Home CalAIM: Transforming Medi-Cal Birthing Care Pathway Policy Updates

Birthing Care Pathway Policy Updates

This page details the ongoing status and completion of the 42 policies outlined in the Birthing Care Pathway. By completing the outlined policy solutions, DHCS advances the ability to address the physical, behavioral, and health-related social needs of pregnant and postpartum members. DHCS has successfully had State Plan Amendments (SPAs) approved, released All County Letters and Behavioral Health Information Notices, and released guidance for MCPs via the Population Health Management (PHM) and the Enhanced Care Management (ECM) Policy Guides. We have also updated websites, held webinars, and released support documents for both members and providers to improve access to care and provider administrative burden. DHCS has additionally collaborated with state agency partners, such as the California Department of Public Health (CDPH), the California Department of Social Services (CDSS), the Office of the Surgeon General (OSG), and the California Maternal Quality Care Collaborative (CMQCC) to create state-level Strategic Plans, soon-to-be-released joint guidance for home visiting for pregnant and postpartum members, and Learning Collaboratives for MCP policy implementation. One year after the release of the Birthing Care Pathway Report, a total of 28 policies have been completed, while 14 remain in progress. 

Policies DHCS Has Implemented/Is Implementing for the Birthing Care Pathway

A. Provider Access and MCP Monitoring and Oversight 

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Leverage CalHealthCares education loan repayment program to build pipeline and increase diversity of obstetrician/gynecologist (OB/GYN) and family medicine workforce. In Progress
  • Additional cohorts in the CalHealthCares Loan Repayment Program are contingent on budget appropriations. None are planned at this time. 
2. Remove administrative barriers to Medi-Cal provider enrollment and reimbursement requirements for all midwives, with a particular emphasis on LMs, by ensuring alignment with state licensing and scope of practice requirements. Completed
3. Clarify MCP network adequacy requirements for CNMs, LMs, and FBCs in California as Mandatory Provider Types and strengthen thresholds that must be met. In Progress
  • Estimated completion Summer of 2026
4. Reiterate Medi-Cal requirements that the MCPs whom DHCS are contracted with are responsible for ensuring all covered services are accessible and the provider network is adequate. Enhance oversight of network agreements and/or delegated arrangements for maternity/perinatal care services to ensure covered benefits (midwifery, doula, and lactation services) are clearly outlined. In Progress
  • Estimated completion Summer of 2026
5. Establish a Doula Implementation Stakeholder Workgroup comprised of doulas, Black birthing justice experts, Tribal representatives, local health departments, advocates, and provider associations to inform DHCS’ doula benefit design and reimbursement approach. Completed
6. Issue a standing recommendation for doula services for all pregnant and postpartum Medi-Cal members to increase access to doula services and launch a Doula Directory for use by Medi-Cal members, providers, and MCPs to identify doulas in their community/network.  Completed
7. Streamline requirements and improve access to a range of high-quality breast pumps. Completed
8. Survey MCPs on promising practices to promote covered perinatal benefits among members as well as providers (e.g., among hospital partners on use of doulas and lactation support) to drive appropriate utilization. The survey will also include questions related to practices to reduce administrative burden for providers (e.g., contracting support through hub models, streamlining authorization processes).In Progress
  • Estimated completion Summer of 2026
9. Consolidate and update Medi-Cal perinatal policies through a single APL and update provider manuals to clearly define perinatal benefits and provider enrollment requirements for midwives, birth centers, and doulas, and encourage MCPs to incentivize network providers to offer group perinatal care models to pregnant and postpartum members. In Progress
  • To be published April 2026
10. Create and enhance member-facing communications materials and outreach strategies on perinatal Medi-Cal benefits and provider types to bolster awareness during and after pregnancy. Completed
11. Create guidance and/or technical assistance for MCPs on supporting pregnant and postpartum members transferring to different care settings and levels of care. Completed
  • January 2026: Published the PHM Policy Guide with updates to Transitional Care Services (TCS) for Pregnant and Postpartum Individuals

B. Behavorial Health and Trauma-Informed Care

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Raise awareness of Children and Youth Behavioral Health Initiative (CYBHI) ongoing investments to provide behavioral health services and supports to pregnant and postpartum individuals and their children. Completed
2. Review MCP, Drug Medi-Cal Organized Delivery System (DMC-ODS), Drug Medi-Cal (DMC), and Specialty Mental Health Services (SMHS) contracts to identify opportunities for strengthening existing contract language, including monitoring and oversight requirements, to ensure pregnant and postpartum members have access to qualified behavioral health providers and their perinatal care is integrated with behavioral health care. Completed
  • Amended MCP contracts to be effective July 1, 2026
  • Updated Behavioral Health and DMC/DMC-ODS contracts to go into effect January 1, 2027
3. Reinforce communication of existing Medi-Cal coverage policy of no maximum stay (e.g., 60 days) for individuals – including pregnant and postpartum individuals – receiving residential SUD treatment.  Completed
4. Update and disseminate SUD Perinatal Practice Guidelines for providers that deliver SUD treatment to pregnant and parenting women.   Completed
  • August 2024: Updated SUD Perinatal Practice Guidelines; subsequently updated in November 2025
  • Guidelines were disseminated to all SUD Perinatal Service County Coordinators, who share with their contracted providers. Guideline updates are discussed during regularly held webinars. 
5. Re-frame services in a trauma-informed context, acknowledging how care needs to be delivered to pregnant and postpartum members who are experiencing or have experienced ACEs, IPV, community violence, and racism.  In Progress
  • Estimated completion December 2026

C. Risk Stratification and Assessment

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Develop a risk stratification, segmentation, and tiering (RSST) process in Medi-Cal Connect to identify pregnant and postpartum members who are high risk, including risks across medical, behavioral, and social domains, and that aims to reduce the bias documented in current methodologies. The RSST will identify members who may benefit from connections to additional social support and clinical care. Completed 
  • February 2026: RSST Birthing released to MCPs
2. Incorporate IPV screening as part of Medi-Cal risk assessments performed by providers and clinical care managers.  In Progress
  • Estimated completion December 2026

D. Medi-Cal Maternity Care Payment Redesign

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Increase rates for maternity care providers and enhance supplemental payments for L&D and hospital-based birthing center services. Completed 
2. Expand maternity measures in the Quality Incentive Pool (QIP) for Designated Public Hospitals (DPHs) and District and Municipal Public Hospitals (DMPHs).  Completed 
3. Redesign how Medi-Cal pays for maternity care services to create a new birthing care payment model that rewards value-based care, incentivizes best practices for pregnant and postpartum members, and supports the goals of the Birthing Care Pathway.  In Progress
4. Develop billing/reimbursement guidance for Medi-Cal providers as well as MCPs and their subcontractors on LM services, including home births, and FBC services.  In Progress
  • Upcoming: Additional Billing/Payment Guidance on LM Services via Medi-Cal Provider Manuals, Provider Bulletins, and Consolidated Perinatal Policy APL 
  • October 2024: LM Webinar on Medi-Cal provider enrollment, member eligibility verification, and billing 
5. Strengthen implementation of dyadic services by establishing an alternative payment methodology (APM) allowing FQHCs, RHCs, and Tribal Health Programs (THPs) to be reimbursed for dyadic services at the Medi-Cal FFS reimbursement rate in addition to the FQHC/RHCs’ PPS reimbursement rate and THPs’ All-Inclusive Rate (AIR)1 for an eligible visit.  Completed 

E. Care Management and Social Drivers of Health

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Leverage Providing Access and Transforming Health (PATH) to support ECM Birth Equity providers by providing technical assistance and prioritize ECM Birth Equity providers for Capacity and Infrastructure, Transition, Expansion, and Development (CITED) Initiative awards.  Completed
2. Conduct outreach to WIC, home visitors, CBOs, and county behavioral health and nutrition services providers with perinatal expertise to become ECM providers.Completed
3. Expand ECM referral pathways, particularly from social services and behavioral health providers, for pregnant and postpartum members.  Completed
  • January 2026: Published the PHM Policy Guide with updates to Transitional Care Services (TCS) for Pregnant and Postpartum Individuals and updated the ECM Policy Guide
  • December 2025: Targeted Outreach to Social Services and Behavioral Health Providers Serving Pregnant and Postpartum Members 
  • December 2024: Closed-Loop Referral Guidance 
  • August 2024: ECM Referral Standards and Form Templates 
4. Encourage utilization of Transitional Rent under the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Section 1115 waiver demonstration as a Community Supports service for eligible Medi-Cal members – i.e., those who (1) meet one or more of the qualifying clinical risk factors2 (e.g., pregnancy and up to 12 months postpartum), are (2) experiencing or at risk of homelessness, and (3) fall within one or more of the transitioning populations3 (e.g., transitioning out of a hospital after giving birth).Completed
5. Encourage MCPs to partner with housing providers that meet the needs of perinatal populations from pregnancy through 12 months postpartum to serve as ECM and Community Supports providers.  In Progress
  • Estimated completion December 2026
6. Encourage MCPs to build partnerships with IPV CBOs to serve as ECM and Community Supports providers.  Completed
7. Encourage MCPs to consider working with facilities that offer rooming in with short-term post-hospitalization stays and have the requisite capabilities to contract as Community Supports providers to provide Recuperative Care (medical respite) or Short-Term Post-Hospitalization Housing to postpartum members experiencing homelessness and who meet clinical criteria.  Completed

F. Perinatal Care for Justice-Involved Individuals

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Ensure pregnant and postpartum individuals are enrolled in Medi-Cal pre-release.  Completed
2. Ensure eligible pregnant and postpartum individuals receive 90-day pre-release services.  In Progress 
  • As of October 2025, 12 California counties and all 31 California Department of Corrections and Rehabilitation (CRDC) state prison facilities are live with pre-release services, including services for pregnant and postpartum individuals. The remaining county facilities will go live Fall 2026.
3. Encourage connection to ECM upon release. Completed

G. Data and Quality 

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Leverage Medi-Cal Connect to support whole person care and provide population insights by safely sharing integrated health care and social data and insights about members among providers, delivery systems, programs, and state agencies that support Medi-Cal members as well as sharing with the Medi-Cal members themselves.  Completed
2. Leverage learnings from the efforts aimed at cross-enrolling Medi-Cal members into crucial safety net supports upon pregnancy through 12 months postpartum, including new linkages in administrative data between Medi-Cal, CalFresh, and WIC pilot programs currently under development in partnership with CDPH, CDSS, the California Center for Data Insights and Innovation (CDII), and Medi-Cal MCPs to inform strategies to facilitate cross-enrollment and the ongoing rollout of Medi-Cal Connect.In Progress
  • Estimated completion December 2026
3. Identify opportunities to leverage and integrate existing California maternity data centers (e.g., CMQCC, CDPH MCAH) with Medi-Cal data to more comprehensively measure and monitor birth outcomes.  In Progress
  • Estimated completion December 2026 
4. Create key performance indicators (KPIs) to track the efficacy of maternity care and monitor adherence to Birthing Care Pathway policies.  Completed
  • KPIs selected and are currently being developed through Medi-Cal Connect to be operable

H. State Agency Partnerships

Policy SolutionStatusOngoing Work Update or Completion Date(s) & Product(s)
1. Partner with CDPH, OSG, and CMQCC to develop the statewide Maternal Health Strategic Plan that prioritizes the care experience; risk-appropriate perinatal care; comprehensive risk assessment and appropriate follow-up; data transparency; and integrated care across systems, programs, and communities.Completed
2. Collaborate with CDPH, CDSS, and MCPs to promote home visiting for Medi-Cal members and ensure eligible members can access home visiting programs.  In Progress
  • To be published May 2026
3. Partner with the Employment Development Department (EDD) and Legal Aid at Work (LAAW) to develop a resource guide for perinatal providers on how their pregnant and postpartum patients can access the state’s PFL and SDI programs.  Completed
4. Leverage the Family First Prevention Services Act (FFPSA) to support SUD and mental health treatment services for pregnant and postpartum individuals at risk of child welfare involvement.  Completed
5. Continue to support the OSG Strong Start & Beyond movement through participation in the Perinatal Advisory Group (PAG).  Completed