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-Editorial
As the Department of Health Care Services (DHCS) continues to transform Medi-Cal, it is expanding access to maternal health through doula services, a birthing care pathway for members from conception through 12 months postpartum, parent-child dyadic care, and other benefits for pregnant members, including some who exceed the typical Medi-Cal income limit.
Doulas are essential to closing racial and ethnic disparities in outcomes for Black, American Indian, Latino, Asian American, and Pacific Islander parents and infants. Doula care can improve birth outcomes and reduce C-sections, epidurals, premature deliveries, low birth weight, anxiety, and labor length.
At an Ethnic Media Services briefing, a DHCS leader and two doula community health care providers shared how Medi-Cal maternal health programs are helping families and babies live healthier lives from conception onward.
Medi-Cal, California’s Medicaid program, covers one in three Californians — 15 million people, including 1.3 million children. Medi-Cal coverage includes expanded services, such as doula visits, to meet all of a member’s physical and mental health needs.
Erica Holmes, Chief of the Benefits Division at DHCS, highlighted the department’s commitment to enhancing maternal care for all Californians, noting that Medi-Cal covers approximately half of all births in the state.
“In recent years, our approach to providing high-quality maternal health services has changed drastically,” Holmes said. “Medi-Cal now offers more options for birthing individuals than ever before, ensuring coordinated care from the start of pregnancy through 12 months postpartum.”
One key initiative is the Birth and Care Pathway Initiative, supporting Medi-Cal members from conception through 12 months postpartum, regardless of birth outcome. This initiative integrates physical health, mental health, and health-related social needs into a comprehensive care model. “The Birth and Care Pathway Initiative translates clinical care and care management guidelines into practical workflows across different healthcare settings, ensuring that every birthing individual is informed and can take control of their health journey,” Holmes explained.
DHCS has also expanded its coverage to include doulas and midwives, emphasizing culturally competent and person-centered care. Since January 1, 2023, doula services have been a covered benefit under Medi-Cal. “Doula services aim to prevent birth complications and improve health outcomes for both the birthing individual and their babies,” Holmes noted. “These services include emotional and physical support throughout pregnancy and one year postpartum, along with guidance on health navigation and evidence-based education for prenatal and postpartum care.”
In addition to doulas, certified nurse midwives and licensed midwives can now provide a wider range of clinical services within their scope of practice. This policy update, effective from March 2024, followed extensive stakeholder engagement and aims to offer birthing individuals even more choices in their maternal care providers.
To further enhance access to maternal care services, DHCS has developed directories for doulas and midwives, enabling Medi-Cal members to find providers who meet their cultural, linguistic, and individual preferences. Holmes emphasized, “These directories will be regularly updated to ensure that our members have the most current information on available services.”
Another significant advancement is the introduction of community health workers (CHWs) into the maternal care framework. As of July 2022, CHWs, who are trusted members of their communities with relevant lived experiences, provide essential support through health education, navigation, screening, and advocacy.
These comprehensive efforts by DHCS reflect a commitment to reducing maternal morbidity and mortality and addressing disparities in maternal health outcomes among Black, American Indian, Alaska Native, and Pacific Islander individuals.
“By implementing various programmatic and policy changes, including the Birth and Care Pathway Initiative and expanding options for maternal care providers, we are making significant strides in improving maternal health in California,” Holmes concluded.
As a Medi-Cal doula provider, Kairis Chiaji is at the forefront of ensuring that birth support is recognized, valued, and accessible to all.
“California has taken it to a level of practical usefulness,” Chiaji says, reflecting on the state’s willingness to understand and incorporate the role of doulas into standard care. This inclusion is crucial, as many people remain unaware of what birth workers do. Chiaji likens the role of a doula to that of a personal trainer, but for childbirth.
“Our job is to get to know you, your goals for your body and baby, and help you create and remember a birth plan,” she explains. Whether the birth setting is a hospital, birth center, or home, doulas provide flexible support tailored to each client’s needs. This flexibility extends beyond logistics; as members of the community, doulas often share cultural and experiential bonds with their clients, making them uniquely positioned to bridge gaps in communication and understanding within healthcare settings.
The benefits of this approach are multifaceted. Doulas help clients navigate the often complex and intimidating medical environment, assisting with everything from understanding medical jargon to developing labor plans and postnatal care strategies. Chiaji emphasizes the importance of this role in the face of the maternal health crisis in the United States, noting that 80% of injuries and losses during childbirth are preventable. Doulas amplify the voices of families and ensure that potential issues are recognized early, reducing the likelihood of crises.
Chiaji’s work prioritizes serving Black and Indigenous populations, who face disproportionately high risks during childbirth. “My priority is always to make sure that the mama with melanin is going to be okay,” she states, highlighting the persistent biases in healthcare systems. By supporting these vulnerable communities, Chiaji and her colleagues are working to close the gap in birth outcomes.
Medi-Cal’s recognition of doula services has been transformative. “For so many years, we had to focus on the outcome rather than the income,” Chiaji explains. The ability to be compensated fairly for their work means that doulas can now sustain themselves while providing critical support. This change also signifies a broader shift in healthcare: understanding that pregnancy and birth are not merely medical events but are deeply embedded in community and relationships.
Working with the Department of Health Care Services (DHCS) to establish this benefit has been a surreal experience for Chiaji, who has been in the field for 25 years. The collaboration with state decision-makers has allowed for a nuanced understanding of the needs and realities of birthing people. This partnership underscores the importance of moving beyond traditional healthcare models to create inclusive and effective support systems.
The role of a doula is deeply rooted in history and community. While the term ‘doula’ comes from Greek origins, implying a woman who serves, the practice of community-supported birth is ancient and universal. Indigenous communities have always had systems in place to support birthing people, ensuring that their needs are met holistically.
Chiaji’s journey into doula work began on a positive note while working for an organization addressing maternal and infant mortality in Black communities. Her experience and dedication have made her a key figure in advocating for and shaping the role of doulas in California’s healthcare system.
Chiaji envisions a future where doula support is normalized and universally accessible. “Every community can be its own best solution for this birth outcome crisis,” she says, hopeful that one day, everyone will understand and value the crucial role of doulas in creating healthy, supported births.
