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For many pregnant people, pregnancy brings a mix of both joy and uncertainty. Alongside excitement, there are questions about finding the right doctor, understanding what care is covered, and knowing where to turn for support after the baby arrives. For Black families in Alameda and San Francisco counties those questions are often compounded by long-standing disparities in maternal health outcomes.

Across California, including Alameda and San Francisco counties,  Medi-Cal is working to address those concerns by expanding and coordinating maternal health services so pregnant and postpartum people receive care that is respectful, comprehensive, and easier to navigate. From the first prenatal visit through a child’s first birthday, Medi-Cal provides coverage and support designed to protect both parent and baby.

These services are available to people who qualify for Medi-Cal. In California, eligibility is based primarily on income, household size, age, pregnancy status, disability, or other qualifying circumstances. Pregnant people qualify at higher income levels than non-pregnant adults and remain eligible through pregnancy and for 12 months after the pregnancy ends.

Importantly, pregnant people who qualify for Medi-Cal are eligible for full-scope coverage regardless of immigration status, including medical, behavioral health, dental, and vision services during pregnancy and the postpartum year.

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A Clearer Path Through Pregnancy: The Birthing Care Pathway

The Birthing Care Pathway helps pregnant people understand what care they should receive and when, while supporting providers in delivering coordinated, culturally responsive services. It outlines key steps during pregnancy, including prenatal screenings, behavioral health check-ins, nutrition support, and preparation for labor and delivery.

For Black pregnant and postpartum people in Alameda and San Francisco counties the pathway emphasizes early prenatal care, shared decision-making, and connections to community-based programs that address medical needs and social drivers of health.

Doula Services: Support Before, During, and After Birth

Medi-Cal covers doula services for pregnant and postpartum members who qualify. Doulas provide non-medical emotional support, education, and advocacy during pregnancy, labor and delivery, and postpartum recovery. Research shows doula care is associated with reduced stress, improved birth outcomes, and increased breastfeeding success.

Covered doula services include prenatal visits, support during labor and delivery, and postpartum follow-up visits, in accordance with Medi-Cal benefit guidelines.

Care That Continues After Birth: The Postpartum Pathway

More than half of pregnancy-related deaths in California occur after childbirth, with Black families facing the greatest risks. The Postpartum Pathway defines the care pregnant and postpartum people who qualify for Medi-Cal should receive during the first year after birth.

The Pathway promotes a comprehensive postpartum visit within 12 weeks, ongoing primary care through 12 months postpartum, screening and treatment for postpartum depression and anxiety, breastfeeding support, chronic condition management, and referrals to community-based services.

Mental Health, Dental, and Vision Care Included

Medi-Cal covers perinatal behavioral health services for eligible members, including screening, therapy, counseling, and medication management when medically necessary. Services may be provided in person or through telehealth.

Pregnant and postpartum people who qualify for Medi-Cal also receive full dental benefits, including exams, cleanings, and medically necessary treatment, as well as vision care such as eye exams and eyeglasses.

Community Supports Through CalAIM

CalAIM (California Advancing and Innovating Medi-Cal) is a statewide initiative that strengthens Medi-Cal by improving care coordination and addressing health-related social needs.

Through CalAIM, eligible Medi-Cal members in Alameda and San Francisco counties may receive Community Supports such as transitional housing assistance, medically tailored meals, and help navigating social services.

How to Contact Medi-Cal in Alameda and San Francisco Counties

Pregnant and postpartum people who meet Medi-Cal eligibility requirements can get help enrolling, choosing a health plan, finding providers, or accessing doula and postpartum services by contacting the Alameda County Medi-Cal office at (510) 795-2428 or the San Francisco Medi-Cal office at (855) 355-5757 or calling the number on their Medi-Cal card.

Support at Every Step

Pregnancy and postpartum care should be clear, compassionate, and complete. Through the Birthing Care Pathway, Postpartum Pathway, doula services, behavioral health care, Black Infant Health, and Community Supports, Medi-Cal is working to ensure that eligible families in Alameda and San Francisco counties — especially Black Californians — receive the care and support they need to stay healthy and give their babies a strong start.

Ready to Learn More or Get Started?

Pregnant and postpartum people in Alameda and San Francisco counties can learn more about Medi-Cal benefits, enroll in coverage, or get help finding providers by contacting the Alameda County Medi-Cal office or San Francisco County Medi-Cal office or calling the number on their Medi-Cal card. Trained representatives can explain eligibility, available services, and next steps.

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By Ken Epstein

People may be aware of the existence of Marin City and know a little about its history as a center of U.S. resistance to fascism in the World War II. But fewer know of the community’s ongoing struggles to survive potential displacement while facing severe toxic health and environmental conditions on a daily basis.

These conditions cause chronic disease and premature death, dramatically shown in the sharp difference in life expectancy between Black and white people living in households only a few miles apart.

A historically African American enclave, Marin City, occupies a 0.5-square mile area between Mill Valley and Sausalito with its own freeway exit near the Golden Gate Bridge. In contrast, the rest of Marin County rates among the healthiest, wealthiest, and most environmentally friendly counties in the country. However, it is one of the least racially equitable counties in California, with Black residents being the most impacted, according to the Advancement Project, a civil rights organization,.

The community owes its continued existence to the World War II generation that came to the Bay Area from the South to work in the shipyards and to the resiliency of its residents. Despite often facing discriminatory practices, such as redlining and a segregated school district, Marin City residents have continually created a strong community rich in culture, spirituality, and community values.

The current statistics are brutal. At present, Marin City residents face more than a 17-year difference in life expectancy compared to neighboring cities and towns.  Contributing to these conditions are a lack of investment in public housing and infrastructure: unsafe drinking water, air pollution caused by proximity to the U.S. 101 freeway, unsanitary stormwater drainage that produces mold and mildew, as well as old and broken lead pipes and sewage in homes.

As an unincorporated community, Marin City residents must rely primarily on the elected Marin County Board of Supervisors, Department of Public Works, Transportation Authority of Marin and Caltrans for the decisions and investments that impact their lives.

“Marin City residents have been fighting for years just to stay here. Residents live with the fear of being forced out, public housing torn down and rebuilt for the wealthy. Due to ongoing issues continually being ignored, residents feel they must be empowered to make their own decisions for the future survival and protection of their community,” said Terrie Green, a lifelong resident and executive director of Marin City Climate Resilience (MCCR).

MCCR’s focus is on environmental justice. Its purpose is to empower and advocate for individuals to embrace sustainable living, envision a future free of environmental harm and collectively work towards a better Marin City.  MCCR’s motto is “Forever Marin City.”

MCCR has created a unique team of Marin City Youth Environmentalists who have studied and researched environmental issues impacting the health of the community.

Serenity Allen is an MCCR Youth Coordinator/Young Environmentalist studying to be a medical social worker at Xavier University. She has been working in the community for six years. “I strongly believe that where you live should not determine how long you are able to live,” she said.

Allen referred to the work done by former Marin County Public Health Officer Dr. Matt Willis, who stated that Marin City has a 17-year life expectancy difference between residents of Marin City (77 years) and more affluent areas like Ross (94 years).

“The research shows this gap is heavily correlated with race and socioeconomic status. Sausalito, which is not even two miles outside of Marin City, has a life expectancy of 92 years,” Allen said.

“Many elements contribute to this gap,” she said. “A major factor may be the 12 acres of toxic flood waters that pour down off the highway into low-lying Marin City.

In addition, “We do not have a barrier wall protecting us along our highway; the rest of Marin County has 16 barrier walls to protect from noise and air pollution. Marin City has been fighting for a barrier wall since 2008,” she said.

Octavien Green, an MCCR high school environmentalist, spoke about the impact of the absence of recreational facilities on health and wellness, particularly for youth.

“Lack of investment in our recreational facilities means we have fewer spaces and opportunities for physical activity, which contribute to serious health problems like heart disease, diabetes, weak bones and low energy, especially for kids.  We are presently involved in an ongoing struggle just to rebuild a sports ball field for the community that’s been unusable for the last 15 years.”

“Marin City is the center of Black culture for all of Marin County,” said Green. “Historically, though, the county has not invested in the community, and you see it in the life expectancy, the highest chronic disease and disability rates and eight times the amount of asthma.  In the last six weeks, we’ve had three young people in their 40s and 50s die from heart attacks.  This is alarming and must be addressed.”

Looking toward next steps, she said, “The way forward is through incorporation,” which would mean that Marin City would have its own elected leadership to find solutions that determine the future of the community.

This is the first in a series of articles on Marin City, examining conditions in the community and interviewing both community members and public officials.

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