As federal health programs face cuts, California is expanding maternal health care through Medi-Cal. The state now offers one of the most complete maternal health benefit packages in the nation.
Pregnant Californians can receive full-scope Medi-Cal, regardless of their immigration status, from the start of pregnancy through 12 months after birth; however, many families are unaware that they qualify for this coverage.
At a December 4 briefing hosted by American Community Media, leaders from the Department of Health Care Services explained how California is expanding access to maternal and reproductive health care. The panel of experts included Raquel Saunders, MS, Section Chief, Medi-Cal Benefits and Legislation; Sarah Gilbert, Chief, Office of Family Planning; and Eva Goodfriend-Reaño, Certified Nurse Midwife, Midwifery Clinical Chief at Alameda Health System.
The briefing emphasized the importance of early access to care and the availability of services regardless of immigration status.
The panel explained that Medi-Cal now covers midwife and doula services, giving families more birthing options beyond hospitals to help improve maternal health outcomes. California also offers Family PACT, a no-cost family planning program that works alongside Medi-Cal to strengthen maternal and reproductive care. The panel emphasized that undocumented Californians can safely access these services, even as access to care becomes more limited in other states.
Scope of Maternal Health Care
Many people in California, especially immigrants and families with different immigration statuses, may feel unsure about how changes to Medi-Cal affect their care, said Raquel Sanders. “We understand that many in our community, especially immigrants and families with different immigration statuses, are feeling uncertain about upcoming changes to medical (care) and how those changes may impact their families.”
However, under current policy, “all pregnant people, regardless of immigration status, are eligible for full scope Medi-Cal from the start of their pregnancy through 12 months after the pregnancy ends or the baby is born,” she clarified.
In recent years, Medi-Cal has expanded maternal health services and introduced more care options. Programs like CalAIM and the Birthing Care Pathway are helping the Department of Health Care Services (DHCS) improve access to care, reduce maternal complications, and provide culturally responsive support for pregnant and postpartum members.
Children and youth under 19 are also eligible for full-scope Medi-Cal.
These benefits help families access essential services, including prenatal checkups, birth planning, and mental health care, such as support for postpartum depression, said Sanders. The Department of Health Care Services has created easy-to-understand flyers to help highlight the wide range of maternal health services available, and choose the care they need, she added.
The prenatal services flyer outlines the full spectrum of maternal health services available to MediCal members, and the other lists perinatal providers. “This is a companion flyer that helps members understand the different types of maternal care providers, such as OBGYN midwives, doulas, and how to choose the right care team.”
Doula Services and Midwifery Care
Sanders also described the doula services, covered by Medi-Cal since January 2023, which offer emotional and physical support during pregnancy, labor, birth, and postpartum.
“The doula and midwifery care.. are helping to reshape the maternal healthcare landscape and expand culturally responsive options for Medi Cal members.” Doulas assist after miscarriage or abortion, provide birth planning and lactation support, help navigate health services, and connect members to community resources.
Medi-Cal covers initial visits, up to eight additional visits, support during labor, and two extended postpartum visits, with the option for up to nine extra postpartum visits with a provider recommendation. DHCS maintains a directory of Medi-Cal-enrolled doulas by county, including languages and specialties, to help members find care.
“I want to emphasize that all pregnant people remain eligible for full scope MediCal services, including preventive dental care, regardless of immigration status,” said Sanders.
Midwifery services are also covered under Medi-Cal she added. Certified nurse midwives and licensed midwives care for healthy, low-risk pregnancies, offering prenatal checkups, personalized advice, and emotional support. They can deliver babies in hospitals, birth centers, or at home, though surgeries like C-sections are not performed by midwives.
Together, Medi-Cal, CalAIM, doulas, and midwives provide accessible, culturally sensitive maternal care, said Sanders, ensuring all pregnant Californians have the support they need for a healthy pregnancy and a safe postpartum recovery.
Cal AIM and Community Supports
She also described how CalAIM and community supports help pregnant Medi-Cal members address challenges that affect their health, such as housing, food, and transportation. These services are designed to meet people where they are and support their well-being before, during, and after pregnancy, she said.
Community health workers, also called promotoras or peer navigators, help Medi-Cal members understand their benefits, schedule appointments, and connect to essential services like prenatal care, mental health support, and postpartum resources. These community health workers build trust and improve health outcomes because they often share the same language and cultural background as the people they serve, added Sanders.
For communities that have historically faced barriers to care, these Medi-Cal programs are making it easier for families to get medical services combined with social supports and culturally responsive guidance, to ensure that every pregnant person has\ tools, resources, and support for healthy pregnancies and recovery.
The Family PACT program
Sarah Gilbert’s Office of Family Planning oversees the Family Planning, Access, Care, and Treatment (Family PACT) program. “The program plays a vital role in maternal health by helping individuals plan space and maintain healthy pregnancies when they are ready to have children,” she said.
Family PACT provides contraceptive and reproductive health services to income-eligible Californians, no matter their immigration status, and “serves California residents with income at or below 200% of the federal poverty level,” she said.
It is especially designed for people without health insurance or who face barriers to accessing reproductive health services. To qualify, a person must live in California and have a California address, but immigration status is not considered.
Free and confidential service
Enrolling in Family PACT is quick and easy, said Gilbert, a nurse practioner People can sign up the same day they receive care at any participating clinic. They can also apply online at familypact.org. All services are free and confidential. No immigration-related questions are asked, and using Family PACT does not affect a person’s public charge status, so people can get care without fear or hesitation.
“The program is designed to reach diverse communities, including individuals who face barriers to care, such as language differences, immigration status, confidentiality concerns, or lack of insurance coverage for family planning,” explained Gilbert.””This approach helps ensure that all Californians, regardless of background, can access the reproductive health services they need in a way that is respectful, inclusive and easy to understand.”
Family PACT offers a wide range of services, including education and counseling, help choosing birth control, and access to all FDA-approved contraceptive methods. Options include long-acting methods like IUDs and implants, as well as birth control pills, patches, rings, shots, and condoms. The program also provides reproductive health screenings, including pregnancy tests, cervical cancer screenings like Pap and HPV tests, and testing and treatment for sexually transmitted infections. These services help people make informed decisions about if and when to become pregnant, supporting maternal health and long-term family stability.
Family PACT providers are located throughout California, including community clinics, federally qualified health centers, Planned Parenthood clinics, and private medical practices. In 2023, the program served about 350,000 clients through roughly 1,200 provider locations statewide, making it a vital resource for accessible, inclusive reproductive health care. “Many clinics offer services in multiple languages, ensuring that care is not only accessible but also culturally and linguistically appropriate,” added Gilbert.
The Role of Midwives
Eva Goodfriend-Reaño, a certified nurse midwife, explained the essential role of midwives in maternal and newborn care in California. “Midwives in California deliver about 13% of the vaginal births,” said Goodfriend-Reaño, mostly in hospitals, but also in birth centers and homes and provide care throughout the pregnancy journey—from preconception and prenatal care to birth and postpartum support—and also care for newborns during the first few weeks, referring to pediatricians if needed.
Midwives also provide routine health services, such as Pap smears, family planning, birth control, and other screenings. While their main focus is pregnancy, birth, and postpartum care, they take a whole-person approach, supporting overall health and well-being.
A key advancement, said Goodfriend-Reaño, is that Medi-Cal now covers midwifery care for the full year after birth. “All of the people who are receiving healthcare coverage through Medi-Cal in California and are pregnant can continue to receive services through the first year postpartum,” she added. This extended coverage allows midwives to support postpartum health, including postpartum depression and anxiety, through therapy, support groups, medication management, and ongoing follow-up. Continuous care during this critical time helps families recover and thrive.
Midwives practice independently for low-risk pregnancies and collaborate with OB-GYNs for more complex cases. While they do not perform surgeries like C-sections, they attend births and sometimes assist in surgical settings.
Ensuring safe pregnancies
Goodfriend-Reaño reiterated that California’s health care services provide care to everyone. “Our community clinics, our FQHCs, our safety net hospitals, our county systems are set up to take care of everybody, no matter what your immigration status is.” Midwives work to ensure families feel safe and supported, offering culturally responsive care tailored to each patient’s needs.
By providing continuous, personalized care from preconception to one year postpartum, midwives help ensure healthy pregnancies, safe births, and strong support for families across California.
“California will continue to invest in the health, dignity, and autonomy of its residents,” said Gilbert. Together, we can ensure that every person has the support they need to make the reproductive health choices that are right for them.”
Resources
Directory for all the county offices:
https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
For general Medi-Cal questions or to apply : (800) 541-5555
Family PACT provider locator:
https://familypact.org/provider-search/
For Family PACT and family planning services: 1-800-942-1054
For Prenatal services offered:
https://www.dhcs.ca.gov/CalAIM/Documents/BD-Perinatal-Services-Offered-Flyer.pdf
https://www.dhcs.ca.gov/CalAIM/Documents/BD-Perinatal-Provider-Differences-Flyer.pdf
Birthing care pathway
website: https://www.dhcs.ca.gov/CalAIM/Pages/BirthingCarePathway.aspx
For information on public charge and other immigration FAQs:
https://www.dhcs.ca.gov/keep-your-Medi-Cal/Pages/Medi-Cal-Immigrant-
Eligibility-FAQs.aspx
Doula Directory:
https://www.dhcs.ca.gov/provgovpart/Pages/Doula-Providers.aspx
Medi-cal data at a glance:
https://www.dhcs.ca.gov/dataandstats/reports/Documents/Medi-Cal-at-a-Glance.pdf
For insurance information:
https://www.nber.org/bh/20223/prenatal-insurance-coverage-undocumented-immigrants-improves-birth-outcomes?page=1&perPage=50
Age groups and ethnic/race breakdown: https://www.dhcs.ca.gov/dataandstats/reports/Documents/Medi-Cal-at-a-Glance.pdf
This article was written with support from the American Community Media Fellowship Program.