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

The Los Angeles Unified School District is preparing for possible “Super El Niño” storms that could damage schools and lead to closures, the district announced in a media release Tuesday.

District staff are clearing drains, trimming trees and checking roofs, windows and doors. LAUSD is also testing emergency equipment, including pumps and emergency lighting systems, and stocking supplies such as flashlights and drinking water.

“Preparing for severe weather starts well before the first raindrop,” Superintendent Andrés Chait said in a statement. “We can’t control the weather, but we can take steps now to protect our students and employees and help our schools stay ready.”

The district will monitor weather patterns using information from the National Weather Service and local emergency officials, it said.

LAUSD encouraged families to update their contact information to ensure they receive district calls, texts and emails. Families should also monitor weather alerts, follow emergency officials’ instructions, avoid flooded roads and review safe routes to and from school, according to the release.

“Preparing for a storm is a shared effort — from the crews maintaining school buildings to the principals reviewing emergency plans and the families making sure they can receive critical updates,” LAUSD said in the release. “By taking these steps before the rain begins, Los Angeles Unified is working to help students and employees stay safe and keep school communities as prepared as possible for the winter ahead.”

Southern California is likely in for a solid dose of rain this week, just days after heat and Santa Ana winds helped fuel several wildfires across the region.

Forecasters expect the bulk of the rain to roll into the Los Angeles basin Wednesday night and continue into Thursday morning, with a small chance of thunderstorms and hail.

The San Fernando Valley, San Gabriel Valley and coastal areas across L.A. and Orange counties could get around an inch over the next few days. Hills and mountains could get up to 3 inches.

“We could see some pretty high rain rates,” said National Weather Service meteorologist Mike Wofford. “It's a good storm for this time of year — it's a little stronger than what we would see normally.”

The possibility of significant rain in the mountains raises concerns about flooding in areas recently burned in wildfires, particularly around the Bryson Fire burn scar near Malibu, which is only a few days old. Burn scars can’t absorb heavy rainfall and are susceptible to landslides.

The National Weather Service has issued a flood watch for the Santa Monica Mountains and surrounding communities from Wednesday afternoon through Thursday. That means heavy rain there could flood streets, creeks and rivers. The flood watch area includes both the Bryson Fire and Palisades Fire burn scars.

This will also be the first nontropical storm of the season, meaning it’s moving into the region from the north. Most storms that hit Southern California follow a similar path, especially during the winter, unlike the tropical storms that formed off the coast of Mexico and brought muggy weather to the region this summer.

Nontropical storms also bring cold air to the region. On Wednesday and Thursday, forecasters expect highs in the 60s and 70s. High elevations will be even cooler.

The science research institute that would likely receive $4.2 billion in public taxpayer money if voters approve Proposition 38 this November had only three employees as of last month — far fewer than the 51 staffers it planned to have hired by last year.

Public statements and public records CalMatters obtained raise questions about how well prepared the institute is to shepherd so much money if the bond measure passes.

Prop. 38 would allocate up to $8.4 billion in bonds for scientific research on diseases and cures concerning the immune system, with an emphasis on finding treatments for Alzheimer’s, cancer and heart disease. The ballot language stipulates that a single, unnamed research institute would receive half the bond’s money to conduct research and partner with other researchers if it meets highly specific criteria. Bonds are a type of debt that must be repaid.

Previous reporting by CalMatters found only one institute in California currently meets those criteria: the California Institute for Immunology and Immunotherapy. The institute’s principal funder is billionaire Gary K. Michelson, who wrote Prop. 38 and is by far the largest donor to its political campaign.

Backers of the proposition said state bond money is needed to stabilize research funding after President Donald Trump repeatedly attempted to cut existing and future federal science grants.

The measure’s critics say Prop. 38 is well-intentioned but poorly designed because it overlooks the many established public and nonprofit university and hospital research labs in California. They also say California should not subsidize subsets of scientific research and instead should support research more broadly.

CalMatters obtained documents that included the five-year business plan of the California Institute for Immunology and Immunotherapy. The plan was part of the formal affiliation agreement between UCLA and the institute, which the two parties signed in August 2024. Among other details, the agreement requires the institute to pay UCLA 7.5% of the net revenue of any drugs and technologies developed by the institute’s staff. The institute is one of the founding tenants at a UCLA-owned research park in West Los Angeles, where the institute is leasing 235,000 square feet of research space, the institute says.

Far fewer employees than plan called for

Between summer 2024 and summer 2025, the institute committed to hiring “approximately” 51 employees, including six executives, five “world-class” scientists who can lead research labs, and 40 other employees, such as data scientists, lab technicians, biologists and administrative personnel. Between 2025 and 2027, the institute would hire roughly 90 more workers, including 10 research lab leaders, according to the agreement.

But John Mazziotta, a senior UCLA official who also serves as a board member of the immunology institute, last month said the institute has hired just three employees: a chief operating officer, a general counsel, and a scientific advisor, and “they're well into the search” for a director. Mazziotta, the CEO of UCLA Health and vice chancellor for health sciences at UCLA, made his comments during the Sept. 16 UC Regents meeting.

The Yes on Prop. 38 campaign has repeatedly refused to comment on whether the bond was written specifically for the immunology institute. Claudia Briggs, a spokesperson for the campaign, told CalMatters in July that whichever nonprofit receives the $4.2 billion portion of the bond fund should be a sophisticated one that “is prepared to accelerate lifesaving research immediately while maintaining the highest standards of scientific quality, accountability, and stewardship of public funds.”

At a September press conference, a Yes on Prop. 38 spokesperson appeared to confirm CalMatters’ findings that only one institute currently qualifies to be the one to receive half the bond money. “It is very likely that CIII, which is a research institute affiliated with UCLA, will qualify for half of the funds under the current criteria,” said Robin Swanson. CIII is the initialism for the immunology institute.

According to the five-year plan, the institute was supposed to spend $25 million on personnel between 2024-25 and 2025-26 and $45 million total on operating expenses in that time, including maintenance, utilities and rent. It was also supposed to spend an additional $167 million in that time on capital expenses, such as construction and demolition. However, Mazziotta told UC regents that the institute had so far spent a total of $20 million on “operating expenses, hires” and other expenses.

The Yes on 38 campaign refused CalMatters’ request to interview Michelson for this story, as did Michelson himself in a separate email. A spokesperson for the institute, Becky Warren, sent a written statement that didn't answer CalMatters' questions about employing far fewer people than the five-year plan laid out. Instead, she highlighted the promise of the institute and a few of its milestones, including signing the affiliation agreement with UCLA and clearing a state environmental review of its forthcoming research facility.

The institute won’t get state bond money if it isn’t ready to begin work, “plain and simple,” wrote Swanson, the Yes on 38 spokesperson, in an email. She stressed that though the institute very likely qualifies, the ultimate decision to award half the bond funding is up to the California Department of Public Health.

Institute facility will be built by 2028

The UCLA research park that houses the institute isn’t slated to be fully built until at least late 2028, according to the agenda item of the September UC regents meeting. The research park is a former mall UCLA acquired in late 2023 that’s now undergoing major retrofitting.

But the 2024 affiliation agreement between UCLA and the institute anticipated this. The agreement permitted the institute to use UCLA health research space on another campus property on an interim basis. Mazziotta told regents that research is underway there.

Mazziotta also told the regents the institute's construction costs are not fully funded — it still needs roughly $100 million. He said UCLA was in serious talks with a donor to provide about $50 million to the institute.

If Prop. 38 passes, the bond funding would be provided in increments based on how often the institute requests new money that senior state officials approve. If all the funds are depleted, Californians would repay the bond at a rate of $500 million to $600 million annually for about 20 years.

Institute would be exempt from public records act

CalMatters submitted the public records request to UCLA, which must comply with the California Public Records Act. The institute, as a private nonprofit, does not have to comply. And while Prop. 38 would channel billions of dollars in taxpayer money to the institute, the proposition’s language specifically exempts the nonprofit that will receive the $4.2 billion from state public meetings laws, political reform laws and the public records act. The other half of the funds would go to a council that’ll pick projects led by researchers from a limited pool of universities and nonprofits. The council would generally be governed by the state’s political reform act, which prohibits financial self-dealing.

Briggs defended the institute’s exemption in Prop. 38, writing that applying state transparency laws to existing private organizations would “not fit well with how private entities are organized and operate.” Instead, she noted the selected nonprofit institute would be required to publish annual reports on its research progress and financial plans plus commit to annual state audits, among other disclosures written into the ballot measure.

Still unclear to the UC regents is the relationship between UCLA and the institute on matters of public disclosure. Four senior UCLA officials sit on the institute’s board. So is a document held by those UCLA officials public because it’s related to UCLA affairs or private because it’s related to the institute’s affairs? UC’s general counsel couldn’t explain where that dividing line is after a regent member asked him. The regent member, Michael Cohen, said he wants more clarity when the regents meet again in November.

Gov. Gavin Newsom and the California Democratic Party endorsed Prop. 38, as have dozens of patient and research advocacy groups, plus the state GOP. The union of graduate students and post-doctoral researchers, whose pay often relies on science research funding, has also endorsed the proposition. The union doesn’t represent faculty.

Money raised in support of Prop. 38 now exceeds $66 million, including at least $61.2 million in contributions from Michelson and his policy institute. Roughly $14 million of that includes loans from Michelson. The no camp has raised about $8,800

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.