This blog post is part of an NHeLP series about current initiatives to improve maternity care in California. This blog post, the first, is on the California Department of Health Care Services Birthing Care Pathway. The second blog post is on California’s Transforming Maternal Health Model. The third and final blog post is on the California Rural Health Transformation Program.
This is an incredibly challenging time for health policy advocates in California. H.R.1’s cuts to Medicaid (Medi-Cal) and other health systems are already wreaking havoc across the country. In mid-May, the Trump administration announced it would defer $1.3 billion in federal Medicaid payments to California, citing alleged fraud. A day later, Governor Gavin Newsom’s 2026-2027 state budget proposal made further health care cuts for some of the most vulnerable Californians, from proposing the reinstatement of the $2,000 Medi-Cal assets test for older adults and for Medi-Cal enrollees with disabilities, as well as plans to impose $50 premiums for adults ages 19-59 with unsatisfactory immigration status on state-only funded Medi-Cal.
Yet in spite of the many challenges facing Medicaid and health care at the national level and here in California, there are also some bright spots to lift up in the state as they pertain to ongoing efforts to improve maternity care and delivery in the state. One of these is the California Department of Health Care Services Birthing Care Pathway.
In 2023, the California Department of Health Care Services (California’s Medicaid Agency, DHCS) received funding from the California Health Care Foundation and the David & Lucile Packard Foundation, to begin to work on a comprehensive roadmap of care for all pregnant and postpregnancy Medi-Cal enrollees. The roadmap is intended to address the physical, behavioral, and health-related social needs of pregnant and postpregnancy people, and to streamline their care from the time they became pregnant, to 12 months after the end of the pregnancy. The underlying goal of the roadmap, which became the Birthing Care Pathway, is to reduce maternity morbidity and mortality, and to address racial and ethnic disparities in maternal health that disproportionately impact Black, American Indian/Alaska Native, and Pacific Islander communities.
In February 2025, DHCS released its Birthing Care Pathway Report, which described the Department’s stakeholder engagement process. After dozens of interviews with Medi-Cal enrollees, leaders in state agencies, community-based organizations, health plans, and birth equity advocacy, and three workgroups comprising Clinical Care, Social Drivers of Health, and Postpartum care, DHCS settled on the eight focus areas for the Birthing Care Pathway. The focus areas as described by DHCS are:
- 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.
- Behavioral Health and Trauma-Informed Care: Increasing access to mental health and substance use services and enhancing trauma-informed care.
- 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.
- 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.
- Perinatal Care for Justice-Involved Individuals: Facilitating enrollment in Medi- Cal and ensuring access to services before and after release from prison or jail.
- Medi-Cal Maternity Care Payment Redesign: Increasing reimbursement rates for a range of maternity care providers and supporting value-based maternity care.
- 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.
- 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.
The report concluded by sharing strategic opportunities for further exploration, which would be dependent on such factors as legislative authority and state budget constraints. These opportunities included increased access to maternity and behavioral health care providers, strengthening oversight of Medi-Cal managed care plans, improving tracking and reporting of quality care and patient experience data, and partnering with state agencies to improve quality and access to maternal health care.
In March 2026, DHCS shared with stakeholders a one-year update since the release and launch of the Birthing Care Pathway Report. Specifically, the Department shared about successful efforts to expand access to maternity care providers including midwives, doulas, and community health workers; strengthening integration of behavioral health and substance use disorder care for pregnant and postpregnancy Medi-Cal enrollees; and improved care coordination for pregnant and postpregnancy Medi-Cal enrollees. The update stated that of the 42 individual policies within the eight focus areas in the Birthing Care Pathway Report, 28 policies had been completed and a remaining 14 policies remained in progress. The Department’s status and progress on each of the enumerated policies can be followed online here.
The Birthing Care Pathway exists primarily as a way for state and county agencies, Medi-Cal managed care plans, social service organizations, Medi-Cal providers, and other stakeholders to better understand and work together in their provision of services for pregnant and postpregnancy Medi-Cal enrollees. For example, one part of the Birthing Care Pathway effort was to consolidate maternity care related All-Plan Letters into a single omnibus All-Plan Letter 26-005. Medi-Cal enrollees may not be aware of the Birthing Care Pathway or even know that such a roadmap exists. However, if it functions as it should, Medi-Cal enrollees’ access to maternity care providers should be easier, their care should be more coordinated and streamlined behind the scenes, and health outcomes should be ultimately improved, particularly for BIPOC Medi-Cal enrollees.
