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Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2

BLACK VOICE NEWS — While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.
The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 first appeared on BlackPressUSA.

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CA acknowledges doula services as part of the solution to reduce maternal mortality

By Breanna Reeves | Black Voice News

The topics of Black maternal mortality and pregnancy-related death have become more prevalent over the last decade as the U.S. has been identified as having one of the worst maternal mortality rates among high-income countries.

report published by the Commonwealth Fund found that the U.S. had the highest maternal mortality rate among wealthy nations: 23.8 deaths per 100,000 live births in 2020. That rate is double for Black maternal mortality: 55.3 deaths per 100,000 live births.

While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.

Available data for maternal mortality rates across race/ethnicity for Riverside and San Bernardino Counties are not available for public access. According to a representative from the California Department of Public Health, the agency “does not publish pregnancy-related death counts or pregnancy-related mortality ratios (PRMR) by race/ethnicity at the county or regional level to maintain data confidentiality and ensure statistical stability,” but noted that across the state, Black birthing people “continue to have the highest PRMR.”

The disproportionate rate at which Black women and birthing people die from pregnancy-related deaths is not new to Black doulas.

Chantel Runnels has been a doula for 14 years, something she said she was “called to do.” Family history of fatal maternal health care, a desire to see public health care change and her own pregnancy experience served as catalysts for her becoming a doula. She was introduced to the Sankofa Birthworkers Collective, an Inland Empire-based organization, through a friend who is a midwife.

A midwife is an individual who is medically trained to assist with labor and delivery and provides prenatal, intrapartum and postpartum care, as well as family planning care. The Sankofa Birthworkers Collective consists of a well-rounded group of birthworkers including licensed midwives, postpartum doulas, lactation specialists, maternal mental health experts and midwives-in-training.

“To be around other Black women who may have secondary or tertiary lines of work that affect Black maternal health care or are directly in Black maternal health care was really attractive to me,” Runnels explained. “To be a part of a community of women who live across the [Inland Empire], who come from different demographics, but want to support each other and just wanted to come together was super attractive.”

Married for nearly 15 years and a mother of four, Runnels provides services to a diverse clientele, some who pay out of pocket for private services, others who receive free services through community-based programs like Sankofa or through insurance programs like the Doula Access Program.

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Runnels explained that as the need for doulas grows, doula training is that much more important to help ensure that they are trained to meet the needs of the community and have the availability to serve clients.

“This is why compensation for doulas is important, too, because the wages that doulas are paid can’t really compensate for the availability that’s required for the job,” Runnels explained.

As the state began to recognize the invaluable services provided by doulas, legislation to implement doula services throughout the state was introduced prior to the start of the pandemic.

Elevating, expanding, standardizing and compensating doulas in CA

In February 2020, Majority Leader of the California State Assembly Eloise Gómez Reyes (D-Colton) introduced Assembly Bill 2258 which aimed to lower maternal and infant maternal mortality rates in California by launching a three-year Medi-Cal pilot program to provide doula services in 14 counties with the highest birth disparities. The bill fell through when the COVID-19 pandemic shifted priorities in March 2020.

The momentum to introduce legislation that addressed maternal mortality picked up again when Governor Gavin Newsom budgeted funding for a Medi-Cal benefit, which will allow doulas to be reimbursed for full spectrum care rendered to Medi-Cal enrollees. I​n order to add these services as a benefit, the Department of Health Care Services (DHCS) is required to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) and receive federal approval — essentially an agreement between the state and federal government on how their Medicaid program will operate and assures the state will abide by federal rules.

Over the last year, DHCS has worked with stakeholders from across California including birthworkers, doulas and community organizations to develop a comprehensive SPA that specifies what doula coverage will look like under Medi-Cal, including the scope of services. Following the first draft of the SPA, a coalition of stakeholders made recommendations for an updated version of the SPA that requested the need for specific language to define doula care and services.

The letter recommended revising the definition of a doula to specify the types of services and support they offer. Part of the letter recommended that the SPA add: “The doula care provided will offer any and all aspects of full-spectrum doula care, including prenatal and postpartum or post-pregnancy doula care, continuous presence during labor and delivery, and doula support during miscarriage, stillbirth and abortion. Doula care includes physical, emotional and other nonmedical care.”

Alexis Robles-Fradet is a Health Policy Analyst at National Health Law Program (NHeLP) in Los Angeles, CA, and drafted the coalition letter in April. Alongside Amy Chen, a senior attorney at NHeLP and member of the stakeholder group, Robles-Fradet has published several reports about the components of successful doula programs and pilot doula programs in other counties as part of the Doula Medicaid Project, launched in 2018.

One of the biggest challenges with finalizing the SPA has been the reimbursement rate offered. The initial proposed rate was one of the lowest rates in the country. Upon receiving the first draft of the SPA from DHCS, the coalition noted in the letter: “We do not believe this benefit will be successful if the reimbursement rate is $450.”

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

With the high cost of living in California and the amount of time doulas spend with their clients, Robles-Fradet explained that $450 is not a living wage and would be a barrier to getting the necessary workforce to cover Medi-Cal patients. Medi-Cal covered more than half of all births in California in 2019.

“Doulas deserve to be paid a fair wage. I know we talk about [a] living wage, but I think we should shift into thriving wages, like they’re doing great work and they’ve been doing this great work for so long,” Robles-Fradet stated. “They know how to support their communities.”

Robles-Fradet explained that listening to the doulas and making sure that the benefit will be equitable for them are important factors that will contribute to the success of the Medi-Cal benefit.

As a member of the stakeholder group, Runnels said that the group has worked “tirelessly” to demonstrate that the situation is nuanced. One of the first tasks for DHCS and the stakeholder group was to define doula services and qualifications since it isn’t defined in state law.

“The doula stakeholders did emphasize to us that the length of service in terms of time that they were spending with individuals needed to be considered since doula services typically last significantly longer than other visits with a licensed practitioner,” said René Mollow, Deputy Director of Health Care Benefits & Eligibility.

Mollow explained that doula services as a benefit will be offered through both the Medicare fee-for-service delivery system and Managed Care delivery systems, so doulas will need to be enrolled as Medi-Cal providers and will have contracts with Managed Care plans.

“The majority of covered populations in our program here in California are served through Medi-Cal managed care plans,” Mollow added. “So, that’s where we would expect to see the bulk of the services being provided.”

Following several stakeholder meetings, feedback from birthworkers and Governor Gavin Newsom’s revised 2022-23 budget, California’s current proposed reimbursement rate has increased to $1,154 with one initial visit paid at $126.31, eight perinatal visits paid at $60.48 per visit and one labor and delivery visit paid at $544.28.

“California is such a large state. We have so many births a year. The cost of living for doulas and families in San Francisco varies greatly to doulas and families that are serving Barstow,” Runnels clarified. “And so, helping them understand that the original rate…was embarrassing. Even other states do better than that. And the rate that they’ve come to now is still embarrassing.”

There are more than 400,000 births each year in California which is roughly one-eighth of all U.S. births, nearly half of which are paid for by Medi-Cal, according to the California Health Care Foundation. Comparatively, in 2020, there were 39,817 births in Oregon. In June 2022, Oregon updated its SPA to increase the doula reimbursement rate to $1,500.

“I am so grateful for the work that the State Plan Amendment workgroup is doing to really work on this,” Runnels stated. “[But] also, it still does not reflect how critical the role of a doula is in addressing maternal health care in the state of California, particularly for those most vulnerable, which are Black women.”

Stakeholder meetings are ongoing as the group continues to discuss the SPA and work on developing a Provider Manual. DHCS plans to publish a public notice and formally submit the SPA in September.

This article is the second in a series produced as a project for the USC Annenberg Center for Health Journalism’s 2022 California Fellowship.

The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 appeared first on Black Voice News.

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Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

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The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 first appeared on BlackPressUSA.

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A Nation in Freefall While the Powerful Feast: Trump Calls Affordability a ‘Con Job’

BLACKPRESSUSA NEWSWIRE — There are seasons in this country when the struggle of ordinary Americans is not merely a condition but a kind of weather that settles over everything.

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By Stacy M. Brown
Black Press USA Senior National Correspondent

There are seasons in this country when the struggle of ordinary Americans is not merely a condition but a kind of weather that settles over everything. It enters the grocery aisle, the overdue bill, the rent notice, and the long nights spent calculating how to get through the next week. The latest numbers show that this season has not passed. It has deepened.

Private employers cut 32,000 jobs in November, according to ADP. Because the nation has been hemorrhaging jobs since President Trump took office, the administration has halted publishing the traditional monthly report. The ADP report revealed that small businesses suffered the heaviest losses. Establishments with fewer than 50 workers shed 120,000 positions, including 74,000 from companies with 20 to 49 workers. Larger firms added 90,000 jobs, widening the split between those rising and those falling.

Meanwhile, wealth continues to climb for the few who already possess most of it. Federal Reserve data shows the top 1 percent now holds $52 trillion. The top 10 percent added $5 trillion in the second quarter alone. The bottom half gained only 6 percent over the past year, a number so small it fades beside the towering fortunes above it.

“Less educated and poorer people tend to make worse mistakes,” John Campbell said to CBS News, while noting that the complexity of the system leaves many families lost before they even begin. Campbell, a Harvard University economist and coauthor of a book examining the country’s broken personal finance structure, pointed to a system built to confuse and punish those who lack time, training, or access.

“Creditors are just breathing down their necks,” Carol Fox told Bloomberg News, while noting that rising borrowing costs, shrinking consumer spending, and trade battles under the current administration have left owners desperate. Fox serves as a court-appointed Subchapter V trustee in Southern Florida and has watched the crisis unfold case by case.

During a cabinet meeting on Tuesday, Trump told those present that affordability “doesn’t mean anything to anybody.” He added that Democrats created a “con job” to mislead the public.

However, more than $30 million in taxpayer funds reportedly have supported his golf travel. Reports show Kristi Noem and FBI Director Kash Patel have also made extensive use of private jets through government and political networks. The administration approved a $40 billion bailout of Argentina. The president’s wealthy donors recently gathered for a dinner celebrating his planned $300 million White House ballroom.

During an appearance on CNBC, Mark Zandi, an economist, warned that the country could face serious economic threats. “We have learned that people make many mistakes,” Campbell added. “And particularly, sadly, less educated and poorer people tend to make worse mistakes.”

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The Numbers Behind the Myth of the Hundred Million Dollar Contract

BLACKPRESSUSA NEWSWIRE — Odell Beckham Jr. did not spark controversy on purpose. He sat on The Pivot Podcast and tried to explain the math behind a deal that looks limitless from the outside but shrinks fast once the system takes its cut.

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By Stacy M. Brown
Black Press USA Senior National Correspondent

Odell Beckham Jr. did not spark controversy on purpose. He sat on The Pivot Podcast and tried to explain the math behind a deal that looks limitless from the outside but shrinks fast once the system takes its cut. He looked into the camera and tried to offer a truth most fans never hear. “You give somebody a five-year $100 million contract, right? What is it really? It is five years for sixty. You are getting taxed. Do the math. That is twelve million a year that you have to spend, use, save, invest, flaunt,” said Beckham. He added that buying a car, buying his mother a house, and covering the costs of life all chip away at what people assume lasts forever.

The reaction was instant. Many heard entitlement. Many heard a millionaire complaining. What they missed was a glimpse into a professional world built on big numbers up front and a quiet erasing of those numbers behind the scenes.

The tax data in Beckham’s world is not speculation. SmartAsset’s research shows that top NFL players often lose close to half their income to federal taxes, state taxes, and local taxes. The analysis explains that athletes in California face a state rate of 13.3 percent and that players are also taxed in every state where they play road games, a structure widely known as the jock tax. For many players, that means filing up to ten separate returns and facing a combined tax burden that reaches or exceeds 50 percent.

A look across the league paints the same picture. The research lists star players in New York, Philadelphia, Chicago, Detroit, and Cleveland, all giving up between 43 and 47 percent of their football income before they ever touch a dollar. Star quarterback Phillip Rivers, at one point, was projected to lose half of his playing income to taxes alone.

A second financial breakdown from MGO CPA shows that the problem does not only affect the highest earners. A $1 million salary falls to about $529,000 after federal taxes, state and city taxes, an agent fee, and a contract deduction. According to that analysis, professional athletes typically take home around half of their contract value, and that is before rent, meals, training, travel, and support obligations are counted.

The structure of professional sports contracts adds another layer. A study of major deals across MLB, the NBA, and the NFL notes that long-term agreements lose value over time because the dollar today has more power than the dollar paid in the future. Even the largest deals shrink once adjusted for time. The study explains that contract size alone does not guarantee financial success and that structure and timing play a crucial role in a player’s long-term outcomes.

Beckham has also faced headlines claiming he is “on the brink of bankruptcy despite earning over one hundred million” in his career. Those reports repeated his statement that “after taxes, it is only sixty million” and captured the disbelief from fans who could not understand how money at that level could ever tighten.

Other reactions lacked nuance. One article wrote that no one could relate to any struggle on eight million dollars a year. Another described his approach as “the definition of a new-money move” and argued that it signaled poor financial choices and inflated spending.

But the underlying truth reaches far beyond Beckham. Professional athletes enter sudden wealth without preparation. They carry the weight of family support. They navigate teams, agents, advisors, and expectations from every direction. Their earning window is brief. Their career can end in a moment. Their income is fragmented, taxed, and carved up before the public ever sees the real number.

The math is unflinching. Twenty million dollars becomes something closer to $8 million after federal taxes, state taxes, jock taxes, agent fees, training costs, and family responsibilities. Over five years, that is about $40 million of real, spendable income. It is transformative money, but not infinite. Not guaranteed. Not protected.

Beckham offered a question at the heart of this entire debate. “Can you make that last forever?”

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FBI Report Warns of Fear, Paralysis, And Political Turmoil Under Director Kash Patel

BLACKPRESSUSA NEWSWIRE — Six months into Kash Patel’s tenure as Director of the Federal Bureau of Investigation, a newly compiled internal report from a national alliance of retired and active-duty FBI agents and analysts delivers a stark warning about what the Bureau has become under his leadership.

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By Stacy M. Brown
Black Press USA Senior National Correspondent

Six months into Kash Patel’s tenure as Director of the Federal Bureau of Investigation, a newly compiled internal report from a national alliance of retired and active-duty FBI agents and analysts delivers a stark warning about what the Bureau has become under his leadership. The 115-page document, submitted to Congress this month, is built entirely on verified reporting from inside field offices across the country and paints a picture of an agency gripped by fear, divided by ideology, and drifting without direction.

The report’s authors write that they launched their inquiry after receiving troubling accounts from inside the Bureau only four months into Patel’s tenure. They describe their goal as a pulse check on whether the ninth FBI director was reforming the Bureau or destabilizing it. Their conclusion: the preliminary findings were discouraging.

Reports Describe Widespread Internal Distrust and Open Hostility Toward President Trump

Sources across the country told investigators that a large number of FBI employees openly express hostility toward President Donald Trump. One source reported seeing an “increasing number of FBI Special Agents who dislike the President,” adding that these employees were exhibiting what they called “TDS” and had lost “their ability to think critically about an issue and distinguish fact from fiction.” Another source described employees making off-color comments about the administration during office conversations.

The sentiment reportedly extends beyond domestic lines. Law enforcement and intelligence partners in allied countries have privately expressed fear that the Trump administration could damage long-term international cooperation according to a sub-source who reported those concerns directly to investigators.

Pardon Backlash and Fear of Retaliation

The President’s January 20 pardons of individuals convicted for their roles in the January 6 attack ignited what the report calls demoralization inside the Bureau. One FBI employee said they were “demoralized” that individuals “rightfully convicted” were pardoned and feared that some of those individuals or their supporters might target them or their family for carrying out their duties. Another source described widespread anger that lists of personnel who worked on January 6 investigations had been provided to the Justice Department for review, noting that agents “were just following orders” and now worry those lists could leak publicly.  

Morale In Decline

Morale among FBI employees appears to be sinking fast. There were a few scattered positive notes, but the weight of the reporting describes morale as low, bad, or terrible. Agents with more than a decade of service told investigators they feel marginalized or ignored. Some are counting the days until they can retire. One even uses a countdown app on their phone.  

Culture Of Fear

Layered over that unhappiness is something far more corrosive. A culture of fear. Sources say Patel, though personable, created mistrust from the start because of harsh remarks he made about the FBI before taking office. Agents took those comments personally. They now work in an atmosphere where employees keep their heads down and speak carefully. Managers wait for directions because they are afraid a wrong move could cost them their jobs. One source said agents dread coming to work because nobody knows who will be reassigned or fired next.

Leadership Concerns

The report also paints a picture of leaders unprepared for the jobs they hold. Multiple sources said Patel is in over his head and lacks the breadth of experience required to understand the Bureau’s complex programs. Some said Deputy Director Dan Bongino should never have been appointed because the role requires deep institutional knowledge of FBI operations. A sub-source recounted Bongino telling employees during a field office visit that “the truth is for chumps.” Employees who heard it were stunned and offended.

Social Media and Communication Breakdowns

Communication inside the Bureau has become another source of frustration. Sources said Patel and Bongino spend too much time posting on social media and not enough time communicating with employees in clear and official ways. Several told investigators they learn more about FBI operations from tweets than from internal channels.

ICE Assignments Raise Alarm

Nothing has sparked more frustration inside the FBI than the orders requiring agents to assist Immigration and Customs Enforcement. The reporting shows widespread resentment and fear over these assignments. Agents say they have little training in immigration law and were ordered into operations without proper planning. Some said they were put in tactically unsafe positions. They also warned that being pulled away from counterterrorism and counterintelligence investigations threatens national security. One sub-source asked, “If we’re not working CT and CI, then who is?”  

DEI Program Removal

Even the future of diversity programs became a point of division. Some agents praised Patel’s removal of DEI initiatives. Others said the old system left them afraid to speak honestly because they worried about being labeled racist. The reporting shows a deep and unresolved conflict over whether DEI strengthened the organization or weakened it.

Notable Incidents

The document also details several incidents that have become part of FBI lore. Patel ordered all employees to remove pronouns and personal messages from their email signatures yet used the number nine in his own. Agents laughed at what they saw as hypocrisy. In another episode, FBI employees who discussed Patel’s request for an FBI-issued firearm were ordered to take polygraph examinations, which one respected source described as punitive. And in Utah, Patel refused to exit a plane without a medium-sized FBI raid jacket. A team scrambled to find one and finally secured a female agent’s jacket. Patel still refused to step out until patches were added. SWAT members removed patches from their own uniforms to satisfy the demand.

A Bureau at a Crossroad

The Alliance warns that the Bureau stands at a difficult crossroads. They write that the FBI faces some of the most daunting challenges in its history. But even in despair, a few voices say something different. One veteran source said “It is early, but most can see the mission is now the priority. Case work and threats are the focus again. Reform is headed in the right direction.”  

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