Medi-Cal expands services to accommodate pregnancy

The health disparity in the Black community is evident, and it’s obvious when it comes to pregnancy and birth. Non-Hispanic Black women are 2.6 times more likely to die from pregnancy-related complications than white women. For Black women 25 and older, pregnancy-related mortality is about four times higher than it is for white women of similar ages between 2000 and 2020. Medi-Cal’s changes offer women a better chance of surviving birth and having a healthy baby.
Half of California births were covered under Medi-Cal and nearly 5 percent of all U.S. births. As of 2021, The California Department of Public Health (CDPH) reports that Black mothers are four times more likely to die than white mothers from pregnancy-related causes and at a 1.7 times higher risk of preterm birth. Black babies are twice as likely to die before their first birthday as white babies.
The new benefits Medi-Cal provides to women are a birthing care pathway for members from conception through 12 months postpartum, dyadic care which serves the parent and child together, postpartum mental health treatment, licensed midwife services, culturally-specific community health resources and other benefits for pregnant members, including some over the Medi-Cal income limit. Medi-Cal eligibility also extended from 60 days postpartum to 12 months postpartum, with premiums eliminated for families.
Medi-Cal also added the services of doulas, “To reduce access barriers, Medi-Cal members now don’t need a separate, written referral to get a doula; they can use our regularly updated doula directory, which includes ethnicities and languages spoken, to get care directly from doulas, who get the highest Medicaid reimbursement in the nation.” said Erica Holmes, benefits division chief at the California Department of Health Care Services (DHCS).
Doulas are trained professionals who provide physical, mental, emotional, and spiritual support to women during their pregnancy and after childbirth. Doula care can help improve birth outcomes and reduce C-sections, epidurals, premature deliveries, low birth weight, anxiety, and labor length.
“For so many years, to do the work, we had to focus on the outcome at the exclusion of the income, what we were investing,” said Kairis Chiaji, a doula for over 25 years who founded Children of the Sun Doula Project, worked a DHCS doula pilot program in Northern California and now works as a Medi-Cal doula in Sacramento.
By developing the doula benefit with DHCS through policy advocacy and implementation advice over the past two years, “we finally have the ear of state decision-makers to shift away from treating pregnancy as a pathology to be cured,” she continued. “To move our state into understanding that leveraging community relationships is crucial to maternal health, that pregnancy is just not the body producing a baby, disconnected to what comes before and after, is historic.”
As of May 31, 2024, DHCS has approved 455 doula applications, with 336 being individual doulas rather than group doulas.