Washington Doulas: How the Apple Health 20 Hours Actually Work
If you support Washington Apple Health (Medicaid) clients, you've seen the headline number: up to 20 hours of prenatal and postpartum visits per pregnancy, paid at $25 per 15-minute unit - $100 an hour - on top of a $750 intake and a $750 labor fee, for a possible $3,500 per pregnancy.
What the headline doesn't tell you is that the 20 hours are not one pool. They're two, and confusing them is how doulas lose money.
Pool one: 1.5 hours reserved for comprehensive postpartum care. A small, protected slice of the 20 hours is set aside for the comprehensive postpartum visit work. Think of it as fenced off - it's there for that specific postpartum purpose.
Pool two: 18.5 hours shared. Everything else - your prenatal visits and your regular postpartum visits - draws from one shared pool of 18.5 hours.
Why does the split matter? Because "I've used 9 of her 20 hours" is not precise enough to run a practice on. If most of those 9 hours came out of the shared pool, the arithmetic for what's left is different than if you assume one flat bucket. Doulas who track one flat number discover the problem late: a client near the end of her postpartum period, hours they thought remained already spoken for, or visit time given away early in pregnancy that can't be recovered when a new mom needs it most. Apple Health pays for documented, eligible visit time - it does not pay for hours you accidentally over-served, and it does not pay twice because your notebook rounded kindly.
Tracking this by hand means unit math on every visit: minutes to 15-minute units, units against two pools, totals per pregnancy, for every client, all year. That's exactly the kind of arithmetic humans are worst at when they're tired - and doulas are often tired, because the visit just happened at somebody's kitchen table at 9 p.m.
In DoulaPilot, the pools are the record. When you log a visit on a client's pregnancy record, you enter the time once. The tool does the unit math and draws the time from the right pool - the reserved comprehensive-postpartum slice or the shared pool - and shows you what's left in each, for that client, at a glance. Hours a backup doula covered for you count as used (they're gone from the client's benefit, and honesty demands the record say so), but they are kept separate and can never end up on your claim - more on that in our backup-doula post.
The point isn't the arithmetic. The point is what the arithmetic protects: a client in week three postpartum who needs you, whose hours are actually still there because you could see them all along.
If you're a Washington doula doing this math in a spreadsheet tonight, you're not doing anything wrong. You're doing a computer's job, by hand, after a full day of doing yours.
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