Medi-Cal at 60: A foundation for health and birth equity

Safety net programs are under threat nationwide. Here in California, we feel those pressures too. But amid this uncertainty, our state continues to strengthen the system that ensures people can access the care they need.

That commitment is worth recognizing as we mark the 60th anniversary of Medi-Cal — a critical program that demonstrates California’s commitment to ensuring health care access for millions of families. 

While many know Medi-Cal as a source of essential health coverage, fewer may understand the depth of services it provides — and the powerful role it plays in advancing health equity. This impact is especially visible in how the program supports pregnant people. 

Maternal mortality is a public health crisis, and disproportionately impacts people of color and parents with low incomes. From 2018 to 2020, Black people in California were three to four times more likely to die from pregnancy-related causes than Hispanic/Latinx, Asian/Pacific Islander, or white people. And people covered by Medi-Cal were more than twice as likely to die as people with private insurance—underscoring the inequities many Medi-Cal members face. 

With Medi-Cal covering 40 percent of births in California,  the California Department of Health Care Services (DHCS) recognized its opportunity to improve maternal health. One year ago, they released the Birthing Care Pathway Report, outlining comprehensive supports for Medi-Cal members from conception through 12 months postpartum. 

The goal is to care for members medically, while also supporting the social and behavioral needs that often come up during pregnancy and early parenthood. The report highlights a critical but often overlooked maternal health challenge: intimate partner violence (IPV). 

According to a recent Foundation poll, nearly 63% of adult Californians are affected by IPV. We know this kind of violence can endanger pregnancy and lead to poor maternal health outcomes. Pregnancy is a vulnerable time where tension with a partner can worsen and increase risk for violence. In fact, homicide is a leading cause of maternal death in the United States — and pregnant people are more likely to be murdered, often as a result of domestic violence, during pregnancy or postpartum than to die from hypertensive disorders, hemorrhage, or sepsis, the three leading obstetric causes of maternal mortality. 

This is unacceptable — and preventable.

Through Medi-Cal, providers and managed care plans can deliver the holistic care needed for healthy, safe pregnancies while also helping prevent IPV. That’s why we’re proud to continue to support DHCS as they develop Birthing Care Pathway policies for early detection and intervention to address and prevent IPV. 

This work includes bringing greater attention to IPV prevention and strengthening trauma‑informed practices across clinicians, social workers, and others caring for pregnant and postpartum members. This work will also help providers better identify IPV, communicate transparently, and educate patients about healthy relationships. And finally, it will connect families with community resources, such as housing supports, healthy meals, and mental health care through CalAIM’s Enhanced Care Management and Community Supports. By aligning the Birthing Care Pathway with CalAIM resources, Medi-Cal creates a more coordinated system that addresses medical needs alongside the social drivers that affect maternal health and safety.

As we mark the 60th anniversary of Medi-Cal, we celebrate its continued evolution as a system that is responsive to the medical, behavioral, and social needs of those who rely on it. The Birthing Care Pathway is just one strong example. By embedding IPV prevention and support into maternal health, Medi-Cal is addressing the root causes of health disparities, improving the quality of care for pregnant and postpartum Californians, and saving lives. 

If you are a Medi-Cal member, especially if you are planning to start a family, we encourage you to learn about the resources available to you. For professionals involved in Medi-Cal — health plans, physicians, providers, community organizations and others — we urge you to recognize the deep harm IPV causes to tens of thousands of members every year by learning trauma-informed practices to use with your patients, and leverage the Birthing Care Pathway resources to ensure that all Medi-Cal members have safe pregnancies they need and deserve.