First 5 Yolo County’s Welcome Baby Program: Leveraging Medi-Cal to Support Birthing Families Through Home Visiting

(An Interview with Gina Daleiden, First 5 Yolo Chief Executive Officer)

In Yolo County, all postpartum families with Medi-Cal coverage are offered the Welcome Baby: Road to Resilience (Welcome Baby) program. Started and championed in 2019 by Gina Daleiden, First 5 Yolo Chief Executive Officer, Welcome Baby first started as The CHILD Project: Road to Resilience, an in-clinic and in-home navigation program. Through American Rescue Plan Act (ARP) funding, received in 2021, First 5 Yolo was able to add nurse home visits immediately postpartum and grow the program into the fully integrated Welcome Baby program we know today.

Welcome Baby is a maternal/child health equity, home visiting program where families receive physical health assessments, lactation consultation, mental health screenings, parenting information, and connections to community resources from two providers: first a Welcome Baby Nurse Home Visitor makes a home visit within one to two weeks postpartum and provides follow-ups, and then for those who are eligible for more intensive services, community health workers provide longer-term home visiting providing parent coaching and behavioral health supports.

To date, the Road to Resilience program has screened and assessed over 2,000 babies and their mothers, delivered more than 1,000 nurse home visits, and conducted over 8,000 home visits to families enrolled in longer-term home visiting. Children who have received Road to Reslience services show measurable health gains: Infants who received a nurse visit were 64 percent more likely to complete their one-month well child visit, children receiving services were 37 percent more likely to be up to date on their well-child visits, and 98 percent of mothers participating in the program received timely postpartum medical visits.

To support an effective countywide program, Welcome Baby is funded by multiple funding streams. This includes not only Proposition 10 tobacco tax revenue (Prop. 10), which supports funding for First 5s, but also state and local city and county funding. By braiding local funding with State grants from the California Department of Social Services, Office of Child Abuse Prevention, and Department of Health Care Services Child Youth Behavioral Health Initiative, First 5 Yolo has been able to develop and scale its Welcome Baby program. Given declining Prop. 10 revenue and the time limited nature of grant funds, First 5 Yolo has turned to Medi-Cal and the new Community Health Worker Services (CHW) and Enhanced Care Management (ECM) benefits to sustain key aspects of the Welcome Baby program.

Launched in 2022, the California Advancing and Innovating Medi-Cal program, otherwise known as CalAIM, is a long-term plan to transform the Medi-Cal program. The goal of CalAIM is to create a health care delivery system that is more equitable, coordinated​, and person-centered.​​​​ As part of CalAIM, services provided under the CHW and ECM benefits closely align with core services delivered and funded by First 5s, such as home visiting. Gina Daleiden reflects:

“CalAIM's approach is an excellent fit for First 5s, who have spent 25 years building infrastructure to coordinate systems of care. First 5s are well-positioned to weave together the necessary services and have a long history in evaluating and improving programs. This depth of coordination is essential for effective care.”

Most recently, First 5 Yolo has become a supervising provider for the Medi-Cal CHW benefit to bill its local managed care plan, Partnership Health Plan, for services delivered as part of Welcome Baby. As a supervising provider, First 5 Yolo takes on administrative, coordination, and billing responsibilities to help sustain Welcome Baby.

“The Welcome Baby Road to Resilience home visiting services fit well with the Community Health Worker benefit. We bill for eligible services, starting with nurse visits and expanding to more intensive, longer home visits. For patients eligible for Enhanced Care Management, we seek to support caseloads of families served by Welcome Baby nurses but who are not covered under longer-term Road to Resilience Community Health Worker services. This offsets costs but doesn't cover all program expenses.”

Although Welcome Baby and other home visiting programs improve health outcomes for Medi-Cal members, California’s Medi-Cal program currently lacks a dedicated benefit to cover these services. Providers can leverage the CHW and ECM benefits to support some activities, as First 5 Yolo has, but it is not a perfect fit. Reimbursement rates, especially for the CHW benefit, are low and cannot cover other members of the care team, data systems, travel, or overhead costs associated with the programs. Leveraging multiple funding sources also comes with different eligibility rules, time horizons and administrative requirements. Fund braiding is less sustainable and can make systems more difficult to access and navigate for families.

Despite the administrative lift and programmatic complexity of braiding funds, First 5s like Yolo take on the work because they know it maximizes the impact of the dollars in their local communities and sustains critical investments in light of declining revenue. However, leaders like Gina envision a future where things are more coordinated at the state level.

“Sustaining it [Welcome Baby] requires better coordination of funding streams to reduce patchworking and ensure consistency. Additional solutions, such as legislative support, are critical to support programs financially alongside Medi-Cal billing.”

The First 5 Center has developed a proposal for an early childhood home and community-based service benefit to support home visiting through Medi-Cal. This proposal is based on the findings from a state and national landscape review, informational interviews with California’s county First 5s, such as Yolo, community-based organizations, community health workers and doulas, a family survey, and discussions with home visiting experts in California. This benefit would not only provide a direct pathway to support Welcome Baby and other home visiting programs, but also would support the state’s interest in expanding access to home visiting services for Medi-Cal members, as outlined in the Birthing Care Pathways Report. 

First 5 Yolo’s leadership has shown that the Medi-Cal CHW services benefit can be used to support home visiting. New parents and their babies can receive the support needed for healthy development and growth in Yolo County because of First 5’s effort to braid multiple funding streams together. “Investing early…and leveraging limited resources to support critical early health indicators leads to healthier trajectories for young children and their families,” said Gina. If California created a Medi-Cal benefit just for home visiting, every family, regardless of where they live or the challenges they face, could receive the support they need during the first, crucially important months.