. 2013 Apr;103(4):e113–e121. doi: 10.2105/AJPH.2012.301201

TABLE 3—

Estimated Annual Savings to State Medicaid Programs Resulting From Reduction in Cesarean Delivery Rates Associated With Doula Services Among a Cohort in Minneapolis, MN, 2010–2012, by Reimbursement Rate

State	Medicaid Births in 2009, No.	Cesarean Deliveries in 2009 Medicaid Births, %	Estimated 2009 Medicaid Payments to Hospitals for Childbirth, $	Scenario 1: Savings With 22.3% Cesarean Rate, by Birth Doula Reimbursement Amount^a			Scenario 2: Savings With Cesarean Rate Reduced by 40.8%, Birth Doula by Reimbursement Amount^b			Scenario 3: Savings With Cesarean Rate Reduced by 31.6%, by Birth Doula Reimbursement Amount^c
State	Medicaid Births in 2009, No.	Cesarean Deliveries in 2009 Medicaid Births, %		$300, $	$200, $	$100, $	$300, $	$200, $	$100, $	$300, $	$200, $	$100, $
Arkansas	21 602	34.14	159 693 579	−483 963	1 676 237	3 836 437	573 980	2 734 180	4 894 380	−1 016 759	1 143 441	3 303 641
Arizona	44 884	26.61	282 710 234	−6 249 819	−1 761 419	2 726 981	12 925 801	17 414 201	21 902 601	17 027 105	21 515 505	26 003 905
California	246 439	32.27	2 277 662,653	50 386 316	75 030 216	99 674 116	164 350 905	188 994 805	213 638 705	201 381 310	226 025 210	250 669 110
Colorado	24 068	23.64	147 560 306	−5 975 935	−3 569 135	−1 162 335	5 764 379	8 171 179	10 577 979	7 782 284	10 189 084	12 595 884
Florida	110 864	36.75	1 400 051,280	14 438 204	25 524 604	36 611 004	38 552 970	49 639 370	60 725 770	49 712 969	60 799 369	71 885 769
Hawaii	6140	25.73	29 066 661	−1 297 455	−683 455	−69 455	574 480	1 188 480	1 802 480	950 014	1 564 014	2 178 014
Illinois	74 646	28.86	526 716 590	−892 110	6 572 490	14 037 090	33 595 754	41 060 354	48 524 954	−11 420 838	49 761 433	57 226 033
Iowa	13 824	28.76	65 393 014	−1 194 848	187 552	1 569 952	3 632 524	5 014 924	6 397 324	4 841 536	6 223 936	7 606 336
Kansas	12 141	30.04	75 733 972	−698 119	515 981	1 730 081	3 123 183	4 337 283	5 551 383	4 174 576	5 388 676	6 602 776
Kentucky	25 160	35.72	117 429 199	383 699	2 899 699	5 415 699	4 948 224	7 464 224	9 980 224	6 890 205	9 406 205	11 922 205
Maine	6012	28.59	24 158 540	−575 940	25 260	626 460	1 498 663	2 099 863	2 701 063	2 011 853	2 613 053	3 214 253
Maryland	27 654	30.52	95 050 379	−5 777 767	−3 012 367	−246 967	−2 760 597	4803	2 770 203	−1 900 334	865 066	3 630 466
Massachusetts	23 570	29.64	117 520 821	−2 763 357	−406 357	1 950 643	3 227 441	5 584 441	7 941 441	4 827 875	7 184 875	9 541 875
Michigan	48 311	30.12	262 689 941	−2 711 439	2 119 661	6 950 761	12 362 426	17 193 526	22 024 626	16 535 951	21 367 051	26 198 151
Minnesota	8591	26.49	53 775 975	−972 856	−113 756	745 344	3 424 292	4 283 392	5 142 492	4 356 972	5 216 072	6 075 172
Missouri	34 177	30.21	209 320 982	−1 499 651	1 918 049	5 335 749	9 542 950	12 960 650	16 378 350	12 619 363	16 037 063	19 454 763
Nebraska	7944	29.66	40 180 116	−98 398	696 002	1 490 402	3 068 977	3 863 377	4 657 777	3 916 275	4 710 675	5 505 075
Nevada	11 087	31.50	67 596 255	858 921	1 967 621	3 076 321	5 159 140	6 267 840	7 376 540	6 477 792	7 586 492	8 695 192
New Hampshire	3990	28.05	17 844 658	−669 029	−270 029	128 971	328 775	727 775	1 126 775	565 889	964 889	1 363 889
New Mexico	14 454	21.88	62 430 527	−4 513 493	−3 068 093	−1 622 693	1 174 588	2 619 988	4 065 388	2 030 995	3 476 395	4 921 795
New Jersey	23 598	32.41	270 147 800	4 694 952	7 054 752	9 414 552	15 260 199	17 619 999	19 979 799	18 731 894	21 091 694	23 451 494
New York	97 092	31.45	507 671 529	−6 152 894	3 556 306	13 265 506	17 611 710	27 320 910	37 030 110	24 875 251	34 584 451	44 293 651
North Carolina	59 127	28.60	282 968 323	−6 553 980	−641 280	5 271 420	12 302 297	18 214 997	24 127 697	16 970 737	22 883 437	28 796 137
Oklahoma	28 670	33.71	168 520 929	868 831	3 735 831	6 602 831	7 960 776	10 827 776	13 694 776	10 534 566	13 401 566	16 268 566
Oregon	19 779	28.31	98 998 489	−2 016 382	−38 482	1 939 418	4 986 067	6 963 967	8 941 867	6 683 058	8 660 958	10 638 858
Rhode Island	5144	28.34	40 126 480	−415 515	98 885	613 285	1 587 656	2 102 056	2 616 456	2 074 208	2 588 608	3 103 008
South Carolina	23 166	33.24	151 860 595	2 503 200	4 819 800	7 136 400	10 050 775	12 367 375	14 683 975	12 692 757	15 009 357	17 325 957
Tennessee	37 556	32.52	206 897 080	173 281	3 928 881	7 684 481	10 280 321	14 035 921	17 791 521	13 628 860	17 384 460	21 140 060
Texas	194 157	34.42	1 203 431,561	12 708 575	32 124 275	51 539 975	61 019 692	80 435 392	99 851 092	79 554 396	98 970 096	118 385 796
Utah	15 622	23.97	56 171 062	−4 117 148	−2 554 948	−992 748	145 110	1 707 310	3 269 510	895 984	2 458 184	4 020 384
Vermont	2432	27.47	9 771 389	−388 163	−144 963	98 237	344 878	588 078	831 278	511 857	755 057	998 257
Washington	31 274	28.35	174 656 160	−2 840 958	286 442	3 413 842	8 772 645	11 900 045	15 027 445	11 594 006	14 721 406	17 848 806
West Virginia	10 714	35.12	41 670 222	−1 126 293	−54 893	1 016 507	171 516	1 242 916	2 314 316	3 911 874	1 769 074	2 840 474
Wisconsin	25 058	23.11	132 079 135	−6 729 124	−4 223 324	−1 717 524	5 727 781	8 233 581	10 739 381	7 786 153	10 291 953	12 797 753
Wyoming	2634	27.79	13 823 634	−165 651	97 749	361 149	1 081 246	1 344 646	1 608 046	1 372 078	1 635 478	1 898 878
State savings
Maximum				50 386 316	75 030 216	99 674 116	164 350 905	188 994 805	213 638 705	201 381 310	226 025 210	250 669 110
75th Percentile				37 441	3 228 003	6 776 796	11 291 309	15 614 723	18 885 660	13 160 808	19 238 077	22 295 777
Median				−892 110	187 552	1 950 643	4 986 067	6 963 967	8 941 867	6 477 792	8 660 958	10 638 858
25th Percentile				−2 802 158	−338 193	487 217	1 336 626	2 361 022	3 667 449	2 021 424	2 600 830	3 825 425
Minimum				−6 729 124	−4 223 324	−1 717 524	−2 760 597	4803	831 278	−11 420 838	755 057	998 257

^{^a}

Average rate for doula-supported births.

^{^b}

Derived from adjusted odds ratio of 0.592 for risk of cesarean delivery in doula-supported births, calculated from multivariate analysis of odds of cesarean delivery for doula-supported, Medicaid-funded births (n = 1079) compared with a national sample of Medicaid-funded births (n = 279 008).

^{^c}

Derived from upper-bound 95% confidence interval for adjusted odds ratio of 0.592 for risk of cesarean delivery in doula-supported births, calculated from multivariate analysis of odds of cesarean delivery for doula-supported, Medicaid-funded births (n = 1079) compared with a national sample of Medicaid-funded births (n = 279 008).