IndigenousNetwork was invited to attend a briefing hosted by American Community Media examining how California is maintaining access to maternal and reproductive health care through Medi-Cal and Family PACT at a time when similar programs face rollbacks nationally. The discussion brought together state health officials responsible for shaping policy and clinicians working directly with patients to outline how California’s maternal health framework continues to expand through state-led reforms, clinical practice, and community-based care, particularly for populations that have historically faced barriers to coverage.
Department of Health Care Services officials emphasized that all pregnant people in California remain eligible for full-scope Medi-Cal regardless of immigration status, from the start of pregnancy through 12 months postpartum. Raquel Saunders, who has worked at the Department of Health Care Services for 16 years and currently serves as section chief of Medi-Cal Benefits and Legislation, oversees policy development for Medi-Cal benefits statewide. She said recent federal debates and immigration enforcement shifts have not changed California’s approach. “We want to be clear,” Saunders said. “Under current policy, all pregnant people, regardless of immigration status, are eligible for full-scope Medi-Cal from the start of pregnancy through 12 months after pregnancy ends.” Saunders, who holds graduate training in counseling, framed continuity of care as central to improving outcomes, particularly for families navigating fear and misinformation.
Speakers pointed to reforms under CalAIM and the Birthing Care Pathway as core to the state’s maternal health strategy. These initiatives are designed to reduce maternal mortality, address racial disparities, and expand access to culturally responsive care. A key component is the expansion of doula services, which have been covered by Medi-Cal since 2023 and now include more than 1,000 enrolled providers statewide. Saunders described doula care as “person-centered, culturally competent care grounded in evidence-based practices,” noting that services extend from pregnancy through postpartum and include labor support, lactation assistance, and care following miscarriage or abortion.
The briefing also addressed Family PACT, California’s free family planning program serving income-eligible residents regardless of immigration status. Sarah Gilbert, chief of the Office of Family Planning at DHCS since April 2025, presented on the program’s role in preventive care and reproductive planning. Gilbert previously oversaw clinical practice across 17 Planned Parenthood Northern California health centers, where she led clinical training initiatives and the expansion of telehealth services. She said Family PACT remains a critical entry point for people without insurance who are planning future pregnancies. “Family PACT might be a great option to choose the optimal timing of that, and also to get tested for sexually transmitted infections in that really important period,” Gilbert said, emphasizing early intervention and continuity of care.
From a frontline perspective, Eva Goodfriend-Reano, a certified nurse-midwife at Alameda Health System’s Highland Hospital, described how expanded Medi-Cal coverage has changed patient engagement. Goodfriend-Reano works across hospital and community settings and is part of a network of midwives serving patients with limited access to consistent care. She said language access and trust remain central challenges. “We want to encourage people across the state of California to make sure that they’re accessing care in pregnancy, in birth, in postpartum, and even in between,” she said, noting that patients are often relieved when they can communicate in their own language with providers who understand their community context.
Goodfriend-Reano also highlighted the growing role of midwives and doulas in addressing gaps in postpartum care, particularly for patients experiencing anxiety or depression after birth. Providers at community clinics and county hospitals, she said, continue to see patients delay care out of fear related to immigration enforcement, despite eligibility protections remaining in place.
Throughout the briefing, speakers stressed that California is not planning to roll back maternal or reproductive health benefits and continues to invest in integrated care models that address both medical needs and social barriers. As national debates over Medicaid funding and reproductive health intensify, state officials and clinicians positioned California’s approach as one grounded in continuity of care, cultural responsiveness, and public health outcomes rather than immigration status.
