Providing equitable maternal health care is of growing interest across the nation. Disparities in access to maternal health services, including prenatal, perinatal, and postpartum care that meet the unique needs of various populations disproportionately impact Black, Indigenous, and other communities of color, leading to poor maternal health outcomes. For example, Black women are 2-3 times more likely to die from pregnancy-related causes than White women. Additionally, maternal mortality rates are higher among Medi-Cal members compared to those with commercial insurance. Every death related to pregnancy is a tragedy – made even more heartbreaking by the fact that over 80% of the these deaths in the US are preventable.

While addressing maternal health disparities may be a challenge, there have been significant efforts at the state and federal levels to address the disparity and improve quality of care for this vulnerable population.

Initiatives Impacting Maternal Health in California Through CalAIM and Other State/Federal Programs
The state of California has made substantial strides in addressing maternal health needs for marginalized communities through the utilization of state and federal waivers and pilot programs that focus on improving access to care. Below are a few state and federal programs that are working to address maternal health needs locally and nationally:

1. CalAIM: CalAIM reforms have been instrumental in supporting maternal health organizations by enabling maternal health organizations to join Medi-Cal managed care networks as ECM and CS providers. Through this decision, Medi-Cal members have increased access to culturally competent, community-based maternal health care. This initiative has identified Birth Equity as a population of focus, which targets pregnant and post-partum women among historically marginalized groups experiencing disparities in maternal health outcomes and provides tailored care management services during and post birth. This initiative is a major step in recognizing and addressing maternal health care gaps.
2. Doulas as Providers: Medi-Cal has formally recognized doulas as provider types, allowing reimbursement for their services. Doulas are trained professionals who provide support for individuals before, during, and after pregnancy. Their involvement during a woman’s pregnancy has shown positive outcomes, including lower odds of cesarean delivery. Taking this step in recognizing doulas as a provider may encourage growth of the doula workforce, a particularly important strategy for addressing maternal health outcomes among Black and other minority populations. With increased access to doulas, these populations may receive the appropriate support needed while navigating their maternal health needs.
3. Transforming Maternal Health Model: In January 2025, CMS selected 15 states to participate in the Transforming Maternal Health (TMaH) Model, a 10-year initiative aimed specifically at improving maternal health for women enrolled in Medicaid and CHIP. The model operates across three core pillars: (1) Expanding access to maternal care, strengthening infrastructure, and increasing workforce capacity; (2) Quality improvement and safety, including the first national quality benchmark focused solely on maternity care; and (3) Whole-person care delivery, which focuses on preventative screenings and addressing other social determinants of health as they relate to maternal care. CMS selected California as one of the 15 states to participate in TMaH and will be preparing and implementing TMaH activities over the next 10 years.
4. Medi-Cal Expansion: Beginning in 2024, California offered Medi-Cal to all income-eligible residents, enabling more women to access preventive care before pregnancy, potentially leading to overall improved maternal health outcomes. This expansion provides crucial access to healthcare for many and is particularly impactful among rural communities, who have historically had high rates of uninsured individuals.
5. Birthing Care Pathway: In 2023, DHCS began developing the Birthing Care Pathway, a model aimed at evaluating and strategizing around maternal health in CA. This model identified potential solutions, including increasing maternity care reimbursement, addressing additional risk factors for pregnant and postpartum Medi-Cal members, and expanding access to maternity care providers.

These are just five initiatives among many others that demonstrate the growing emphasis on maternal health and efforts to close care gaps. Continued investment in and discussion around maternal health programming is expected through Medicaid waiver extensions and expanded social service offerings in California and nationwide.

COPE Health Solutions works with provider groups and community-based organizations to design, implement, and optimize programs for maternal health organizations and other high-need populations. We’ve seen what works- and we’re here to help organizations put that knowledge into practice.

Contact us at info@copehealthsolutions.com to learn how our expertise can help drive your success in California’s changing health care landscape.