Doula collectives care most and can influence least, while the Medicaid agency and an appropriations chair decide; every other group falls between them in this NU506 analysis for Unit 3. Searches like "nu 506 unit 3 assignment example", "nu506 unit 3 sample" and "nu506 unit 3 example" land here.
The Rate Decides Everything: A Stakeholder Power Analysis of a State Medicaid Proposal to Pay Community Doulas
[Student Name]
Purdue University Global
NU506: Health Policy, Ethical, and Legal Perspectives of the Health Care System
Unit 3 Assignment
[Instructor Name]
[Date]
The state, its agencies and the proposed rate are composite; the evidence and analytic frameworks cited are published.
The Proposal
The state Medicaid agency has published a state plan amendment that would cover doula services for Medicaid-enrolled pregnant people: up to three prenatal visits, continuous support during labor and birth, and up to three postpartum visits, paid at a flat $[1,100] per pregnancy. The amendment needs a line in the next budget, federal approval of the plan amendment, and enrollment of doulas as Medicaid providers. Advocates spent three years reaching this point, and the proposal now turns on the rate.
The Evidence Each Side Reads
All parties cite the same evidence and read it differently. A Cochrane review of 26 trials with usable data from 15,858 women found that continuous support during labor was associated with more spontaneous vaginal births and fewer cesarean births, with an average relative risk for cesarean of 0.75, although the evidence was rated low quality (Bohren et al., 2017). A study of Medicaid beneficiaries found lower odds of cesarean among doula-supported births and estimated potential savings to Medicaid programs, with the size of the savings depending on each state's rates and cesarean levels (Kozhimannil et al., 2013). The national obstetric consensus on preventing primary cesareans lists continuous labor support among its recommendations (Caughey et al., 2014). Advocates read these findings as proof of savings; budget analysts read "low quality" and "depends on reimbursement rates" as reasons for caution.
The Grid
A power-interest grid places each group by how much it can influence the outcome and how much it cares about it (Bryson, 2004).
High power, high interest: the Medicaid agency; the chair of the House appropriations committee. High power, lower interest: the governor's budget office; Medicaid managed care organizations. Moderate power, moderate interest: the state hospital association and labor and delivery administrators; the state section of the obstetricians' professional college; labor and delivery staff nurses and their specialty organization's state section. High interest, low power: community doula collectives; Medicaid-enrolled pregnant people; community health centers; a reproductive justice coalition.
The Two Actors Who Can End It
The Medicaid agency writes the plan amendment and sets the rate. It gains a policy that addresses maternal health outcomes it is measured on, and it risks a benefit that costs money and shows no savings within a budget cycle. Its lever is the rate itself, along with the rules for doula certification and billing. The appropriations chair funds the benefit. The chair gains a visible maternal health win and risks a new line in a tight budget. The chair's lever is the appropriation: a line funded at a level that assumes low enrollment effectively caps the program.
Powerful but Less Interested
The governor's budget office scores the cost and can recommend a delay or a pilot limited to some counties. Managed care organizations, which enroll most of the state's Medicaid members, control credentialing and claims. They gain little from doulas directly, and their lever is administrative: a slow credentialing process, a requirement for a separate contract with each plan, or payment delays of 90 days would deter small doula practices far more than the rate would.
The Middle: Hospitals, Physicians and Nurses
The hospital association is broadly supportive if doulas do not add liability or crowd labor rooms; its lever is hospital policy on who may be present during labor. The obstetricians' state section supports continuous labor support, consistent with the national consensus, and can lend clinical credibility in testimony.
Labor and delivery nurses hold little formal power over the rate, yet they decide much of what a doula can do at the bedside. Unit policies on visitors, on how many support people may stay during an epidural or a cesarean, and on whether doulas may accompany patients to recovery are written and enforced on the unit. A nurse who treats a doula as a visitor rather than a member of the support team can make the benefit hollow even where it is paid for. The state section of the nurses' specialty organization could support the benefit and propose joint orientation for nurses and doulas, a low-cost lever with high practical effect.
High Interest, Low Power
Community doula collectives have the most at stake: the rate determines whether doula work pays enough to continue. Their resources are testimony, relationships with families and data on their own clients. Medicaid-enrolled pregnant people gain the service directly but are rarely organized; their lever is individual testimony and, through the coalition, collective stories. Community health centers could host doulas and refer patients, and they carry credibility with legislators. The reproductive justice coalition can frame the benefit around racial disparities in maternal outcomes, which gives it moral force with some legislators and invites opposition from others.
Coalitions
The low-power groups gain influence by combining. A coalition of doula collectives, community health centers and the reproductive justice coalition, with the obstetricians' section and the nurses' specialty section signing on, would present the benefit as clinical, community-based and equity-focused at once. Its strongest ask would not be the benefit, which is already proposed, but the details that decide enrollment: a rate that reflects the hours involved, a single credentialing process across managed care plans, and payment within 30 days.
What Each Group Would Accept
Mapping positions is only half the analysis; the other half is predicting where agreement is possible. The agency could accept a higher rate if the benefit started as a two-year pilot in the counties with the highest cesarean and preterm birth rates, which limits cost and produces data. The appropriations chair could accept a funded line if it were paired with a report back on enrollment and outcomes. Managed care organizations could accept a uniform credentialing process if the state ran it centrally, which also lowers their administrative cost. Doula collectives could accept a pilot if the rate were high enough to sustain their members, since a pilot that fails to enroll doulas will be read as proof that the benefit is not wanted.
The Decisive Variable
The rate decides whether coverage exists beyond paper. A flat $[1,100] for three prenatal visits, a labor that may last twenty hours and three postpartum visits works out to a low hourly wage once travel and on-call time are counted. Below a threshold that doula collectives can state, most community doulas will not enroll, and the benefit will exist in the state plan while very few pregnant people receive it. The analysis predicts that the agency and the appropriations chair will set the rate near the low end, and that the coalition's best chance is to win a scheduled rate review after the first year, tied to enrollment data.
References
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
Bryson, J. M. (2004). What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Management Review, 6(1), 21-53. https://doi.org/10.1080/14719030410001675722
Caughey, A. B., Cahill, A. G., Guise, J.-M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American Journal of Obstetrics and Gynecology, 210(3), 179-193. https://doi.org/10.1016/j.ajog.2014.01.026
Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O'Brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 103(4), e113-e121. https://doi.org/10.2105/AJPH.2012.301201
How this NU506 Unit 3 example is structured
Power organizes the analysis, since interest without influence decides nothing. The grid comes first as a summary, and the narrative then works through the quadrants in order of influence, starting with the two actors who can end the proposal. For each group, the analysis states what it gains or loses in concrete terms, the resources it holds, and the specific lever it could pull: a rate, a credentialing rule, an appropriation, a unit visitor policy. The nursing section sits in the middle deliberately, because labor and delivery nurses hold little formal power over the rate yet decide much of what a doula can do at the bedside. A coalition section shows which low-power groups could combine. The conclusion names the decisive variable, the rate, and predicts that below a threshold most doulas will not enroll, leaving coverage on paper only.
Get an NU506 Unit 3 example written to your instructions
The policy behind your NU506 Unit 3 analysis can be current or proposed; what matters is that someone gains, someone loses and someone decides. Name it, add your state and the rubric. Inside 24-48h a free first analysis arrives, every group placed by the lever it holds and the outcome predicted from that distribution. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU506 Unit 3 questions, answered
Which stakeholder model should the analysis use?
Mendelow's power-interest grid is common and easy to read, and many instructors accept it. Some sections prefer a salience model that adds legitimacy and urgency. Whichever you use, apply it: every placement needs a reason tied to resources or formal position. A model named and then ignored in the narrative earns little credit.
How many stakeholders should be included?
Enough to capture every group with a lever over the outcome, often eight to twelve. Omitting a powerful actor costs more than including a minor one, so check the payer, the funder, the implementer and the professionals at the point of care. Grouping similar actors is fine if their interests and power truly match.
Should nurses appear as a stakeholder group?
Almost always in this course, and with honest placement. Nurses may hold little formal power over a rate or statute but considerable influence over how a policy works in practice, through unit policy, staffing and professional associations. Analyses that locate that influence precisely tend to score better than those listing nurses as supportive and moving on.