While Medicaid maternal health access narrows nationwide, California is preserving and expanding care.
Residents income-eligible for Medi-Cal, the state’s version of Medicaid, can access one of the broadest range of maternal health services in the country — and nearly two years of continuous coverage is available for all eligible pregnant people, regardless of immigration status, as soon as pregnancy starts through 12 months postpartum.
Benefits available include not only traditional services like family planning, labor and delivery, doctor visits, hospital stays, emergency care, medical supplies, medications, preventive dental and vision, breastfeeding coaching, but also “doula and midwifery care that are reshaping the maternal health care landscape” well beyond the hospital model, said Raquel Saunders, section chief of Medi-Cal Benefits and Legislation at the Department of Health Care Services (DHCS), at a December 4 American Community Media briefing.
Since Medi-Cal launched the doula benefit in January 2023, at least 1,098 doulas — trained professionals who provide physical, emotional and informational support to patients before, during and after childbirth — have enrolled statewide.
Covered doula services include an extended-duration initial visit, up to eight additional visits across prenatal and postpartum periods, “support during labor and delivery including in cases of stillbirth, abortion or miscarriage, and up to two extended, three-hour postpartum visits after the end of a pregnancy,” Saunders explained. “Medi-Cal members who have used all of these standard visits may request up to nine additional postpartum visits within one year after pregnancy.”
Doula care saves $58.4 million from the $26.2 billion spent on preterm delivery in the U.S. — $51,600 per baby — and prevents 3,288 preterm births annually.
To find an available doula by county, Medi-Cal members can visit the monthly-updated DHCS Doula Directory, or contact their health plan through the Managed Care Plan Health Directory.
Members have even more benefits to choose from with midwifery services, either from certified nurse midwives or from licensed midwives — both specially trained professionals who can practice without physician supervision to care for people with healthy, low-risk pregnancies.
Midwife services available through Medi-Cal “include prenatal checkups, advice and emotional support, personalized approaches to pregnancy and childbirth and delivery in hospitals, birth centers or at home,” said Saunders. “Midwives do not perform surgeries such as C-sections.”
In addition to these services, pregnant Medi-Cal members can also access community supports for issues affecting their pregnant, birthing and postpartum life including mental health counseling, transportation to appointments, housing navigation, rent aid and food aid.
Even amid Medicaid cuts and immigration crackdowns nationally, “California does not have any intention of changing the services that we provide to pregnant individuals,” added Saunders.
California residents at or below 200% of the federal poverty level, regardless of immigration status, including those not enrolled in Medi-Cal, can also access Family PACT, the state’s free program for family planning services including birth control, testing for sexually transmitted infections, fertility awareness, cervical cancer screening and reproductive health screening, said Sarah Gilbert, chief of the DHCS Office of Family Planning, which administers Family PACT.
In 2023, the last year of complete data, Family PACT, funded jointly through the federal and state government, served approximately 350,000 Californians.
People can enroll online at familypact.org, or on-site at any participating clinic the same day services are needed.
A directory of the approximately 1,200 community clinics, private practices and federally qualified health centers providing Family PACT statewide is available here.
“No immigration-related questions are asked, and using Family PACT does not affect an individual’s public charge status,” said Gilbert, adding that even for people “who may be preventing pregnancy for now, but thinking about a pregnancy in the near future, Family PACT is a great option to choose optimal timing.”
In 2023, there were 400,108 live births in California.
Midwives attend 13% of all vaginal births in California, and 95% of these occur in the hospital.
But lately, “We are noticing that patients are dealing with a lot more stress. There have been increases in people’s reports of postpartum depression and anxiety,” said Eva Goodfriend-Reaño, a certified nurse midwife and midwifery clinical chief at Alameda Health System, adding that the fact that she treats patients for a full year postpartum through Medi-Cal is thus critical given this rising depression and anxiety.
Meanwhile, “maternity centers are being closed across the state, and hospitals have closed their labor and delivery units, so people in California have to travel further to receive care,” she continued.
Nearly 60 hospitals and labor and delivery units statewide have closed since 2012, roughly 30% in Los Angeles County alone, according to CalMatters.
“But because we do have this significant shortage, we are doing everything we can to increase access to training programs for California,” said Goodfriend-Reaño, noting that doula training pathways, and a Medi-Cal provider certification portal for both doulas and midwives, are available online through DHCS.
As California works to preserve maternal health coverage and even expand it through postpartum coverage, doula and midwife services, she added that her biggest concern regarding healthcare access is misinformation.
“People are worried that their coverage has been limited or has been cut, or that they no longer qualify for pregnancy services,” Goodfriend-Reaño explained. “What we want people to know is that the services have not changed, Medi-Cal coverage has not changed. We are here, ready to serve our community, and we encourage people to come get the care that they need, and not to wait.”