Advancing Equitable Maternal Health in California
Key Sections
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Overview: Learn about the strategic roadmap designed to address the physical, behavioral, and health-related social needs of pregnant and postpartum Medi- Cal members.
Learn More about the Strategic Roadmap.
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Birthing Care Pathway Report: Summarizes the findings and action steps from the Birthing Care Pathway Report.
Read the Report.
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Development & Engagement: Discover how the Birthing Care Pathway was developed through Medi-Cal member and partner engagement.
Explore Development & Engagement.
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Birthing Care Pathway Policy Solutions and Strategic Opportunities for Further Exploration: Understand the steps DHCS is currently taking to improve Medi-Cal maternity care as well as strategic opportunities DHCS may explore in the future.
View Policy Solutions and Strategic Opportunities.
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Looking Ahead: Learn about next steps to advance maternal health and birth equity in California.
See What's Next.
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Materials: Access press releases, key documents, relevant webpages, and presentations related to the Birthing Care Pathway.
Explore Materials.
Overview
Like the rest of the nation, California is facing a maternal health crisis. Every five days, a Californian loses their life to pregnancy-related complications. Although the state's pregnancy-related mortality ratio is lower than the national ratio, it has been rising in recent years, and the majority of these deaths are preventable. The severe maternal morbidity rate in California has also been rising and is higher than the national rate. This crisis is disproportionately impacting Black, American Indian/Alaska Native, and Pacific Islander individuals.
With Medi-Cal covering 40 percent of births statewide, DHCS is uniquely positioned to drive significant improvements in maternal health and birth equity. DHCS began developing a comprehensive policy and care model roadmap called the Birthing Care Pathway in 2023 to cover the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum. The Birthing Care Pathway is designed to be a strategic roadmap for state entities, managed care plans (MCP), counties, providers, social service entities, philanthropy, and other key partners serving pregnant and postpartum Medi-Cal members. The goals of the Birthing Care Pathway, which is generously supported by the
California Health Care Foundation (CHCF) and the
David & Lucile Packard Foundation, are to reduce maternal morbidity and mortality and address racial and ethnic disparities that disproportionately affect Black, American Indian/Alaska Native, and Pacific Islander individuals.
Birthing Care Pathway Report
In February 2025, DHCS released the Birthing Care Pathway Report, which:
Summarizes the current state of maternal health in Medi-Cal and outlines DHCS' vision for the Birthing Care Pathway.
Shares findings from Birthing Care Pathway Medi-Cal member engagement.
Provides an overview of the partner engagement conducted to date.
Discusses the policies DHCS is implementing for the Birthing Care Pathway and shares progress to date.
Identifies strategic opportunities for further exploration for the Birthing Care Pathway.
The report includes a series of policy solutions that address the physical, behavioral, and health-related social needs of pregnant and postpartum members by improving access to providers; strengthening clinical care and care coordination across the care continuum; providing whole-person care; and modernizing how Medi-Cal pays for maternity care.
For a comprehensive overview of the Birthing Care Pathway, including detailed policy solutions and strategic opportunities for further exploration, please read the full Birthing Care Pathway Report.
Development and Engagement
To develop the Birthing Care Pathway, DHCS:
- Assessed California's existing maternal health policies and initiatives, national best practices, and evidence-based programs.
- Recruited pregnant and postpartum Medi-Cal members to share their lived experiences and recommendations.
- Interviewed more than two dozen state leaders, maternity care providers, community-based organization (CBO) leaders, Medi-Cal MCP representatives, and birth equity advocates.
- Launched three workgroups focusing on clinical care, social drivers of health, and the postpartum period.
- Invited additional input on the Birthing Care Pathway from clinical and non- clinical maternity care providers and association representatives, social services providers, MCPs, Tribal health providers, local public health and behavioral health representatives, and consumer advocates across the state.
Medi-Cal Member Engagement
In fall 2023, DHCS engaged 30 members who were either currently pregnant or up to 24 months postpartum to share their lived birthing experiences while enrolled in Medi-Cal. Medi-Cal members were selected to represent diverse experiences and especially to represent the lived experiences of groups facing health disparities. Members participated in one of three activities – interviews, journaling, or a workgroup with other Medi-Cal members – and all were compensated for their participation.
Key findings from the Birthing Care Pathway member engagement activities include:
- Feeling Heard and Respected. Feeling respected and heard by health care providers is critical to a member's perinatal experience in Medi-Cal. Members often feel that their birth plans and breastfeeding choices are not respected; however, members feel like midwives and doulas listen to their needs and preferences.
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Discrimination in Health Care. Some members experienced discrimination in their health care encounters during pregnancy, birth, and the postpartum period, but felt connected to their health care providers and better supported when they received racially concordant care.
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Trust Building Opportunities. Key moments for trust building with members are often missed, particularly around trauma-informed approaches to intimate partner violence (IPV) screening, smooth hospital discharge after birth, timely access to high-quality breast pumps, and mindful discussions on behavioral health screening results and referrals to services.
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Care Coordination. Medi-Cal members often felt like it was their responsibility to independently navigate and coordinate many aspects of their perinatal care – ranging from coordinating their care across different health care providers to ensuring Medi-Cal coverage for themselves and their newborns.
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Behavioral Health Services. Finding mental health providers who accept Medi- Cal, are taking new patients, and have perinatal experience is difficult; Medi-Cal members want more frequent and intensive mental health support.
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Medi-Cal Benefits. Medi-Cal members often do not understand what Medi-Cal benefits and public benefits/social services are available to them during pregnancy or the postpartum period (e.g.,
doula services;
Enhanced Care
Management;
Women, Infants, and Children Program (WIC)/CalFresh; and
transportation services).
Partner Engagement
Key Informant Interviews. Throughout summer and fall 2023, DHCS interviewed more than 25 state leaders, perinatal care providers, advocates, and representatives from CBOs, associations, and health plans. Interviewees represented such associations as the
American College of Obstetricians and Gynecologists (ACOG),
California Nurse-MidwivesAssociation (CNMA), and
California Association of Licensed Midwives (CALM). Providers interviewed included obstetrician-gynecologists (OB/GYNs), family medicine physicians, certified nurse midwives (CNM), licensed midwives (LM), freestanding birth center (FBC) providers, pediatricians, addiction medicine physicians, reproductive psychiatrists, lactation consultants, doulas, and community health workers (CHW). DHCS also interviewed county leaders of
Black Infant Health (BIH),
WIC, and
Maternal, Child, andAdolescent Health (MCAH) programs as well as CBO leaders and advocates focused on LGBTQI+ health; IPV services; and birth justice and supports for Black, American Indian/Alaska Native, and Pacific Islander individuals.
Workgroups. In summer 2023, DHCS launched three workgroups – Clinical Care Workgroup, Social Drivers of Health Workgroup, and Postpartum Sub-Workgroup – to inform the design of the Birthing Care Pathway.
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The Clinical Care Workgroup identified appropriate clinical care for Medi-Cal members, whether in a hospital, birthing center, provider office, or the community, from conception through 12 months postpartum.
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The Social Drivers of Health Workgroup identified programs and providers that address health-related social needs in the prenatal and postpartum period.
- The Postpartum Sub-Workgroup addressed what clinical providers can do during the postpartum period to achieve positive birthing health outcomes.
All three workgroups met throughout 2023 and 2024 to discuss key challenges with the Medi-Cal prenatal, birthing, and postpartum experience and provide feedback on proposed policy solutions. Workgroup members who indicated financial barriers to participation were compensated for each meeting they attended.
Additional Partner Engagement. DHCS also gathered feedback on the Birthing Care Pathway from several forums throughout 2023 and 2024, including:
Birthing Care Pathway Policy Solutions and Strategic Opportunities for Further Exploration
The policy solutions and strategic opportunities for further exploration outlined in the Birthing Care Pathway Report were developed based on feedback from a diverse array of partners, including pregnant and postpartum Medi-Cal members whose lived experience is central to the design of the Birthing Care Pathway.
Policy Solutions. DHCS is implementing 42 Birthing Care Pathway policy solutions across eight focus areas, including:
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Provider Access and MCP Oversight and Monitoring: Expanding access to a range of maternity providers, including doctors, midwives, and doulas; enhancing oversight of maternity services delivered through Medi-Cal MCPs; and improving communication to Medi-Cal members on available benefits and provider types.
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Behavioral Health and Trauma-Informed Care: Increasing access to mental health and substance use services and enhancing trauma-informed care.
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Risk Stratification and Assessment: Identifying pregnant and postpartum Medi- Cal members who are high risk and connecting them to needed services and supports; and strengthening intimate partner violence screening.
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Care Management and Social Drivers of Health: Delivering whole-person care; addressing social needs, including housing and nutrition; and strengthening partnerships with community providers that have perinatal expertise.
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Perinatal Care for Justice-Involved Individuals: Facilitating enrollment in Medi- Cal and ensuring access to services before and after release from prison or jail.
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Medi-Cal Maternity Care Payment Redesign: Increasing reimbursement rates for a range of maternity care providers and supporting value-based maternity care.
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Data and Quality: Building integrated systems for data sharing; supporting cross-enrollment of Medi-Cal members into vital safety net supports; and creating new performance metrics to improve the quality of Medi-Cal maternity care.
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State Agency Partnerships: Coordinating across different California programs for maternal health – such as home visiting and Paid Family Leave – to boost member awareness and access; and partnering with the
California Department of
Public Health (CDPH),
Office of the California Surgeon General (OSG), and
California Maternal Quality Care Collaborative (CMQCC) to develop a statewide Maternal Health Strategic Plan, of which the Birthing Care Pathway serves as a foundational element, to reduce maternal mortality and morbidity.
Supporting and strengthening the implementation and sustainability of many of these policy solutions in the Medi-Cal program is their alignment with DHCS' Medi-Cal Transformation program areas currently being operationalized, such as
PopulationHealth Management (PHM),
Enhanced Care Management (ECM),
Community Supports, and the
Justice-Involved Reentry Initiative.
Strategic Opportunities for Further Exploration. DHCS' engagement with Medi-Cal members and community partners identified several strategic opportunities for further exploration for the Birthing Care Pathway. These strategic opportunities include increasing access to maternity and behavioral health providers, strengthening MCP oversight and perinatal quality measures, and partnering with state agencies to improve maternal health. These opportunities are subject to additional assessment and planning and are contingent on external factors, such as legislative authority or additional state budget resources.
Transforming Maternal Health (TMaH) Model
In January 2025, the Centers for Medicare & Medicaid Services (CMS) announced California as one of 15 states selected for the federal ten-year
Transforming MaternalHealth (TMaH) Model and awarded DHCS $17 million in federal funding to implement it. DHCS will implement TMaH in five Central Valley counties: Fresno, Kern, Kings, Madera, and Tulare. TMaH is a Medicaid and Children's Health Insurance Program (CHIP) delivery and payment model designed to improve maternal outcomes and reduce health care expenditures through a whole-person approach to pregnancy, childbirth, and postpartum care. The TMaH Model will implement evidence-informed interventions within a value-based payment (VBP) framework, reimbursing providers based on patient health outcomes and quality of care, rather than the volume of services provided. DHCS will work with MCPs, providers, CBOs, and other partners to implement the TMaH Model, which is complementary and synergistic with the Birthing Care Pathway. While TMaH will be implemented in five counties, the Birthing Care Pathway is a statewide transformation effort designed to improve maternity care and outcomes in all 58 counties.
Looking Ahead
The Birthing Care Pathway is a multi-year initiative for DHCS to advance maternal health and birth equity in California. DHCS will continue working with maternity care and social services providers, state and local leaders, MCPs, birth equity advocates, and other partners to implement the Birthing Care Pathway using existing resources. DHCS is committed to reducing pregnancy-related mortality and morbidity in California and closing the significant racial and ethnic disparities in maternal health outcomes through the Birthing Care Pathway and recognizes this will only be possible with the partnership, engagement, and support of all of the individuals and organizations committed to the care of pregnant and postpartum Medi-Cal members.
Materials
Press and Media
Key Documents