The 2024 rollout of the New York State Doula Medicaid Benefit highlights the operational challenges of integrating non-clinical providers into Medicaid managed care networks. Despite evidence that doula care improves maternal outcomes and reduces costs, uptake was limited in the first year - only 651 claims for doula services paid by January 2025 - in large part due to barriers to doula enrollment, lack of support during onboarding, and persistent billing challenges. Doulas, like other non-clinical providers, often lack the administrative infrastructure, Medicaid literacy, and institutional support medical professionals have access to. As a result, the complexity of enrollment processes and claims workflows constrain participation and threaten the benefit’s scalability. For health plans, this underscores that expanding coverage to non-clinical providers requires more than benefit design. Successful implementation depends on intentional investment in onboarding, capacity-building, and administrative simplification. Adapting plan systems to community-based workforces is essential to realizing the equity, access, and cost-saving goals of non-clinical Medicaid benefits.