The Brief

This month, California more than doubled what doulas can earn supporting low-income families through pregnancy, birth, and the year after.

Doulas provide expecting and new parents with educational, emotional, and physical support before, during, and after a baby is born, and also through miscarriages, stillbirths and abortions.

The state started covering doulas through Medi-Cal in January 2023, but few families have used the benefit in the year since. The benefit could bring support to more than 100,000 families a year— 40% of births here are funded through California’s Medicaid program.

Advocates have pushed the state to increase compensation since the benefit’s inception.

“If the reimbursement rate is not adequate, there will not be an adequate work force and the program will not be successful,” was one takeaway from a 2022 panel discussion hosted by the National Health Law Program. A dozen other states cover doulas through Medicaid and those that paid below market rate often failed to serve the vast majority of people who qualified for care.

“My hope is that with this new reimbursement rate, you can now have a situation where doulas… are not just serving Medicaid enrollees as their side, pro bono-ish gig,” said National Health Law Program Senior Attorney Amy Chen. “But this is [work] that they're doing more broadly.”

What doulas do

Doulas’ health education, emotional support, and advocacy is associated with healthier births and lower health care costs.

Christina Wherry completed her first birthworker training in 2017. She also guides people in yoga and meditation.

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Courtesy Christina Wherry

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“You are deserving of having someone there to support you, someone there to answer the questions,” said Christina Wherry, who uses the term birthworker instead of doula, which is derived from the Greek word for female helper or slave.

When Wherry started working with clients in Los Angeles about six years ago, she had to set her own rates.

“Putting a number on caregiving when it's from the heart is definitely difficult,” Wherry said.

With the recent exception of Medi-Cal, most health insurance does not cover doulas, so families pay anywhere from a few hundred to a few thousand dollars out-of-pocket.

“I burnt out very quickly,” Wherry said. “I wasn't charging enough. I was doing the work and I wasn't able to take care of myself.”

New California doula rates are the nation’s highest

As of Jan. 1, doulas will earn at least $3,263.21 for attending a birth and providing a family a full set of prenatal and postpartum visits. The previous maximum was $1,152.

California also increased its reimbursements for providing other types of maternity care as part of last year’s budget. The state’s Department of Health Care Services is also proposing additional rate increases in 2025, wrote an agency spokesperson in a statement to LAist.

Most Medi-Cal enrollees get their health insurance through a managed care plan. In Los Angeles, the major plans include L.A. Care Health Plan, Kaiser Permanente, and Health Net.

Doulas who contract with those insurers can be paid no less than the minimums set by the Department of Health Care Services.

Chen, with the National Health Law Program, has researched Medicaid doula programs throughout the country.

“Higher reimbursement rates does seem to be a trend nationally,” Chen said. She noted that California’s doula payments are now the biggest among the states that offer the program.

Birthworkers and advocates continue to collaborate with state leaders to improve the Medi-Cal benefit; the next meeting is Jan. 31.

Doulas look for other improvements

Wherry said the new rates are “decent,” but that she wants to see more opportunities for doulas to rest and recover.

There is an emotional labor in being present for people’s most vulnerable moments and birthworkers also confront the disparities in California’s health care system. Maternal deaths increased during the pandemic and Black Californians die from pregnancy complications at a rate nearly four times higher than the general population.

Still, Wherry said she plans to enroll as a Medi-Cal provider to work with clients who might not otherwise be able to afford to hire a doula.

“It strikes a chord in providing this service for everyone,” Wherry said. “Making it accessible to everyone who's open to it.”

I'm a Medi-Cal member and I want a doula

Dan Shimell, an attorney and a new face in local politics, is Santa Ana’s next mayor after a shocking win against incumbent Valerie Amezcua. His win has become one of the most surprising upsets in Orange County’s general election and marks a shift for a city that previously elected its first Latina mayor.

Amezcua congratulated Shimell on social media late Monday night after the last round of election results nearly doubled Shimell’s lead. As of Tuesday night, Shimell held a 5-point lead over Amezcua. Amezcua did not respond to LAist’s requests for comment.

“It has been the honor of my life to serve the people of Santa Ana,” Amezcua said in a post. “Together, we have accomplished great things. We invested in our neighborhoods, expanded opportunity for families, and strengthened the services that make Santa Ana home. Our work was never about one person. It was about all of us moving this community forward.”

Aside from Shimell, progressives Sandra de Anda and Isuri S. Ramos are also projected to win City Council seats, deepening the Santa Ana City Council’s progressive bench.

A flashpoint in Amezcua’s re-election campaign was during the U.S. Immigration and Customs Enforcement raids that rattled much of Southern California, including Santa Ana, Orange County’s only sanctuary city. The raids sparked protests that drew a heavy law enforcement response from Santa Ana police, including rubber bullets and tear gas.

In Amezcua’s first public response, she accused protesters of inciting chaos and violence. She later walked back her comments in a city statement, saying most protesters were demonstrating peacefully and that she did not support the raids.

Shimell told LAist he thinks Santa Ana voters, especially young and first-time voters, went to the polls to vote for those who can't.

“Those who have been or might in the future be impacted by immigration policy and enforcement,” Shimell added. “Taking a bold stance on immigration and police accountability seemed to resonate with voters I spoke with, and stood in stark contrast to the [police]-backed candidates who remained largely silent on those issues.”

What does this say about Santa Ana politics? 

Orange County Supervisor Vicente Sarmiento served as mayor of the city from 2020 to 2022, and his current district includes Santa Ana. Sarmiento told LAist that the results were surprising but reflected the change voters want to see in their elected officials.

“I think the underlying message is that money and establishment conventional politics no longer is the formula to success in a campaign in the city,” Sarmiento said. “It's really the influence of people and voters over money. That's really the theme here.”

Santa Ana City Councilmember Thai Viet Phan told LAist that the race results were somewhat surprising — but spoke to a larger trend.

“[In] the election results throughout the country … you saw a very leftward shift, with not just candidates but also just how voters voted,” Phan said. “I think that was reflected here in Santa Ana on the council.”

Amezcua outspent Shimell — by a lot

Shimell raised about $28,500 in his campaign for mayor. Amezcua raised more than $75,000 and received more than $200,000 in outside support — more than half of that came from the Santa Ana Police Officers Association.

Mike Moodian, a public policy professor at Chapman University, told LAist that in many ways, the races capture the zeitgeist of Santa Ana.

“Here we saw that there was a police union-backed group, and there was a resistance to that,” Moodian said. “People might have seen the incumbent mayor as part of a police union-backed establishment."

He explained that voters may have looked at Shimell as a fresh face who can represent more people and that the city is experiencing a deeper progressive shift.

“I find the residents of Santa Ana tend to be much more involved and engaged in local politics than most other cities in Orange County. So you also have a well-informed, engaged citizenry that showed up, and the voices were heard in Santa Ana,” Moodian said.

Moodian said Amezcua may have lost support from some voters because they were unsatisfied with her response to immigration enforcement.

What’s next?

Ballots are still being counted. The OC Registrar of Voters posts updates every day, except Sundays, at 5 p.m. Election results will be certified by Dec. 3. You can find updates on key measures and other races here.

For seven years, Nazmul Chaudhry has been trying to get the city of Los Angeles to fix a broken sidewalk in front of his store.

Chaudhry owns Deshi Food, a restaurant and grocery store in Little Bangladesh. Before I could even begin our interview, he led me to the front of his store to show me the sidewalk that pedestrians sidestep and electric scooter riders slow down around.

He said he’s tried to get the attention of city officials, but nothing has been done.

The broken sidewalk in front of Nazmul Chaudhry's shop in Little Bangladesh.

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Yusra Farzan

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LAist

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He’s hoping that will soon change. He said then-candidate Nithya Raman spent time in the historic enclave just north of Koreatown this fall, talking with community members about their problems. For the first time since he moved to the United States in 1989, Chaudhry is excited about a mayoral election.

“Everybody's happy because we've never seen anyone [come] like that directly to us,” Chaudhry said.

Mayor-elect Raman is of Indian descent and an immigrant. When she takes office, she will be the first South Asian mayor of Los Angeles. Chaudhry is proud of that distinction. But what means more to him is that Raman spent time walking the streets of Little Bangladesh, visiting businesses and speaking to community members about their concerns. Chaudhry said that, because of that, he asked all his customers and family members to vote for Raman. At dinner parties, Chaudhry said, Bengalis would share how they were excited to vote for Raman in this election.

Nazmul Chaudhry and one of his customers, Mohamed Hassen. They both voted for Nithya Raman for mayor.

In the Little Bangladesh area, vote returns to date show Raman with a 2-to-1 margin over Mayor Karen Bass.

 "Hopefully she's gonna take care of the city," Chaudhry said.

His business has been hit hard after federal immigration raids ramped up in Southern California. People are afraid to leave their homes for fear of being taken by U.S. Immigration and Customs Enforcement. And for those who do come to his store, he said, they are met with increased prices because of tariffs imposed by President Donald Trump's administration on imported goods.

Nazmul Chaudry offers a lunch buffet at his restaurant but he has seen a drop in foot traffic after ICE raids ramped up.

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Yusra Farzan

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LAist

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"Everybody's suffering actually these days," Chaudhry said. “If you see, Nov. 3 is a huge change because people [are] fed up."

Chaudhry also said city services don’t do a good job keeping the streets clean. So he takes it upon himself to pick up trash in front of his shop.

A few weeks before Election Day, Raman posted a social media video from Little Bangladesh addressing the trash along the street.

His relatives in New York told Chaudhry that New York City Mayor Zohran Mamdani, also of Indian descent, has “changed the whole city.” He’s hoping for some of that change in Los Angeles when Raman takes office in December.

Shift away from identity politics

While Raman’s Indian background was a feature of her campaign, it was “not the central thesis,” said Sara Sadhwani,  an associate professor of politics at Pomona College and a senior researcher with AAPI Data.

In 2020, when Kamala Harris, also of Indian descent, was running for vice president, Sadhwani said, she conducted research on Indian Americans who wanted to see more representation in politics. In 2024, some of them turned away from Harris.

“When the economy is bad, identity slips away as the top issue on someone's mind,” she said.

Identity politics, Sadhwani said, was important in 2008 when the nation elected the first Black president, Barack Obama.

Los Angeles mayor-elect Nithya Raman poses for a photograph with family members after casting her vote on Election Day during the midterm elections at the Silverlake Community Church.

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Frederic J. Brown

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AFP via Getty Images

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“ We're ushering in a new political generation of millennials and Gen Z; diversity is just expected at this point amongst a vast majority of Americans,” she said, highlighting how at the last census more people identified as multiracial.

Nationally too, Sadhwani said, thec ountry is seeing a shift. South Asians have gone from “model minority” to “governing minority.”

”The old script was that for Indian Americans, for South Asians, that being that quiet professional is what success meant,” she said. “When we look at Raman and also Mamdani, they're fighting for executive power in very visible, very messy city politics, and they won not by following the rules, but they won by challenging the status quo.”

South Asians as a political force

That idea resonates with Faizah Malik, managing attorney for housing justice at Public Counsel and a former L.A. City Council candidate.

“When we were growing up, our parents said, ‘Just keep your head down, go to school, get educated, make a nice life for your family, and that's it,’” she said. “Politics was not really part of the conversation, but I think what we're seeing is that we can run for office, we can win by being our full selves.”

This is an exciting time, she said, for “South Asian political empowerment,” with Raman set to join Mamdani in leading the country’s two largest cities.

Malik said that, as a housing advocate, she cares about Raman’s fight “to build more housing around the city that people can afford, her fight to keep renters in their homes, to prevent homelessness, her fight to try and really solve our homelessness crisis but also be efficient with our public dollars.”

Nikita Chaudhry, an actor and political organizer, wants to see Raman revitalize L.A.’s film industry, “to call the city the home of Hollywood again.”

“Having that kind of representation and knowing that it exists is really exciting because I think and hope it will activate South Asian Americans of all ages to get more involved in their communities,” Chaudhry said.

Raman's and Mamdani’s victories were years in the making, Chaudhry said: from organizing in their communities to holding other elected positions to engaging voters who are otherwise ignored by elected officials. And she hopes that it will inspire other South Asians to become more involved in their communities.

“If you're feeling activated, if you're feeling excited, that's great," she said. "Take that energy and the time and the skills and the specificity of what fires you up towards your local organization, towards your neighborhood, towards your community.”

As the race to represent L.A.’s Council District 9 remains too close to call, candidate Estuardo Mazariegos’ campaign has accused the campaign of Jose Ugarte, the front-runner, of potential ballot tampering.

The Mazariegos campaign made the accusations Monday, saying it had filed a complaint with the Los Angeles County Registrar-Recorder/County Clerk. In a press release, the campaign alleged that representatives for the Ugarte campaign had collected voters’ ballots to drop off without signing the appropriate line identifying the individual who returned the ballot.

In one case, Mazariegos’ team accused Ugarte campaigners of filling out a ballot on a voter’s behalf without her knowledge of who she was voting for.

“Taking people’s ballots, filling them out, and not following legal voter assistance guidelines in a district that has faced so much disenfranchisement is disgusting,” Mazariegos said in a statement.

Mike Sanchez, a spokesperson for the L.A. County Registrar-Recorder/County Clerk, said his office had forwarded the news release to the district attorney for review. He also pointed to the California Elections Code, which says that a “ballot shall not be disqualified solely because the person authorized to return it did not provide on the identification envelope their name or signature.”

Under California law, a voter can authorize another person to return their mail-in ballot — an approach also called ballot harvesting.

Justin Levitt, a  professor of constitutional law at Loyola Marymount University, told AirTalk Tuesday that there is no legal limit on the number of ballots an individual can turn in on others’ behalf, so long as they aren’t being compensated per ballot returned.

“Even if there were some sort of administrative wrongdoing, as long as there's no indication of fraud with the ballot itself, those ballots will all be counted,” he said.

Levitt said, however, that signing a ballot and then handing it to someone else to fill out would be illegal.

“ To the extent that there are allegations now that the DA may investigate, I suspect that's what they'll be focusing on,” Levitt continued.

The Mazariegos campaign also sent a collection of photos to the press, including one of a campaigner, USC student Amir King, returning a stack of ballots at a ballot drop box.

The Mazariegos campaign alleged that representatives for the Ugarte campaign had collected voters’ ballots to drop off without signing the appropriate line identifying the individual who returned the ballot.

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Courtesy of Estuardo Mazariegos' Campaign

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Ugarte’s campaign responded to the accusations by pointing to a post by King on Instagram in which he accused the Mazariegos campaign of bullying him and making false claims about him.

“Why is he attacking me? For participating in our democracy, as is my right under California state law and for helping others participate in democracy, as is their right under California state law,” King said in the post.

As of Tuesday morning, just under 300 ballots separate Ugarte and Mazariegos, with 44,000 ballots left to count in L.A. County. It’s not clear how many ballots in Council District 9 are left to count.