The Department of Health Care Services (DHCS) is making significant strides in transforming Medi-Cal to enhance maternal health care services. The expansion includes the integration of doula services, a comprehensive birthing care pathway from conception through 12 months postpartum, parent-child dyadic care, and other benefits. These improvements aim to support pregnant members, including those slightly above the traditional Medi-Cal income limits.
In a briefing organized by Ethnic Media Services (EMS), three key speakers shared insights into the expanded Medi-Cal maternal health programs:
- Erica Holmes, Chief of the Benefits Division at DHCS, provided an overview of the newly expanded maternal health services, including the beneficiaries and the next steps for doulas under Medi-Cal.
- Kairis Chiaji, a Medi-Cal doula provider, discussed the impact of doula services on maternal health and shared firsthand experiences working with Medi-Cal members.
- Khefri Riley, another Medi-Cal doula provider, highlighted the importance of culturally competent care and shared stories of how doula services have improved health outcomes for birthing individuals.
Importance of Doulas
Doulas play a critical role in bridging racial and ethnic disparities in maternal and infant health outcomes. Their support can lead to improved birth outcomes and a reduction in complications such as C-sections, epidurals, premature deliveries, low birth weight, anxiety, and labor duration. The focus on culturally competent care ensures that the needs of Black, American Indian, Latino, and Asian American and Pacific Islander parents and infants are met effectively.
Program Highlights
Erica Holmes emphasized the transformative efforts in maternal care. Medi-Cal, which covers approximately half of the births in California, is dedicated to reducing maternal illness and death while addressing racial and ethnic disparities. The program aims to support birthing individuals with a comprehensive approach that includes physical and mental health, as well as health-related social needs, both in traditional and non-traditional care settings.
New Benefits and Services
Doula Services: As of January 1, 2023, doula services are a covered benefit under Medi-Cal. These services include:
- Emotional and physical support during pregnancy and postpartum.
- Assistance with miscarriage or abortion.
- Guidance on health navigation, prenatal, postpartum, childbirth, and infant care education.
- Lactation support and development of birth plans.
- Connection to community-based resources.
- No need for a separate referral; members can directly access doulas through the Medi-Cal doula directory.
Midwifery Services: Certified nurse midwives and licensed midwives can provide a full range of clinical services within their scope of practice. A dedicated midwifery webpage will be created to increase awareness and accessibility.
Community Health Worker Benefit: Launched on July 1, 2022, this benefit includes health education, navigation, screening and assessment, and individual support and advocacy. Community health workers are trusted members of their communities, offering culturally responsive maternal care.
Birthday Care Pathway Initiative: This initiative supports members from conception through 12 months postpartum, focusing on physical and mental health and social needs. It aims to improve health outcomes and reduce disparities through evidence-based clinical care and care management guidelines.
Commitment to Maternal Health
Medi-Cal is committed to continuing its efforts to enhance maternal health services and reduce disparities. This includes extending coverage from 60 days postpartum to 12 months postpartum and eliminating premiums for families. The DHCS is dedicated to improving health outcomes and ensuring that all birthing individuals have access to comprehensive, culturally sensitive care.
The ongoing transformation of Medi-Cal into a whole-person health system is creating a more inclusive and supportive environment for maternal health care in California. Through expanded services and innovative approaches, Medi-Cal aims to help families and babies live healthier lives, starting from conception and extending well beyond postpartum.
Kyra Chaji’s Advocacy and Work
Kyra Chaji, with over 25 years of experience as a doula and founder of the “Children of the Sun Doula Project,” has been a pioneer in early health plans funded through a dual service program. She initiated a pilot program through DHCS in Northern California and currently works as a doula through Medi-Cal in Sacramento.
Kyra delved into her extensive experience advocating for the doula community and her efforts to bridge maternal health access gaps through Medi-Cal. Her focus is on integrating community-based relationships within a medically managed system, enhancing support for birthing individuals. She expressed her excitement about being part of this event, reconnecting with familiar faces, and addressing the media professionals who play a crucial role in disseminating valuable information to the community.
Role and Impact of Doulas:
Kyra explained her role as a doula, likening it to that of a personal trainer for childbirth. Doulas provide personalized support to birthing individuals, helping them develop birth plans and supporting them through various birthing environments, be it hospitals, birth centers, or home births. She emphasized the flexibility doulas offer, allowing them to enter any birthing space their clients’ insurance or resources permit.
Addressing Maternal Health Gaps:
Highlighting the critical maternal health crisis in the United States and California, Kyra stressed the importance of doulas in preventing injuries and losses, 80% of which are preventable according to statistics. Doulas amplify the voices of families, recognize early signs of complications, and help navigate healthcare systems, especially for those without insurance.
Value of Community Relationships:
Kyra shared her journey of working with the state to develop the doula benefit, acknowledging the significant progress made in the last few years. She praised DHCS for their willingness to understand and integrate doula services into standard care. The collaboration allowed for a paradigm shift, recognizing that a large part of healthcare involves leveraging relationships, which doulas are uniquely positioned to foster.
Origins and Practice of Doulas:
Discussing the origins of the term “doula,” Kyra explained that while it has Greek roots meaning “woman who serves,” the practice itself is ancient and deeply rooted in indigenous traditions. Doulas have always been integral to community-based birthing support, ensuring the well-being of birthing individuals and their families.
Kyra’s Personal Journey into Doula Work:
Kyra’s path into doula work began serendipitously while working administratively for an organization combating maternal and infant mortality in the Black community. An unexpected call to support a laboring woman led her to discover her passion for birth work. A nurse’s suggestion to get certified solidified her journey, leading Kyra to dedicate her life to supporting birthing individuals and training other birth workers.
Kyra’s Vision for the Future:
Looking ahead, Kyra envisions a future where every community can be its own best solution for birth outcome crises. She aspires to see a time when doulas are an integral and normalized part of healthcare, ensuring that every birthing individual has the support they need for a safe and positive birth experience.
Ky Riley’s Advocacy and Work
Ky Riley, co-founder and director of Frontline Doulas, who has served over 700 families, particularly African-American families, through community doula programs across LA County, has been working with DHCS for the past two years to develop a new doula benefit and workforce.
Ky Riley shared her journey, saying, “I’ve served as a doula, educator, advocate, and business owner for over 23 years in the field of birth work and maternal-infant advocacy. Now, as co-founder and director of Frontline Doulas, we’ve served hundreds of African-American families with culturally congruent doula care. We create innovative, culturally competent, solution-oriented programs to address the maternal-infant mortality crisis. These must be community-centered initiatives to fulfill the need for conscious healthcare connections and advocacy that facilitate empowered communications with healthcare providers, communities, and consumers around birth, justice, and human rights at birth.”
Community-Centered Care:
Ky emphasized the importance of community-centered care, explaining, “Community doulas typically come from the communities they serve and connect clients to community resources. This is crucial for marginalized or underserved birthing families who often face socioeconomic hardships and institutionalized racism in medical settings. Community doulas are more likely to encounter and support clients in navigating these challenges.”
Historical and Cultural Significance:
Ky highlighted the historical and cultural significance of doula care, noting, “Doulas have been a part of traditional care for families, rooted in the practices of Black grandmothers, indigenous midwives, and midwifery in general. This is not a new concept but a continuation of a cultural inheritance that has supported birthing families for generations.”
Transformative Potential of the Medi-Cal Doula Benefit:
She underscored the transformative potential of the new Medi-Cal doula benefit, stating, “This benefit is a significant step towards achieving equity in birth and reproductive care, particularly for Black and indigenous birthing people. It covers all aspects of the reproductive journey, including abortion, miscarriage, stillbirth, and the first year postpartum. This comprehensive support can radically transform outcomes, especially in the postpartum period where many maternal health issues arise.”
Call to Action:
In closing, Ky Riley called for support in spreading the word about this vital benefit, stressing that “doula care is now covered under Medi-Cal for all birthing families in California, providing equitable and quality care for everyone. This is a historical benefit rooted in reproductive justice, thanks to the hard work and vision of activists, advocates, and community members.”
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