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

Raul Malo, the leader of the country band The Mavericks and one of the most recognizable voices in roots music, died Monday night, according to a representative of the band. The guitarist and singer had been battling cancer.

He was hospitalized last week, forcing him to miss tribute shows staged in his honor at the Ryman Auditorium over the weekend. He was 60 years old.

"No one embodied life and love, joy and passion, family, friends, music and adventure the way our beloved Raul did," read a statement released by his family.

Malo's group, The Mavericks, mourned the loss of their leader in a social post.

"Anyone with the pleasure of being in Raul's orbit knew that he was a force of human nature, with an infectious energy," the statement read. "Over a career of more than three decades entertaining millions around the globe, his towering creative contributions and unrivaled, generational talent created the kind of multicultural American music reaching far beyond America itself."

Over a career that lasted four decades, The Mavericks lived up to the band's name, challenging expectations and following a roadmap crafted by Malo's expansive musical upbringing as the son of Cuban immigrants in Miami.

"I grew up in a very musical household. There was all kinds of music around always," he told WHYY's Fresh Air in 1995. "We listened to everything from Hank Williams to Celia Cruz to Sam Cooke to Bobby Darin. It didn't matter."

In 1992, Malo told NPR that his widespread influences weren't always understood or appreciated in his South Florida hometown, but he said that his struggle to fit in taught him to trust his instincts. Malo had become the guitarist and lead singer for The Mavericks in 1989, alongside co-founders Robert Reynolds and Paul Deakin, and his roaring, sentimental voice defined the band's sound and remained its constant as the group's catalog moved from slow, tender ballads to full-throttle rock songs. In 1995, the band released its biggest hit with "All You Ever Do Is Bring Me Down," a swinging country song featuring an assist from Tex-Mex accordion legend Flaco Jimenez.

As the band grew in members and devoted listeners, The Mavericks continued to push the boundaries of American music, weaving a richly layered tapestry of textures and stories. With more than a dozen studio albums, The Mavericks collected praise and recognition from the Academy of Country Music, the Country Music Association and the Recording Academy. Although they took a hiatus for several years, Malo never stopped making music — and returned to his bandmates with renewed inspiration.

Following its 30th anniversary, the group released its first full-length Spanish album in 2020, aptly titled En Español. The record reimagined Latin standards and folklore-tinged popular tunes; it also made an implicit political statement about Latin music's contributions to American culture.

"In our own little way, if we could get somebody that perhaps is on the fence on issues and hears us singing in Spanish and perhaps reminds them of the beautiful cultures that make up what this country is trying to be and what it should be, so be it," Malo told NPR at the time. "Yeah, I'm OK with that."

The following year, the Americana Music Association recognized The Mavericks with the Trailblazer Award. In 2024, the band released its last studio album, Moon & Stars. The release coincided with news of Malo's cancer diagnosis, which he discussed openly with NPR's Ayesha Rascoe.

Before being hospitalized last week, Malo had been scheduled to perform with The Mavericks at a pair of tribute concerts held this past weekend at the legendary Ryman Auditorium in Nashville. Over 30 artists, including Patty Griffin, Jim Lauderdale and Steve Earle, still gathered to pay tribute to Malo, with some of the proceeds of the night going to the cancer prevention organization Stand Up To Cancer.

According to his spokesperson, though Malo was too ill to attend, the concert was streamed to his hospital room Friday night.

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The Los Angeles County Sheriff’s Department has mostly blocked efforts to investigate misconduct within its ranks, according to the county inspector general, who announced his retirement Tuesday after 12 years on the job.

In an open letter, Max Huntsman cited examples of how the county has thwarted his efforts to watchdog the department, which in the past has been plagued with accusations that deputies use excessive force and lie on the job.

Huntsman said one example is former Sheriff Alex Villanueva’s misuse of criminal enforcement powers to discredit critics, such as opening an investigation into former County Supervisor Sheila Kuehl.

Villanueva was sheriff from 2018 to 2022.

“My requests for investigation were rejected,” Huntsman’s letter reads. “Even after receiving an official subpoena, the Sheriff’s Department has failed to turn over records regarding the improper surveillance.”

He added: “Sometimes members of the public wonder if frightening new surveillance techniques will be used for improper purposes under the guise of criminal investigation. Sadly, the answer is yes.”

Before becoming inspector general in 2013, Huntsman, 60, was a deputy district attorney who specialized in public corruption. He told LAist on Tuesday that the inspector general job wasn’t something he wanted initially.

“I didn’t want to go work for politicians,” he said. “But the need to provide some kind of independent reporting and analysis was significant.”

The Sheriff’s Department issued a statement saying it valued the Office of the Inspector General and all county oversight bodies and that it wished Huntsman and his family well in his retirement.

The department said it “continues to make great strides in advancing the department in a transparent manner.”

LAist also reached out to the county CEO and county counsel for comment, but they declined.

After George Floyd

In the letter, Huntsman says the state of California has come a long way in strengthening the power of local law enforcement oversight bodies, in part because of the 2020 murder of George Floyd by police in Minneapolis.

After widespread protests — and lobbying by Huntsman — the state provided authority to inspectors general to enforce subpoenas requiring law enforcement agencies to hand over documents and authorized external investigation of police misconduct, including deputy gang conduct.

The Sheriff’s Department — backed by county lawyers — has resisted.

“Los Angeles County may not follow those laws, but it will not be able to avoid them forever,” Huntsman wrote. “The county refuses to require the photographing of suspected gang tattoos in secretive groups that the undersheriff has identified as violating state law.”

“Just a few weeks ago, we requested some information regarding an investigation, and a pair of commanders refused to give it to us,” Huntsman said in an interview with LAist.

Origin of the office 

The Inspector General’s Office was created by the county Board of Supervisors in 2013 in response to a scandal that included former Sheriff Lee Baca covering up the abuses of jail inmates.

Baca went to federal prison.

Since then, the office has issued dozens of reports with recommendations for improving living conditions inside jails that some have described as “filthy,” stopping abuses of juveniles inside juvenile halls and providing shower privacy for inmates as part of the requirements under the Prison Rape Elimination Act.

“All of these abuses were reported by the Office of Inspector General and recommendations were ignored,” Huntsman wrote. Often, it took court orders to enact change.

“When we first blew the whistle on the torturous chaining of mentally ill prisoners to benches for 36 hours at a time, it was only a court order that ended the practice,” he wrote. “Time and time again, this pattern repeated itself.”

Huntsman wrote the county has permitted the Sheriff’s Department to block oversight and defunded the Office of Inspector General by removing a third of its staff.

“It's not surprising the county has driven out two successive chairs of the Sheriff Civilian Oversight Commission,” he wrote.

“Government always claims to value transparency and accountability, but shooting the messenger is still the most common response to criticism,” Huntsman wrote.

Despite setbacks, Huntsman values work 

Huntsman told LAist on Tuesday that he was proud of his career as a public servant.

“I’ve really enjoyed the work and I’m sad to have it end,” he said.

It’s a sentiment he echoed in his letter, adding that despite the setbacks and roadblocks, he was proud of the people with whom he shared the office.

“It has been my honor to work with a talented, brave and tireless group of public servants to ensure that the public knows what its government is doing,” he wrote.

He noted the inspector general’s reports are fact-checked by the office and public.

“When government abuses occur, they are sometimes kept secret, but that is no longer the case for much of what is happening in Los Angeles County,” Huntsman wrote. “What you do about it is up to you.,”

Huntsman’s last day is Friday.

Topline:

The backstory: Last month, the council's Transportation Committee voted to bring a proposal forward to implement a policy change that allows the city to impound and immediately destroy abandoned or inoperable RVs worth less than $4,000. The change is inspired by new state law AB 630, which was created to prevent previously impounded RVs from ending back up on the street.

The motion, authored by Councilmember Traci Park, reports that abandoned RVs pose as public and safety hazards.

What's next: Councilmember Nithya Raman requested that an implementation plan be presented to the council's public safety and housing and homelessness committees.

Go deeper: L.A. pushes policy to make it easier to remove RVs from city streets.