needs 115 primary care providers to meet the national benchmark for our population size. That figure includes OBGYNs, pediatricians and family medicine docs. By 2030, as our state’s population grows even older, the Vermont Medical Society expects the state to need 370 more primary care physicians to meet the national benchmark.
— Olivia Gieger
Sen. Alison Clarkson, D-Windsor, spoke with members of the House Commerce and Economic Development Committee Tuesday afternoon about S.327, an economic development bill that supports a number of public resources for business owners across the state.
The bill has had a tough go of it so far.
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Clarkson handed out copies of what she referred to as “the actual bill,” which meant the package voted out by her own Senate Economic Development Committee before being “pretty much fully gutted” on its way through the Senate Appropriations Committee.
In a tight budget year, she said, this bill’s focus was on “supporting what works really well” for Vermont businesses. For Clarkson, that means continuing to invest in the initiatives like the Vermont Economic Growth Incentive program, a set of grants to help businesses expand in the state, which is scheduled to end in January. The Senate, she pointed out, has voted to extend the program for several years in a row, most recently through S.327.
“I am charging the House with doing the same thing,” she said.
Clarkson is also in favor of deepening the state’s relationships with outside investors by funding state delegates abroad. Vermont, she argued, should have more well-placed representation in areas like Québec — which this bill would provide for — and in the future Taiwan, which recently pledged to invest heavily in U.S. tech industries.
“We need somebody whose hand is up saying ‘yes, over here!’” Clarkson said.
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House commerce members met informally with a delegation from Taipei later Tuesday.
— Theo Wells-Spackman
On the move
The Senate advanced a bill Tuesday that would allow parents in Essex County to pay tuition to send pre-K students to New Hampshire schools.
In Vermont’s most rural county, families struggle to access pre-K programs, at least on this side of the border.
But S.214, legislation originally proposed by Sen. Kesha Ram Hinsdale, D-Chittenden Southeast, would allow for a handful of families near the New Hampshire border in Essex County to tuition their pre-K-aged children to New Hampshire schools, Sen. Steve Heffernan, R-Addison, said on the Senate floor.
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Kindergarten through grade 12 are already able to tuition to New Hampshire schools.
The Senate will need to vote on the bill once more before sending it to the House.
Vermont and the federal government faced off Monday over the state’s first-in-the nation law aimed at forcing polluters to pay for the effects of climate change with the Trump administration warning it would spur “the type of chaos that the Constitution is designed to prevent.”
The hearing before Judge Mary Kay Lanthier of the U.S. District Court for the District of Vermont comes as the administration has unleashed a broad assault on state-based climate efforts, including suing to invalidate the Vermont law establishing a “climate superfund” to recoup money from the oil and gas industry.
The Biden appointee did not tip her hand, pressing attorneys for the state and the federal government over whether the state is within its rights or stepping on federal authority. The administration is challenging a similar law in New York, and a ruling against Vermont would likely jeopardize that law and chill efforts in other states to adopt climate superfunds.
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Vermont argued the law — “a modest action” — was passed by state lawmakers in 2024 to help raise money to deal with climate change.
RUTLAND, Vt. (WCAX) – Attorneys defended Vermont’s landmark climate superfund law on Monday, as it faces a lawsuit filed by the Trump administration.
Vermont lawmakers passed the Climate Superfund Act in 2024 after devastating flooding in 2023 and other extreme weather events.
The law requires certain large fossil fuel companies to help cover the costs of climate-related damage linked to their emissions between 1995 and 2024.
It is being challenged by the federal government, along with the American Petroleum Institute, the U.S. Chamber of Commerce and attorneys general from 24 Republican-led states.
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They argue Vermont is overstepping and that climate policy should be handled at the federal level.
Attorneys for Vermont and environmental groups asked a federal judge in Rutland to dismiss those challenges, arguing the state has the right to hold companies accountable.
“It was an intense and technical day of legal arguments over whether the Climate Superfund Act passes muster under federal law, and whether it is appropriate under our Constitution and other doctrines, and is going to survive this series of lawsuits that have been filed against it,” said Christophe Courchesne of the Vermont Law and Graduate School.
Vermont was the first state to pass a law like this. New York followed, and more than 10 other states are considering similar measures.
This case could help decide whether those laws move forward.
