Midwife Madeleine Wisner measures Chloé Mick’s belly during a maternity care consultation at Mick’s home in Sacramento on Feb. 6, 2024. Photo by Miguel Gutierrez Jr., CalMatters

California offers extensive pregnancy benefits to low-income mothers, but the state’s top health agencies have no way of knowing how many people are getting help or whether the program improves the health of moms and babies, a new report from the California State Auditor asserts.

The audit’s findings come at a time when California is grappling with increasing rates of maternal mortality, persistent disparities for Black women and growing maternity care deserts. In 2020, the state reported the highest rate of maternal mortality in a decade, and Black women were three to four times more likely to die of pregnancy-related complications than others.

Despite statewide efforts to reverse those trends in recent years, the departments of Health Care Services and Public Health fail to monitor one of the longest-standing pregnancy programs for moms and babies, the audit found. The departments have not made any significant improvements to the program since its establishment in 1984, the audit said.

“We found that neither Health Care Services nor Public Health provide the perinatal program with sufficient oversight,” State Auditor Grant Parks wrote in a letter to lawmakers.

Medi-Cal is the state’s public health insurance program for extremely low-income residents. It pays for roughly 40% of all births in California. Parents and pregnant patients on Medi-Cal die from complications at a rate 3.7 times higher than those with private insurance, according to state data. Babies with Medi-Cal are the most likely to be born with a low birth weight, a predictor for other health complications later in life.

In a joint statement to CalMatters, health care services Director Michelle Baass and state Public Health Officer Dr. Tomás Aragón said the agencies would work together to address the audit findings. They plan to conduct regular reviews of Medi-Cal providers that include audits and enforcement actions. They also plan to update informational material outlining pregnancy benefits.

“It is our collective responsibility to hold each other accountable while raising the standard higher to ensure that pregnant individuals in the Medi-Cal program have timely access to quality, equitable maternal health care services,” the statement said.

Under the state’s Comprehensive Perinatal Care Program, Medi-Cal members are eligible to receive health education, nutrition counseling, psychosocial services, prenatal vitamins, referrals to other social services and an individualized care plan.

Early assessments of the program conducted in the 1980s and 1990s showed a significant decrease in low-birth weight babies among those who received services. Today, auditors found, the state is not collecting sufficient data to assess how many people are using services or whether the program is helping vulnerable patients.

The number of babies born too small in California has grown slightly in the past 10 years to about 7.3% of all births, auditors noted, although the state still has fewer low-birth weight babies than the national rate of 8.5%.

Data limitations were so significant that the State Auditor’s office could not complete its assessment of how many eligible patients received benefits statewide. Data was only available for 14% of the roughly 14 million Medi-Cal enrollees.

The audit also found that the agencies have conducted very little oversight of the doctors, health departments and insurers that administer benefits in each county. Instead, the state has relied on “voluntary local oversight” and general compliance investigations that do not specifically address maternity care. The Medi-Cal member handbook also fails to notify enrollees about pregnancy-related benefits.

The audit warned that without state intervention, the problems would continue.

“Medi‑Cal members may not seek available services because they are unaware of the perinatal program, which, in turn, increases the likelihood of poor maternal and infant health outcomes,” the audit said.

In the joint statement, Baass said the Health Care Services department plans to also publish a Birthing Care Pathway report this summer that will have policy recommendations on how the state can “effectively reduce maternal morbidity and mortality and address racial and ethnic disparities.”


Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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