The Brief

California’s insurance program for low-income residents, known elsewhere as Medicaid, started paying for doula services in January.

The added benefit has the potential to make emotional, physical, and educational support during pregnancy, childbirth, and postpartum available to tens of thousands of families. It can also support a workforce that often chooses between their livelihood and serving low-income clients.

“I feel like this really bridges that gap of like, really like, sustainably doing the work for people who need it the most,” said Long Beach doula Andrea Howard.

Nearly a year after the benefit began, it’s clear that without more doulas enrolled in the program, not every family will get the care they are entitled to receive.

As of mid-November, 180 individual doulas and about 70 doula organizations had completed the Medi-Cal provider enrollment process, according to the Department of Health Care Services.

“It's been an arduous process, a lot slower than we imagined,” said Birthworkers of Color Collective Co-Founder Stevie Merino, who’s also based in Long Beach.

How many people with Medi-Cal have doulas now?

Only a tiny fraction of people insured through Medi-Cal have been able to access doula support so far.

As of July, 50 Medi-Cal members had received doula services, according to DHCS. The data is an incomplete picture, because claims were still being processed and the total does not include the managed care plans through which most members receive their insurance.

One potential challenge for Medi-Cal recipients is a lack of access to maternity care, let alone providers who have the knowledge and willingness to provide the required recommendation for doula services.

In November, DHCS issued a statewide recommendation affirming that Medi-Cal members would benefit from doula support that could substitute for that of an individual provider.

LAist went to two of L.A. County’s largest Medi-Cal providers— Health Net and L.A. Care Health Plan— to learn more about how they’ve implemented the benefit since January.

L.A. Care Health Plan reported 79 members have received doula services since the benefit started in January.

“Members who are pregnant, recently given birth, or experienced loss have expressed gratitude for these services,” wrote L.A. Care Health Education Program Manager Kristin Schlater, in a statement.

A Health Net spokesperson said in a statement that the health plan has partnered with doulas throughout the state, but declined to share how many members had received services.

"Having a space really helps to normalize the work that we're trying to do," said Birthworkers of Color Collective co-founder Stevie Merino. "It creates that visibility in the communities that we are really trying to make doula work more accessible to."

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Brian Feinzimer

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LAist

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The rate of people dying from pregnancy and birth complications in California has declined in recent years, but there are still stark racial disparities. Black Californians die from pregnancy complications at a rate nearly four times higher than the general population.

The continuous support doulas provide is increasingly seen as part of the solution for the high rate of U.S. mothers and babies who die each year compared with other developed countries.

In 2021, 168,000 births were covered by Medi-Cal insurance— 40% of all births in the state. Research suggests many families are interested in doula support— 55% of recent parents insured through Medi-Cal said they would definitely want or consider a doula in a statewide survey from 2018.

How do doulas become Medi-Cal Providers?

In many cases, provider enrollment is only the first step to serving clients.

Then doulas have to contract with one or more of the managed care plans that provide health care access for the majority of California’s Medi-Cal recipients. In 2024 there will be six in L.A. County.

“That's really the challenge,” said Priya Batra, an OB-GYN and medical director for the L.A. County Department of Public Health's Health Promotion Bureau. “Not only bringing doulas and the community up to speed on these new processes, but then also trying to retrofit the system a little bit to make it easier for doulas to participate and for everyone who's eligible to take advantage of the benefit.”

Initially, Riverside County led the state in doula Medi-Cal enrollment, in part because the local health plan and community organizations worked to transition doulas that had participated in a pilot program to the state’s system.

An illustration of medicinal plants used by the Chamoru people — who are indigenous to Guam and Mariana Islands where Merino's family is from — hangs next to a chart that shows the stages of cervical dilation at the Birthworkers of Color Collective's space.

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Brian Feinzimer

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LAist

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Howard gave birth to her son Cub, left, without medication. “It was the most empowering thing I've ever done in my life, essentially," Howard said. Less than a year after her son was born, she enrolled in a doula training with the Birthworkers of Color Collective.

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Brian Feinzimer

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LAist

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In Los Angeles County, the Birthworkers of Color Collective is one of several organizations spreading the word about the benefit to Medi-Cal members and helping doulas enroll with the state.

“Doulas are not billers ... they're not contract negotiators,” co-founder Merino said. “They aren't used to working with huge conglomerates like insurance companies and managed care plans and so we've really been taking on the onus of that burden.”

"Birth is unpredictable," said doula Andrea Howard. "We can't control what happens, but if you feel like you've had some decisions, like some choices, some agency — you feel like you were an active participant in your labor process... then I feel like I've done my job."

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Brian Feinzimer

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LAist

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Andrea Howard, the Long Beach doula, is part of the collective and started the enrollment process in March. She said one of the biggest challenges was securing a business license from the city of Long Beach. It took more than a month and cost $260. She also spent about nearly $100 on required trainings, including CPR, and, to meet the requirement of some managed care plans, has liability insurance that costs about $30 a month.

Howard said she’s had a full roster of Medi-Cal clients since she finished signing up in June.

“This is what I've gone through all the red tape for,” Howard said. “It’s to be able to really get out there and serve people who are so grateful, so happy to have me, [and] did not think in their wildest dreams they'd be able to afford a doula.”

However, Howard is still waiting to get paid from some health insurers while the collective continues to negotiate with managed care plans.

“I'm OK with that because I see the bigger picture,” Howard said.

How much the state pays doulas has been an ongoing point of contention. After months of negotiation, California agreed to pay doulas an estimated average of $1,095 over the course of a pregnancy, though doulas can earn more with additional postpartum visits; that rate is expected to increase next year.

The current average is about half of what Howard would charge a private client, but she said the consistency of Medi-Cal clients can make up the difference.

“You have to really think about how to do this work sustainably,” Howard said. “Because if you're going to births, but your lights are off at home, you're not going to be present enough for your client to really help them in the way that they need.”

The future of California’s Medi-Cal doula program

Los Angeles County is developing a doula resource hub that will provide new doula training, professional development for existing birth workers, and assistance with Medi-Cal billing.

“We're definitely enthusiastic about being able to have a backbone and support for the doula workforce, as well as the community,” said Ashley Skiffer-Thompson, the program coordinator for the African American Infant and Maternal Mortality Prevention Initiative (AAIMM) doula program.

Next month, the Department of Health Care Services will again convene a workgroup of doulas, health advocates, and other stakeholders to discuss the Medi-Cal benefit and how it might be improved.

Merino, who’s participated in these meetings before, said one shortfall is the absence of money for community organizations to do outreach to Medi-Cal recipients and coach doulas through the enrollment process.

“Right now we're all essentially doing this because of our commitment to our communities,” Merino said. “But how sustainable is it if we aren't receiving funding for these things?”

Resources for California doulas

What Medi-Cal enrollees need to know

California students are likely to see fewer cell phones and more gender-neutral bathrooms next year as new state education laws go into effect.

Protecting students from immigration raids was a priority for state legislators this year, resulting in several new laws, including one prohibiting school staff from allowing immigration officers to enter campuses or providing student or family information.

The most controversial of the new laws is one meant to target antisemitism, although amendments made during the legislative session resulted in a bill that defines discrimination more broadly.

New Office of Civil Rights to open

Assembly Bill 715 establishes a state Office of Civil Rights to help school districts identify and prevent discrimination based on antisemitism, gender, religious and LGBTQ status. It will also handle questions and complaints.

The legislation, along with Senate Bill 48, creates four positions to track and report discrimination. These positions will be appointed by the governor and confirmed by the Senate after Jan. 1.

“California is taking action to confront hate in all forms,” said Gov. Gavin Newsom in a statement. “At a time when antisemitism and bigotry are rising nationwide and globally, these laws make clear: our schools must be places of learning, not hate.”

The legislation has been controversial, with some organizations saying it infringes on academic freedom and prioritizes the rights of certain students over others. The California Teachers Association and California Faculty Association have said the legislation could result in the censoring of educators.

Parents can’t be jailed for truant kids

Beginning Jan. 1, parents of chronically truant children will no longer be fined or face jail time.

Assembly Bill 461 amends the state’s Penal Code to remove a section that makes it a criminal offense for a parent to have a child who is chronically truant, which is defined as missing school without a valid excuse for 10% or more of the school year.

California law requires students age 6 to 18 to attend school.

The Penal Code called for a fine of up to $2,000 or up to a year in jail for parents whose children habitually missed school.

“Criminalizing parents for their children′s truancy ignores the root causes of absenteeism and only deepens family hardships, especially as many immigrant families now fear sending their children to school,” said Assemblymember Patrick Ahrens, D-Sunnyvale, in a statement. “(This bill) ensures support and resources to keep students in school and on track for success.”

Gender-neutral bathroom required

Beginning on July 1, all California school campuses, except those that have only one bathroom for male students and one bathroom for female students, are required to have a gender-neutral bathroom.

Senate Bill 760, which was signed by the governor in 2023, requires that posted signs identify the designated bathroom as being open to all genders and that it be kept unlocked and available to all students.

“SB 760 is a measure that aims to create a safe and inclusive environment not only for non-binary students, but to all students, by requiring each public school to establish at least one all-gender restroom,” said former Sen. Josh Newman, author of the bill.

Cellphone use to be limited

School districts, county offices of education, and charter schools have until July 1 to adopt a policy limiting the use of cellphones during school hours.

Assembly Bill 3216, renamed the Phone-Free School Act, was approved in an effort to curb classroom distractions, bullying, and addiction to the devices. At least five other states, Florida, Indiana, Louisiana, South Carolina and Ohio, have similar laws.

Last year, Gov. Gavin Newsom sent a letter to school district leaders urging them to restrict cellphones. Excessive smartphone use increases anxiety, depression and other mental health issues in children, he said. 

Shielding schools from immigration raids

Protecting students from immigration raids was a priority for legislators this year, resulting in several pieces of new legislation.

Assembly Bill 49, known as the California Safe Haven Schools Act, was passed amid a series of immigration raids that have resulted in the arrest of thousands of people. It went into effect as an urgency measure in September.

The bill prohibits school staff from allowing immigration enforcement officers on school campuses or sharing student or family information with them without a warrant or court order. School districts have until March 1 to update school policies to align with the law.

Senate Bill 98, also effective in September, requires leaders of school districts, charter schools, universities and colleges to notify staff and parents when immigration officers are on a campus. School safety plans should include an official procedure for making these notifications by March 1.

This bill, which is in effect until Jan. 1, 2031, does not prevent governing boards from establishing stronger standards or protections.

Protecting preschools, preparing families

Assembly Bill 495, known as the Family Preparedness Plan Act, expands the pool of relatives that can be authorized to make decisions and care for children if parents are detained by immigration authorities or deported.

Beginning Jan. 1, all adults related to a child by blood or adoption, within five generations, could be authorized to enroll a child in school or make decisions about their medical care while on campus.

The bill also permits courts to appoint a person, nominated by a parent, to have joint custody of a child if they are detained or deported by immigration officials.

It also requires school districts to provide information to parents and guardians regarding the right of children to have a free public education.

The legislation also extends the requirements of AB 49 to child care facilities and preschools, prohibiting staff from collecting information or documents regarding the immigration status of children or their family. Instead, they are required to report requests for this information to the California Department of Education and the state Attorney General’s Office.

Easing the road to college

This year, California high school students will find it easier to be admitted to a California State University campus.

Senate Bill 640 establishes a direct admission program that sends mailers to high school students who are eligible to attend participating campuses, informing them of that status. Qualified students must have completed all the required coursework and maintained the necessary grade point average.

“Tens of thousands of California students are fully qualified to go to CSU, but don’t jump the hurdles of the admissions process,” said Sen. Christopher Cabaldon, D-Napa, the law’s author. “At the same time, nearly half of CSU’s campuses have substantial available enrollment capacity and need more students to sustain their high quality academic programs.”

The legislation also requires the California Community Colleges system to promote the CSU dual admission transfer program, which guarantees CSU admission to eligible community college students.

Student IDs to include suicide hotline number

Student identification cards issued at California public secondary schools and institutions of higher education after July 1 will include the phone number for The Trevor Project, a crisis and suicide prevention hotline for LGBTQ youth.

Suicide is the second leading cause of death among young people age 10 to 14, and the third leading cause of death for 14- to 25-year-olds, according to the Centers for Disease Control and Prevention.

“In today’s political climate, LGBTQ+ students face significant levels of bullying, harassment, and discrimination — negatively impacting their mental health and academic success,” according to Assemblymember Mark González, author of the bill. “AB 727 will provide critical resources to support LGBTQ+ youth in crisis and those who have experienced harassment.”

Early education to take seats on board

The next eligible seat that comes open on the California Commission on Teacher Credentialing in 2026 must go to an early childhood education teacher, according to Assembly Bill 1123.

The bill calls for one of the six teacher representatives on the commission to hold a child development teacher permit. It also reduces the number of public representatives on the board from three to two to allow the governor to appoint someone who teaches early childhood development at a university or college.

The commission, which governs the licensing and preparation of the state’s teachers, is made up of 15 voting members, including the state superintendent of public instruction, six practicing teachers, a school administrator, a school board member, a school counselor, a faculty member from a teacher preparation program, a human resources administrator, and three public representatives.

The early childhood representatives will be seated after the next eligible seat is vacated or a representative’s term ends.

In the 60 years since California first began issuing child development permits to early childhood educators, there has never been a voting member on the commission, which governs their licensure and preparation, said Assemblymember Al Muratsuchi, D-Torrance, author of the bill.

In 2025, California became the frontline of a federal playbook for more militarized immigration enforcement.

Raids on California streets and lawsuits that followed helped rewrite the ground rules for how agents can operate. What began as before-dawn operations in Golden State farm towns quickly expanded into a broader nationwide strategy: surprise workplace and neighborhood sweeps and roving patrols miles from the border.

CalMatters reporters across California documented how tactics first seen in Kern County, such as warrantless traffic stops and a heavy reliance on appearance-based profiling, spread statewide and then across the country. The U.S. Supreme Court has upheld these methods.

Early in the second Trump administration, the federal government sent Marines to the border, citing a crisis. Those troops have since quietly gone home.

Hundreds of National Guard troops were deployed to Los Angeles following civil unrest about immigration arrests. President Donald Trump threatened to send forces to the Bay Area, then backed off. State officials objected, while federal leaders characterized the moves as necessary. The standoff deepened long-running tensions between California and the White House over the state’s sanctuary policy and federal authority.

All this fell most heavily on families with deep roots in California. CalMatters found deportations increasingly reached people who have decades-long residence, U.S.-citizen children, stable employment, and even those following legal pathways. ICE detained people at green-card interviews and routine check-ins. The changes destabilized school systems, the agricultural economy, and health care.

A federal lawsuit over a deaf asylum seeker’s prolonged detention exposed gaps in medical care and disability accommodations in immigration facilities. Under Trump, asylum seekers with pending claims lost protection from arrest. A new system is emerging where people trying to follow the rules are easier targets than those evading them. Detention centers drew scrutiny as local authorities shied away from conducting health and safety inspections, while advocates reported worsening conditions inside.

A quieter but equally consequential trend has emerged: The immigrant population shrank. Love them or hate them, Trump’s immigration policies were achieving the administration’s goals. Pew Research found the national immigration population shrank by about 1.4 million people in the first half of 2025, the first decline in half a century. Economists warned about slower growth. State leaders weighed long-term impacts on the workforce, schools, and social service systems.

Enforcement grew more data-driven. Drone surveillance expanded in urban areas, and advocates warned about new uses of artificial intelligence to identify deportation targets and analyze asylum and visa applicants’ digital histories.

2026 outlook

California expects further interior enforcement, additional legal battles over sanctuary laws, funding, and renewed attempts to expand detention capacity. School districts and employers are preparing for more mass removals, while lawmakers are considering new privacy protections.

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

Days after 2025 began, two fires scorched through Los Angeles neighborhoods, the most destructive in California’s history. The Eaton and Pacific Palisades fires also renewed attention to issues such as utility oversight, insurance coverage, and the broader challenges of wildfire planning in a changing climate. And their harms rippled outward, leaving thousands of low-income workers and immigrants without jobs. 

But California found pushing its climate agenda forward to be an uphill battle this year: Ambitious climate goals faced a hostile federal government economic pressures.

Anticipating opposition from President Donald Trump, state leaders chose to abandon important clean-air rules before he even took office, including plans to phase out diesel trucks and transition to cleaner trains. Nearing mid-year, Trump and his allies in Congress blocked the state’s clean-car mandate, a blow to emissions reduction plans.

Nevertheless, as part of budget negotiations, Gov. Gavin Newsom sought to reauthorize California’s landmark cap-and-trade program, launching a debate that would resolve in the final hours of the legislative session.

Blaming climate and environmental regulation, Phillips 66 and Valero followed through on plans to shutter oil refineries, raising concerns about gas prices and the future of the state’s oil industry. In Wilmington, Phillips 66 is now closed. A high-profile explosion at Chevron’s El Segundo refinery nearby underscored persistent safety and environmental risks tied to remaining facilities.

By the end of the legislative session, these issues converged, as legislators passed a six-bill deal that included a plan to boost oil drilling, relief for ratepayers who fund wildfire mitigation, and an extension of the now rebranded “cap-and-invest” program.

As lawmakers passed sweeping reforms to California’s landmark environmental review law, critics warned exemptions may make it easier for potentially high-polluting advanced manufacturing facilities to take root in already vulnerable areas.

Longstanding conflicts over water continued to simmer this year. The governor continued pressing to fast-track a $20 billion tunnel around the Sacramento-San Joaquin Delta to send more water south — to the outrage of Delta lawmakers. And dry conditions led to dire projections for the Colorado River, a vital water supply for Southern California. They ramped up the tensions — and the urgency — as negotiators from states that rely on the river tried, and failed, to reach a deal portioning out water supplies.

2026 Outlook

Affordability, the cost of climate adaptation, and pollution harms, in the skies and in the waste stream, continue to be key issues for California. As Gov. Gavin Newsom’s balancing act continues, the state will navigate tensions with environmental justice advocates unhappy with compromises. Emerging risks include the cost – in energy and water – of data centers, and the environmental consequences of the battery economy.

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