CALIFORNIA TAKES ACTION ​TO IMPROVE MATERNAL HEALTH

SACRAMENTO – The Department of Health Care Services (DHCS) today released the Birthing Care Pathway report, a comprehensive plan to improve maternity care for Medi-Cal members. This roadmap covers the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum, aiming to make care accessible, equitable, and patient-centered.

“The Birthing Care Pathway represents a critical step forward in California's commitment to improving maternal health," said DHCS Director Michelle Baass. “By centering member experiences, aligning policies with actionable recommendations, and strengthening partnerships across sectors, we aim to ensure every Medi-Cal member has access to safe, equitable, and comprehensive maternity care."

KEY OBJECTIVES: The Birthing Care Pathway report details policies DHCS has implemented or is in the process of implementing to support all pregnant and postpartum members enrolled in Medi-Cal. Additionally, the report identifies opportunities for future exploration.
 
The Birthing Care Pathway prioritizes:

• Reducing maternal mortality and morbidity: Establishing evidence-based interventions to save lives.
• Addressing health disparities: Tackling racial and ethnic inequities in maternal care, particularly for Black, American Indian/Alaska Native, and Pacific Islander individuals who face the most significant maternal care and outcomes gaps in California.
• Improving access and coordination: Enhancing care across the continuum, including clinical, behavioral, and social support services.
• Modernizing payment models: Transitioning to a value-based payment system to incentivize quality care.

The Birthing Care Pathway will work to achieve these objectives by transforming Medi-Cal's maternity policy to create a member-centered approach to prenatal and postpartum care that meets members where they are and provides whole-person care that addresses behavioral health and social needs in addition to medical needs. DHCS will revise and modernize existing Medi-Cal policies to provide members with increased choice of types of maternity providers and supports, like doulas, community health workers, and others, and creating critical linkages between health care and other programs across the state to make it easier for members to get the full range of needed services.

Additionally, DHCS will address the needs of special populations who are pregnant/postpartum, including people involved with the justice system, individuals with severe mental health and substance use needs, LGBTQI+ individuals, and Black, American Indian/Alaska Native, and Pacific Islander individuals.

DHCS will continue working with state departments, including the California Department of Public Health (CDPH) and Office of the California Surgeon General (OSG), maternity care and social services providers, state and local leaders, Medi-Cal managed care plans (MCP), birth equity advocates, and other partners to implement the Birthing Care Pathway policies outlined in the report. Continuing to engage a diverse set of partners to implement and further develop the Birthing Care Pathway will be vital to align the numerous maternity initiatives occurring so they are not siloed.

"Through a comprehensive, whole-person approach, California is not just enhancing perinatal health, but we are setting a bold new standard for care that delivers better outcomes for families statewide," said California Surgeon General Dr. Diana Ramos. “The Birthing Care Pathway is a vital addition to the state's efforts that advance perinatal health, building on the innovative, collaborative work already underway."

“Having served rural communities throughout my career, I know that providing access to services from conception through one year postpartum has always been a challenge," said Dr. Robert Moore, Chief Medical Officer at Partnership HealthPlan of California. “Collaborations like the DHCS Birthing Care Pathway are vital in bringing together multiple partners and stakeholders to find solutions. The entire community must engage on this issue to make lasting progress."

WHY THIS MATTERS: Nearly one in eight U.S. births occur in California, and 40 percent of those births are covered by Medi-Cal. While California currently has the lowest maternal mortality rate in the nation, Medi-Cal members have a higher rate of maternal mortality than individuals with commercial insurance.

While the Birthing Care Pathway lays out a long-term strategy for transforming maternity care in Medi-Cal, many services and supports are already available to pregnant and postpartum members. Medi-Cal members can access comprehensive maternity care, including prenatal and postpartum visits, doula services, behavioral health care, and lactation support, through their health plan and provider network. DHCS remains committed to improving and expanding these services as part of the ongoing work to implement the Birthing Care Pathway.

ABOUT THE BIRTHING CARE PATHWAY: The Birthing Care Pathway includes policy recommendations that address the physical, behavioral, and health-related social needs of pregnant and postpartum members. Opportunities include improving access to providers, strengthening clinical care and care coordination, providing whole-person care, and modernizing how Medi-Cal pays for maternity care.

The Birthing Care Pathway is part of a multi-year commitment to transforming maternal health in California, and maternal health reform is already underway. DHCS is implementing the federal ten-year Transforming Maternal Health (TMaH) Model in five Central Valley counties: Kern, Fresno, Kings, Tulare, and Madera. TMaH is a delivery and payment model designed to test whether effective implementation of evidence-informed interventions, sustained by a value-based payment model, can improve maternal outcomes and reduce Medi-Cal program expenditures.
 
COLLABORATIVE PROCESS: The Birthing Care Pathway reflects a collaborative effort of pregnant and postpartum Medi-Cal members, state partners and a range of health care and social services providers, community-based organizations (CBO), and advocates, ensuring a community-informed policy approach to the future of birthing and maternal health care in California. Additionally, the California Health Care Foundation and the David & Lucile Packard Foundation provided funding to support engagement and report development. Key insights from Medi-Cal members highlighted critical needs, such as respect for birth preferences, access to racially concordant and culturally centered care, improved behavioral health support, and better care coordination. Member experiences directly shaped the pathway's policy recommendations. For more information, please visit the Birthing Care Pathway webpage​.
 
"Learning about the Birthing Care Pathway gave me a sense of relief and hope because it meant I could take care of my and my baby's health without adding additional stress," said M. Thao, mother of an 11-month-old baby. “Every time I called for help to navigate resources and to sign up for the program, I received clear guidance from Medi-Cal. That feeling of knowing you'll be OK is one I hope every birthing parent in California can count on." 

A BROADER VISION FOR MATERNAL HEALTH: DHCS will work with MCPs, providers, CBOs, and other stakeholders to implement TMaH Model elements, which are aligned with and complementary to the Birthing Care Pathway. Additionally, DHCS is working with the California Maternal Quality Care Collaborative, CDPH, and OSG to develop a Maternal Health Strategic Plan by September 2025 to improve maternal health throughout California.​