First 5s Offer a Wealth of Knowledge and Experience to Support the Implementation of the Birthing Care Pathway

As California focuses on improving the quality of maternal care delivery and reducing disparities for our Medi-Cal birthing population, many First 5s are already engaged in work to support families during the prenatal and postpartum periods. In March this year, the Department of Health Care Services (DHCS) launched the Birthing Care Pathway. DHCS began developing the Birthing Care Pathway in 2023 in response to the persistent and disproportionate rise in pregnancy-related mortality and severe maternal morbidity rates faced by Black, American Indian/Alaska Native, and Pacific Islander pregnant and postpartum individuals.

The Birthing Care Pathway is a comprehensive policy and care model roadmap for all systems and entities that serve Medi-Cal members from conception through 12 months postpartum. This roadmap outlines policy solutions to improve access, care coordination, whole-person care, and payment models to meet Medi-Cal members’ physical, behavioral, and social health needs.

Building on recent Medi-Cal policy enhancements for perinatal care, including new benefits such as the doula, community health worker, dyadic care, and enhanced care management benefits, the Birthing Care Pathway report outlines how DHCS is currently working to improve the birthing experience for Medi-Cal members. It also presents strategic opportunities for further exploration across six focus areas that can be expanded to better support California’s birthing families.

Two opportunities are particularly relevant to how First 5s are already supporting birthing families across the state. First is creating a perinatal specialization as part of the community health worker (CHW) services benefit. This would enable licensed community health workers, promotoras, and other community providers trained in serving perinatal individuals to support birthing Medi-Cal members through the entire perinatal period, which can last almost two years. Currently, Medi-Cal members are only entitled to receive CHW services with perinatal expertise through the Comprehensive Perinatal Services Program (CPSP) up to 60 days postpartum.

Several First 5s are exploring leveraging the Medi-Cal CHW benefit for the perinatal services they fund, or have programs that could be billed under a future perinatal CHW specialization. For example, First 5 Fresno partners with UCSF’s Preterm Birth Initiative, Fresno State’s Central Valley Health Policy Institute, Community Based Organizations (CBOs) and medical providers to deliver a Group Prenatal Care and Support Program coined Glow!.

Glow! aims at improving prenatal care and birth outcomes for Medi-Cal-eligible pregnant individuals in Fresno County, particularly among Black and Latinx communities. The Program brings together pregnant individuals with similar due dates for up to 10 sessions of medical care, education, and peer support. Facilitated by healthcare providers and trained CBO staff, these sessions deliver a community-informed and trauma-responsive approach to maternal wellness by addressing key topics such as nutrition, stress management, labor and delivery, and newborn care. Studies show that participation in group prenatal care can reduce maternal health disparities and lead to less stress, better sleep and feeling better prepared to care for a newborn. Fabiola González, First 5 Fresno County’s Executive Director shares:

"Programs like Glow! and initiatives like the Birthing Care Pathway remind us that birth justice means building systems that truly support every birthing person and baby. We need more of these community-rooted, equity-driven efforts to ensure every family welcoming a child is surrounded by care, dignity, and support from the very beginning. By working together, we can ensure systems of care don’t just respond to needs but anticipate and uplift them—creating a future where thriving families are the norm, not the exception."

A second opportunity for DHCS introduced in the Birthing Care Pathway report that closely aligns with the core services First 5s fund and deliver is working with the Department of Public Health, Department of Social Services, and managed care plans to provide at least one voluntary home visit to every newly pregnant Medi-Cal member. For many years, First 5s have invested in home visiting and developed targeted universal programs. For example, Welcome Baby home visiting program in Los Angeles is available to all L.A. County families who deliver or plan to deliver at one of 13 participating Welcome Baby hospitals.

Furthermore, the First 5 Center has leveraged learnings from First 5 investments in home visiting and from other leaders in the field to develop a proposal for a universal home visiting strategy in Medi-Cal. This research is well-positioned to support DHCS with next steps for expanding access to home visiting through Medi-Cal.

As the state explores which opportunities in Birthing Care Pathway it will prioritize and pursue, it can leverage the programs and systems First 5s have built with community partners to improve the birth experience and birth outcomes for Medi-Cal members. From prenatal education programs and home visiting, to doula trainings and dyadic care implementation, the First 5 network holds a wealth of experience and expertise on families during the perinatal period and can support the state in reaching its goals.