Urban Baby Beginnings Community Cares

Referral Partner*

Member Needs (Select One, Home Visiting may select up to 2 options)*

Doula Prenatal, Postpartum + Navigation onlyDoula Prenatal, Birth + Postpartum SupportDoula Postpartum + Lactation SupportDoula High-Risk Pregnancy SupportOptima Home Visiting PIPResource Mothers Teen Program (Central Virginia only)

Doula Support **IMPORTANT CHANGE**

Virginia now covers doulas under Medicaid. If you are requesting prenatal, birth and/or postpartum services and do not fill out the doula recommendation form, we will be unable to honor the referral request. This form must be received before services can be rendered (See below). The only exception is for Optima/Resource Mothers Home Visiting clients.

Doula clients can receive up to 4 prenatal doula visits and 4 postpartum doula home visits. Birth attendance is also an option that will be provided at during intake but make sure to select this option above if you or your client wishes to have a doula attend their birth as well.

Home Visiting visits are weekly (pregnancy to 2 months postpartum) or biweekly (early childhood). Program restrictions apply.

Due Date Availability

If you or your client's due date less than 7 weeks away and you need a doula for birth please note that availability is limited. We will do our best to assist but cannot guarantee coverage.

Diapers

Please do not submit requests for diapers here but do note that with availability clients signing up for services will receive diapers through our Mom's Day Out events and home visiting programs.

What is the cost?

Our services are covered by Medicaid Managed Care Plans (Molina, Optima, Aetna, Anthem, United Health Care, Virginia Premier)

Referral is not a guarantee of program coverage.

Private pay clients who are not Medicaid-approved will be subject to direct billing at cost.

Who can refer?

Anyone! Just note that your submission does require that the state recommendation form be filled out unless seeking home visiting services.

When will I hear back?

Please allow 48 business hours for a Clinical Coordinator to contact you via text with an appointment link to schedule a visit with us. If the request is urgent, please contact our office at 833-RVA-BABY between the hours of 10 am-2 pm M-Fri.

How can I get the doula recommendation form?

A link and download to the form is below.

VA Member Full Legal Name (first, last)*

First Name Last Name

VA Member DOB (MM DD YYYY):*

Date

VA Member Phone Number*

Area Code Phone Number

VA Member Email

Confirmation Email

Address*

Street Address

Street Address Line 2

City State

Zip Code

Medicaid Insurance Type

Medicaid Managed Care ID#

Do you have a secondary insurance type (commercial)?*

YesNo

If the answer above is yes, your secondary insurance name is blank and the insurance member ID number is Type a label . This information is required for Medicaid billing.

Estimated Due Date/Date of Delivery*

MonthDay Year

Select which applies*

Member's primary language

EnglishSpanish