Medicaid Doula Contract

This agreement is entered into by and between Adrienne Bullock, doing business as Adrienne's Love, hereafter referred to as "Doula," and the undersigned Client, hereafter referred to as "Client."

1. Services Provided:

The Doula agrees to provide full-spectrum doula services to the Client in accordance with the Ohio Medicaid guidelines. These services will include, but are not limited to:

• Pregnancy Support:

  • Emotional and physical support throughout pregnancy.

  • Assistance with birth plan creation and education on birth options.

  • Education on pregnancy health, nutrition, and wellness.

• Labor and Birth Support:

  • Continuous emotional and physical support during labor and delivery.

  • Advocacy during the birth process and assistance in navigating medical options.

  • Comfort measures including breathing techniques, positioning, and relaxation.

  • Support for the birthing person and their partner during the birth process.

• Postpartum Support (as detailed above):

  • Emotional support for the client and family.

  • Breastfeeding support and education.

  • Assistance with newborn care.

  • Light household assistance related to newborn care.

  • Information on postpartum recovery and family adjustment.

The services will be provided in multiple sessions, to be scheduled at mutually agreed times. The Doula and Client will determine the exact number and duration of sessions, based on the Client’s needs.

2. Payment and Billing:

• The Client understands that the services provided are eligible for billing to Medicaid.

• The Doula will submit claims for the services to Medicaid for reimbursement.

• The Client confirms that they are eligible for Medicaid coverage and authorizes the Doula to submit these claims.

• If Medicaid does not cover any part of the service, the Client agrees to discuss alternative payment arrangements with the Doula, if necessary.

3. Consent to Bill Insurance: The Client authorizes the Doula to bill Medicaid directly for postpartum doula services provided under this Agreement. The Client agrees to cooperate fully with Medicaid billing requirements and provides the necessary insurance information to process these claims.

4. Duration and Termination: This Agreement will remain in effect for the duration of the three postpartum doula sessions (12 total hours of service). Either party may terminate this Agreement with written notice, with the understanding that services provided up to the date of termination will be billed appropriately.

5. Confidentiality: Both parties agree to keep confidential any personal or medical information shared during the course of these services, as required by law and ethical guidelines.

6. Signatures:

By signing below, both parties agree to the terms outlined in this Agreement.

Adrienne Bullock

Doula, Adrienne's Love