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-Editorial
While federal health programs face cutbacks, California is expanding protections for pregnant residents through Medi-Cal, offering one of the most comprehensive maternal health benefit packages in the country.
Pregnant Californians, regardless of immigration status, are eligible for full-scope Medi-Cal coverage during pregnancy and for 12 months postpartum, providing continuous care during a critical period. The expansion includes services and benefits under the California Advancing and Innovating Medi-Cal (CalAIM) program, though many families remain unaware of the support available.
In addition, Family PACT (Planning, Access, Care, and Treatment), the state’s no-cost family planning program, offers services such as birth control, sexually transmitted infection testing, fertility awareness, and cervical cancer screening to all income-eligible residents, regardless of immigration status.
Raquel Saunders, section chief of Medi-Cal Benefits and Legislation at the Department of Health Care Services (DHCS), said the state has introduced initiatives under the California Advancing and Innovating Medi-Cal (CalAIM) program and the birthing care pathway to reduce maternal mortality, address racial disparities, and modernize care delivery.
“Under current policy, all pregnant people, regardless of immigration status, are eligible for full-scope Medi-Cal from the start of pregnancy through 12 months postpartum,” Saunders said. Children and youth under age 19 are also eligible for full-scope Medi-Cal. The coverage includes prenatal checkups, birth planning, mental health care, and counseling for postpartum depression.
DHCS has also highlighted two resources to help members understand available services: a prenatal services flyer outlining the full range of maternal care benefits and a companion guide explaining different provider types, including obstetricians, midwives, and doulas.
Doulas, whose services became a Medi-Cal benefit on Jan. 1, 2025, provide culturally competent care during pregnancy, labor, birth, and postpartum, including support after miscarriage or abortion, lactation assistance, health navigation, and referrals to community resources. Members can access doulas through a DHCS online directory or, for managed care members, through their health plan. Most visits do not require prior authorization, and additional postpartum visits can be accessed via a provider recommendation form.
Midwifery services are also covered under Medi-Cal, offering certified nurse midwives and licensed midwives the ability to practice independently for low-risk pregnancies. Their services include prenatal care, personalized support, and deliveries in hospitals, birth centers, or at home. Midwives do not perform surgeries, including C-sections. In March 2024, DHCS updated its policy to allow midwives to provide and bill for clinically appropriate services.
Saunders emphasized that these services are designed to meet cultural and language needs, giving members a wider range of options for safe and personalized maternal care. Additional information and resources are available on DHCS’s maternal and perinatal services web pages.
Sarah Gilbert, a nurse practitioner and chief of the Office of Family Planning at the Department of Health Care Services (DHCS), said the program provides free, confidential, and comprehensive services to low-income Californians, regardless of immigration status. “Family PACT plays a vital role in maternal health by helping individuals plan, space, and maintain healthy pregnancies when they are ready to have children,” Gilbert said.
The program serves residents with incomes at or below 200% of the federal poverty level who either lack health insurance or face barriers to accessing family planning services. Eligibility does not consider immigration status, though participants must live in California and have a state address. Enrollment is simple and can be completed on-site at any participating clinic or online at familypact.org.
Family PACT offers a wide range of services, including education and counseling, contraceptive counseling, and access to all FDA-approved contraceptive methods, such as IUDs, implants, pills, patches, rings, shots, and condoms. The program also provides pregnancy testing, screening for sexually transmitted infections, and cervical cancer tests, including PAP and HPV tests. These services allow individuals to make informed decisions about whether and when to become pregnant, which is critical for both maternal health and long-term family well-being.
The program operates across more than 1,200 provider locations in California, including community clinics, federally qualified health centers, private practices, and Planned Parenthood clinics. Many clinics offer services in Spanish and other languages, ensuring that care is culturally and linguistically appropriate. Gilbert said the program is designed to reach diverse communities, including those who face barriers to care due to language differences, immigration status, confidentiality concerns, or lack of insurance coverage.
In 2023, Family PACT served approximately 350,000 clients statewide. Gilbert emphasized that using Family PACT does not affect an individual’s public charge status and that no immigration-related questions are asked, ensuring participants can access care without fear or hesitation.
“California is committed to ensuring that all eligible residents, regardless of background, have access to reproductive health services they need to make informed decisions and support their overall well-being,” Gilbert said. “Family PACT is a vital part of California’s commitment to reproductive health equity, offering free, confidential, and comprehensive family planning services to individuals with low income and ensuring everyone has the opportunity to make informed decisions about their reproductive health.”
Eva Goodfriend-Reaño, Certified Nurse Midwife and Midwifery Clinical Chief at Alameda Health System, said she is increasingly hearing from patients who are uncertain about whether it is safe to seek medical care. “We definitely hear frequently from patients, and we have people ask whether it is okay to come in,” Goodfriend-Reaño said during a recent briefing. She noted that some individuals are delaying appointments or waiting until symptoms worsen before seeking help.
Goodfriend-Reaño emphasized the wide scope of midwifery care in California, explaining that midwives attend births in hospitals, birth centers, and homes, and provide care before, during, and after pregnancy. “Midwives in California deliver about 13 percent of the vaginal births,” she said, adding that providers offer prenatal care, postpartum support, and newborn care in the early weeks of life. Midwives also deliver primary care services such as Pap smears, family planning, and routine health screenings.
A key change in state policy, she said, has improved continuity of care. “Coverage for patients in California does include care all the way through the first year postpartum, and that’s really important because that’s a recent change,” Goodfriend-Reaño said. The extension allows people experiencing postpartum depression or anxiety to continue receiving support, including therapy, medication management, and access to support groups. “There has been a pretty big impact on our ability to take good care of people through the postpartum period within the whole first year,” she added.
Goodfriend-Reaño said midwives independently manage care for low-risk patients and collaborate with OB-GYNs when complications arise. While midwives do not perform surgeries, she said, they often assist in surgical procedures depending on the clinical setting.