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Midwives are specialized maternity care clinicians who support birthing people’s reproductive health through pregnancy, childbirth, and postpartum care. Midwives, ob/gyns, and family physicians are trained to deliver babies in California. An element of successful midwifery care is appropriate consultation with ob/gyns and transfer to physician care if the need arises. Although midwives are the primary maternity care providers in many industrialized nations — which have significantly better maternal health outcomes than the US — they are an often-overlooked workforce in this country.

Access to Midwives Is Critical to High-Quality Maternity Care

In California and nationwide, a worsening ob/gyn shortage paired with hospital labor and delivery unit closures have generated interest among advocates and some policymakers, who are pushing to expand the number and scope of practice of midwives.

• California credentials two types of midwives: nurse-midwives and licensed midwives.
• In 2021, there were 420,000 births in California, with 86% of those delivered by physicians and 13% delivered by midwives. With California’s demand for ob/gyns projected to exceed supply by 1,160 full-time equivalents by 2030, midwives could help address the workforce shortage and other maternity care access issues that loom large.
• Midwifery care is recognized by many health policy experts as an important model for improving maternity care outcomes and addressing racism-based disparities in maternal health care, especially when provided by culturally and racially concordant providers.
• Robust research demonstrates that midwifery care results in positive health outcomes. These include lower rates of cesarean sections and fewer interventions during birth, as well as higher rates of spontaneous vaginal birth and higher patient experience scores.
• In a survey of California mothers, a majority said they would want or consider a midwife for a future pregnancy.

Aspiring Midwives in California Face Shrinking Training Options

• Certified nurse-midwives: The state has 1,200 certified nurse-midwives — nurses with graduate training from approved nurse-midwifery programs who provide care mostly in hospitals. California has only two education programs for nurse-midwifery, and one is not currently admitting students.
• Licensed midwives: California’s 500 licensed midwives are providers trained in approved three-year programs who mainly practice in birth centers and homes. The state currently has no accredited midwifery training programs for licensed midwives, though two are in the works with funding from the California Department of Health Care Access and Information.

Policy Considerations: What Can State Leaders Do to Increase Access to Midwives?

• Expand professional autonomy. The state statutes for licensed midwives and nurse-midwives impose a narrower scope of practice than their training allows and require physician oversight in certain situations, undermining their professional autonomy. Nearly 9 in 10 licensed midwives identify government scope of practice restrictions as a “major” (39%) or “minor” (49%) problem in their practices. Among nurse-midwives, 10% consider this a “major” and 27% a “minor” problem in their practices.
• Integrate midwives into the health care system. In addition to ensuring access to midwives who have professional autonomy, truly integrating midwives into maternity care in California requires the respectful inclusion of midwives as members of the health care team as well as broad insurance coverage of midwifery services in both hospital and community settings.
• Increase funding to grow the midwifery workforce. Expanding access to midwifery care in California requires financial support for midwifery students to reduce barriers to education, for clinical sites to take in midwifery students, and for midwives of color to diversify the workforce.
• Streamline licensing requirements for birth centers. Research shows freestanding birth centers provide high-quality, midwife-led care that can produce excellent outcomes for birthing people and babies. But due in large part to California’s onerous licensing requirements that many experts say do not improve safety, at least 19 birth centers have closed since 2020, leaving the state with only five licensed birth centers.

To learn more:

• Cochrane Library: Midwife Continuity of Care Models Versus Other Models of Care for Childbearing Women
• CHCF: Understanding California’s Midwife Workforce
• CHCF: Midwives Speak: Integration Challenges in California’s Health System
• CHCF: Advancing Midwifery and Birth Equity in California
• CHCF: Listening to Mothers in California survey (2018)

The post What Is a Midwife? — Policy at a Glance appeared first on California Health Care Foundation.

Artificial intelligence (AI) is swiftly reshaping the health care landscape, but the impressive array of helpful new tools is not equally accessible to everyone. While private hospital systems and commercial insurance plans can afford technologies that could alleviate burdens on their workforce and improve patient care, California’s health care safety net is at risk of being left behind. It’s a problem that worries the people who run the medical and social service organizations that serve millions of Californians with low incomes.  

If safety-net institutions miss out on the potential of AI, it could widen persistent racial and ethnic health disparities in that population, said Stella Tran, senior program investment officer at the CHCF Innovation Fund. “It would be a tale of two health systems,” she said.  

The potential applications of AI are significant: Ambient note-taking technologies that could reduce burnout and give providers more face time with patients. Chatbots that could offer speedier access to care. Tools that could assist with diagnostics and help predict patient health outcomes. Many others are being developed as well. 

CHCF wanted to learn more about spreading AI equitably, so it partnered with the California Health and Human Services Agency to listen to 45 safety-net leaders from across the state. In three focus group sessions conducted between August and October 2024, leaders of managed care plans, hospitals, community clinics, and community-based organizations offered their perspectives on AI. There was a strong desire to share their experiences and perceptions. “We had one clinic leader drive over three hours each way to be at the table,” said Katie Heidorn, CHCF’s director of state health policy. 

Safety Net Access to AI

The lively strategic discussions, which offered confidentiality to encourage candor about sensitive issues, confirmed that safety-net organizations face restrictive barriers to the safe and effective adoption of AI. Those obstacles include prohibitive costs, workforce limitations, and concerns about liability.  

Participants shared the capabilities of AI that excite them, offered use cases, and commiserated over challenges — especially the need for increased resources to help safety-net institutions rapidly adopt AI tools that could improve their services. Many said their organizations cannot afford to integrate new digital tools into their workflows. “The pricing models don’t work for the safety net,” said Kara Carter, CHCF’s senior vice president for strategy and programs. AI products that charge per usage or per provider visit are currently too expensive for safety-net organizations, she said, adding, “That’s going to have to change.” 

Participants also explored group purchasing and other strategies to access AI products. One solution could be for vendors to offer discounts to safety-net organizations, perhaps by partnering with other AI companies to create bulk deals, said Heidorn. 

But that method wouldn’t ease the infrastructure and personnel requirements, she said. Few safety-net organizations can afford to hire expert staff to oversee AI implementation.

Well-resourced hospital systems have large data management capacity, with large IT departments and data science staff at their disposal. “A community clinic may not have the data scientists on staff needed to implement AI,” said Tran.

Because safety-net organizations are already burdened by projects aimed at improving infrastructure and care delivery, the surge in AI technology is causing a sort of paralysis, participants said. Organizations may need to put AI adoption on the back burner because they are prioritizing the enhancement of other technical capabilities, such as data exchange.  

Nimble Organizations Take More Risks

“Across the board, there are underlying problems in infrastructure,” Carter said. “But if we wait to move on AI until we fix all of those, we miss the boat.”  

The sessions revealed that nimble organizations with simpler structures and decisionmaking pathways feel freer to take risks with AI, such as a small community health worker organization that created its own generative AI tools because commercial options didn’t suit their specific needs. 

Providers say they often hesitate to purchase AI tools because the financial benefits are unclear. “We need to find examples of return on investment and share them widely to make the case for AI really clear,” Tran said. 

Ambient scribing improves physicians’ quality of life by reducing the time needed to write patient notes after hours. Hospitals and health systems, however, assign less value to savings generated by physicians who were volunteering their time anyway. Yet when the tool is framed as a way to bolster employee retention, other cost savings become clearer. “What is the cost of losing the doctor? Or of hiring a new provider?” Tran said. Taken further, employee retention yields savings by ensuring that patients can be seen in a timely fashion, and therefore possibly avoid developing more complex conditions that are expensive to treat.   

Examining returns on investment this way reflects lessons learned from mistakes of the past, CHCF leaders said, pointing to missed opportunities when electronic health record (EHR) systems were introduced two decades ago. That process resulted in discrepancies in the implementation of EHRs in well-resourced versus safety-net systems. “It was fragmented, and it wasn’t made for effective data exchange,” said Carter. “Those mistakes have been really expensive to fix.”  

The listening tour showed that safety-net organizations already see the AI revolution as an opportunity to do things differently, Carter said. “I was thrilled to hear that sentiment from participants,” she said.  

Top Worries About AI in the Safety Net

But as eager as they are to seize AI opportunities, several concerns about access and equity remain top of mind. 

First and foremost, safety-net providers are worried about who bears the financial risk for AI errors. They said the state should establish accountability guidelines showing which parties are responsible for the safety of the technology. “They’re concerned about risk if it messes up,” said Heidorn.  

The path of least resistance may be to put the onus on health organizations rather than on AI developers because health care providers are already accustomed to being heavily regulated, Heidorn said. But that might create a chilling effect in which safety-net organizations avoid AI out of liability fears, she said.  

On the other hand, laying too much financial risk on developers might deter innovators from tackling safety-net problems. Some form of safe harbor for providers and developers alike may be the sensible path forward, Carter said. “Organizations want to be able to try and fail, and that is hard to do without clear accountability,” she added.  

Safety-net organizations need to be included in data exchange networks, and their patient data should be used to train AI models to counter racial and ethnic biases, Carter said. Small clinics need to have access to the same large data resources that well-resourced systems have, and AI innovators need to ensure that their technologies prioritize primary care. “We can’t be leaving out the part of the infrastructure that safety-net patients interact with the most,” Carter said.  

Likewise, attention needs to be directed to ensuring that certain regions and populations aren’t left out of these digital advances. The Central Valley and rural Northern California, for instance, suffer from poor broadband connectivity, affecting organizations’ abilities to implement new AI technologies. Participants from Southern California emphasized the challenges of sharing data between Los Angeles County’s many systems, while those from the Central Valley spoke of the need for data exchange programs that can follow the movements of farmworkers. And regions with sizable immigrant populations are concerned about the technologies reaching those who speak languages other than English. Designing AI tools that can address these barriers will help to shrink health care’s existing digital divide. 

Extensive Dialogue Needed

Crafting new policies will require extensive dialogue among lawmakers, safety-net providers, and AI developers. “There are information gaps on all sides,” Heidorn said. “We need to ensure that lawmakers are educated in AI, and that the AI learnings specific to health care are passed on to the state.” 

So far only health care leaders and providers have had input on AI, so CHCF plans to host listening sessions with safety-net patients to understand their perspectives, said Heidorn. That will help policymakers, developers, and safety-net leaders ensure that the deployment of AI is tethered to the future of health equity. Already, Medicaid enrollees have worse health outcomes than those with commercial coverage — and if Medicaid patients are unable to reap the same benefits of AI tools as commercial health systems, those disparities will worsen. What’s more, in the face of workforce shortages, primary care deserts, and other critical health care problems facing the state, AI could help the Californians with lower incomes edge closer to having equitable access to care.  

The safety net needs to be given a seat at the table, CHCF leaders said. “AI can address long-standing issues in our delivery system,” said Tran, “and we want to make sure our corner of the world has access to that.”  

Authors & Contributors

Robin Buller

Robin Buller is an Oakland-based writer, researcher, and editor. She has reported on harm reduction, maternal health, migration, housing, and policing for The Guardian, The Oaklandside, and other publications.

Originally from Canada, she holds a doctorate in history from UNC Chapel Hill and has lived in California since 2018.

Jessica Brandi Lifland

Jessica Brandi Lifland is a freelance photographer, instructor of journalism at City College of San Francisco, and mother. Her work with publications and nonprofits such as Operation Smile, Tostan, and the California Health Care Foundation has taken her all over the world, including West Africa, the Middle East, Kosovo, Burma, Haiti, and South America.

For two decades she has been photographing the National Cowboy Poetry Gathering and has been working on a long-term project documenting the lives of the cowboy poets of the American West in affiliation with the Western Folklife Center. She plans to make her project into a book.

The post AI Tools Promise Better Care but Challenge Safety-Net Providers appeared first on California Health Care Foundation.

Through structured conversations, interviews, interactions, and observations of in-person activities with providers, health plan members, and CBOs, Molina Healthcare identified three essential learnings that might be helpful to other organizations collaborating with communities on reducing racial disparities in maternal health care.

Lesson 1: Building trust through community engagement must come before information gathering

Building relationships to establish trust is critical before formal qualitative data collection from an underserved community can begin. Mimi Velazquez, health equity program manager for Molina Healthcare, developed relationships in the Inland Empire over six months by attending local health meetings with public health agencies, meeting with leaders of local CBOs, and joining Black maternal health community collaboratives.

The trust-building process not only involved connecting with long-standing partners and building new connections but also repairing relationships within Molina Healthcare’s network to help address and resolve existing issues. For example, CBOs shared with Velazquez that they had provided services to Molina Healthcare’s members but had yet to be paid. This prompted Molina Healthcare to create more direct connections between CBOs and their billing department to resolve any standing issues, and as a result, those CBOs became more willing to share insights with Velazquez.

In its efforts to build credibility in the community, Molina Healthcare also realized the importance of acknowledging the historical oppression often encountered when engaging with underserved communities and the mistrust these communities can experience due to past exploitation and lack of follow-up from research initiatives. “Research projects are known for coming into a community, taking data, publishing information, and then the community never hears from them again and they feel used,” says Velazquez.

In an effort to repair and honor the value of community members’ time and wisdom, Molina Healthcare provided monetary compensation ($100 per interviewee) to people sharing their lived experiences, whether they were providers, health plan members, or CBO representatives.

Through consistency and demonstrated actions over time, Molina Healthcare earned trust — community partners noted that they now feel more connected, seen, and heard by the health plan.

Lesson 2: Health plans must prioritize sharing information — for members and for providers

Through the interview process with members and providers, Molina Healthcare learned of information gaps that exist for their prenatal and postpartum members, as well as for doulas serving the community. Members shared that they didn’t have sufficient information about their doula care options and doulas shared they didn’t have information about how to contract with Molina Healthcare. This information gap is particularly harmful for patients who identify as Black, Indigenous, and People of Color who are most in need of culturally appropriate care options which doulas can often provide, to ensure positive health outcomes. It also aligns with lower rates of doula usage by Medi-Cal members in the Inland Empire, despite this region having the second highest number of Medi-Cal enrolled doulas in the state.

Members shared that they didn’t have timely information about the types of services doulas offer or how to choose a doula best suited for their maternal care needs. One of their members shared, “When I found out that I could get a doula and signed up, Riverside County was busy as far as the availability. I was told I could have maybe three or four visits with the doula before I had the baby and three or four visits after. But by the time I finally got matched with a doula, I was pretty close to my due date,… And I didn’t even know that the insurance would cover doula services!” Not only did this member miss their opportunity to receive timely care, but they were unaware that their health plan covered doula services due to lack of information sharing.

Additional members suggested a possible solution in the form of a handbook of doulas in their region, sorted by relevant demographics, as well as a welcome packet from the health plan with information about doulas and the services they provide. Of note, the Department of Healthcare Services offers an FAQ page for Medi-Cal members around doula services.

Similarly, doulas also voiced a need for more communication from the health plan. They asked for workshops about contracting with Molina Healthcare and to be recruited to provide doula care in rural areas where they live, which are known as health care deserts. Listening to doulas was therefore just as important as listening to members when understanding how information gaps were impacting maternal health care delivery.

Lesson 3: Health plans must follow through on community-informed programmatic interventions

Acting on the information shared with them was Molina Healthcare’s critical next step to maintaining trust and making progress on maternal health equity. In addition to fixing CBO payment issues, Molina Healthcare is now actively responding to members’ and providers’ requests related to doula care. Molina Healthcare offers a guide to members seeking doula services and has provided workshops on how doulas can contract with the health plan. Molina Healthcare is also looking to secure a doula consultant from among the interviewees to help the health plan in its efforts to equitably build out its doula services.

Another important example of action is Molina Healthcare’s efforts to continue to foster relationships and maintain or build trust across the Inland Empire. For example, CBOs have invited Velazquez to participate in the qualitative data collection process for their community health needs assessments and organizations that support Black maternal health in the region are now partnering with Molina Healthcare.

By building meaningful partnerships based on trust, prioritizing the elimination of information gaps that serve as barriers to care, and by committing to acting on learnings from members and providers, Molina Healthcare is optimistic that those efforts will soon translate into more equitable maternal health care. How might your organization partner with community stakeholders to create maternal care interventions that eliminate health disparities?

The California Improvement Network (CIN) is a learning and action community that advances equitable health care experiences and outcomes for Californians through cross-sector connections, spreading good ideas, and implementing improvements. Learn more about the California Improvement Network, a project of the California Health Care Foundation that is managed by Healthforce Center at UCSF, and sign up for the CIN newsletter.

The post Listening to Community Voices: A Health Plan’s Approach to Reduce Racial Disparities in Maternity Care appeared first on California Health Care Foundation.

A growing body of research suggests that a maternity care workforce that reflects the diversity of the people it serves and encompasses a range of provider types can deliver better care and positive outcomes for babies, mothers, and birthing people.

This series of conversations takes a look at the critical roles of doulas, lactation professionals, mental health professionals, and midwives.

Featured Resources

Expert Perspective

Shifting the Narrative About Black Birthing Experiences

A conversation with birth equity advocate Kimberly Seals Allers about improving maternity care for Black women and birthing people.

February 6, 2025

Maternal Health

How We Can Reduce Racial and Ethnic Disparities in Maternal Mental Health

July 12, 2024

Maternal Health

More Doulas Are Needed in California’s Health Workforce

April 15, 2024

Maternal Health

Diverse Maternity Care Workforce Essential to Advance Birth Equity

March 14, 2024

Health Workforce

The post Maternity Workforce Insights appeared first on California Health Care Foundation.

When Kimberly Seals Allers became pregnant in 2000, she instinctively applied her journalism skills to researching pregnancy and childbirth statistics among Black women and birthing people. She was shocked to learn that education and income are not protective factors for Black families — and this remains true today. After her childbirth experience at a top-rated New York City hospital gave her a firsthand view of disrespect and discrimination inflicted on so many Black women and birthing people, Seals Allers pivoted from journalism to birth equity work. She has since become a leading voice pushing to shift the mainstream media narrative surrounding Black maternal health away from the theme of “doom and gloom.”

She is the founder and executive director of Narrative Nation, a nonprofit organization that creates media content and technology to address health disparities and share positive Black birthing stories. One of Narrative Nation’s projects is Irth, a Yelp-like app in which women and birthing people of color can rate and review ob/gyns, maternity hospitals, and pediatricians. On the back end, the reviews are anonymized and turned into robust patient experience insights and data. With CHCF support, Irth is piloting a statewide project on hospital quality improvement and patient safety data analysis to reduce racism and bias in Black maternity care and birth experiences.

Seals Allers also has been a pioneer in shifting the narrative about lactation support, especially in Black communities. I interviewed her about the unique perspective she brings to birth equity work, her advocacy for Black breastfeeding, and the importance of building a sustainable doula workforce for the long term. Our conversation has been edited for length and clarity.

Q: You are not a medical professional, but you are a major contributor to the birth equity movement. How does your background create opportunities and challenges for advancing this work?

A: I believe my contribution to this field that I love so much is bringing a different lens to the issue. I didn’t arrive at this work through a public health program or through medical school, both of which are their own forms of conditioning. I came to this work as a journalist by trade who was motivated by my own birth experience.

I had a wonderful career as a business journalist. I covered Wall Street, I worked at Fortune magazine, I worked at the New York Post. I did not think about birth equity at all until I became pregnant. Then I started researching my own situation and learned that Black women back then were twice as likely as White women to die and three times more likely to have a preterm low-birthweight baby. I was terrified by the statistics about Black women, and the explanation for why this was happening was unsatisfactory.

At that time, we were not having the conversations about equity and the impact of racism that we’re having now. When I started delving into those subjects, they inspired me to pivot from writing and producing news to supporting birthwork. My instinct was to write. My first book, The Mocha Manual to a Fabulous Pregnancy, explored Black pregnancy and childbirth through a sociocultural lens.

We need all types of people in birth equity work — not just the researchers, not just the data people. The beauty of having people in birth equity who are not from traditional maternal and child health backgrounds is that they can bring unique perspectives.

Q: Your experiences giving birth to two children inspired you to found Narrative Nation. How did you come up with that name, and what is your organization’s approach to shifting narratives?

A: I named it Narrative Nation because I believe that narratives drive everything. Back in 2018, I was talking about the danger of the doom and gloom narrative in Black maternal health. I wrote about it in Women’s eNews. And quite frankly, I took a lot of heat for that because people were saying, “No, Kimberly, we have to put out the grim statistics. How do we make them care? They’re not going to know.” And I said, “Well, at what cost, and to whom?”

There was a lot of focus on how do we get White people to care, which includes funders and policymakers. But nobody was thinking about the impact on the Black subjects of those narratives. It was important to me to shift the focus to our people and to say that the doom and gloom narrative is harmful.

We get a lot of questions from pregnant people asking things like, “Hey, should I write a will before I go into labor?” These things should not be on our minds at this time. When you’re afraid, your cervix might not dilate, so negative narratives can have a medical impact in addition to an emotional one.

It is important to recognize that there’s value in changing the storyline — that we can tell another story, and that Black women and birthing people must tell it themselves. That’s why I launched the Black Birth Joy Line (844-5-GETJOY), a toll-free phone line to hear stories of positive Black birth experiences. We are analyzing the story transcripts and creating an instructional tool for doctors and nurses to learn from these stories.

Q: Your 2017 book, The Big Letdown, took a deep look at the forces in health care and big business that converge to undermine breastfeeding. In California, Black birthing people have the lowest in-hospital breastfeeding initiation rates of all races/ethnicities. What are the greatest opportunities to promote Black breastfeeding today?

A: I’m one of the creators of Black Breastfeeding Week, so breastfeeding is incredibly important to me. I have really pushed for diversification of our lactation workforce. Increasing breastfeeding rates in our community won’t happen until we have more lactation consultants who reflect our communities. There’s a trust issue. “This is my breast. It’s a highly personal part of my body.”

So hospitals have to think about diversifying the lactation support they offer. Does their workforce reflect the community they serve? Everybody’s being asked this question across industries, and hospitals need to ask the question too.

That said, just because someone has the same skin tone as you does not mean they haven’t been affected by the cultural training that often happens in medicine. Hiring Black doctors and nurses is not a panacea. We have Black and brown birthing people leaving reviews in Irth that are not positive, and they have been against Black providers or nurses. The medical field has a deep culture that has impacted people in their practice. I just want to point that out because diversifying the workforce is an important place to start for a lot of people, but that should not be the end of our due diligence.

Q: Many doulas and other birthworkers are motivated to serve their communities even though the time demands are significant and wages are often insufficient. What practices do you support to sustain this workforce?

A: Everyone is excited about training doulas, but nobody gives much thought to sustaining them. There’s no support for doulas – they’re going into these oppressive health care environments, and mentoring opportunities are not very structured.

We most closely touch this issue through our Irth ambassador program, a perinatal workforce sustainability program. It’s an opportunity for doulas and other birthworkers to receive professional development support and access to a peer learning community in exchange for completing Irth reviews.

If we are saying that something is important for birth equity, we must think about sustaining that workforce beyond what has often been unacceptable reimbursement rates. That’s just step one. We should be talking about what the floor for paying doulas is – not what the ceiling is.

Birthworkers who participate in the Irth ambassador program are paid, and every ambassador has access to a licensed therapist in their city who does bi-monthly group sessions. Ambassadors can also book individual hours with the therapists. The mental health of birthworkers is deeply concerning to me. When I listened to some of the stories of doulas, I’m like, “I don’t know how y’all go back to work.”

Q: What policy or practice changes would improve maternal and infant health outcomes for Black families?

A: My short-term goal is to drive more accountability and transparency to help health care systems do better by Black and Brown women and birthing people. That is why we are trying to increase the number of reviews posted in Irth. Our pilot programs with systems such as Cedars-Sinai [in Los Angeles] and Temple University Hospital [in Philadelphia] involve getting patient reviews, which we then analyze to identify opportunities for improvement.

Within the next five years, I want Irth to be the public accountability mechanism driven by Black and Brown birthing people that health care systems pay attention to. In the long term, we are pushing for system transformation.

Authors & Contributors

Amber Bolden

Amber Bolden, MPP, is a freelance communications consultant and member of the Los Angeles Chapter of the National Association of Black Journalists. She works as a consultant facilitator for the Village Fund, the community grantmaking program for the African American Infant and Maternal Mortality (AAIMM) prevention initiative. She has worked on several community development initiatives and served as a founding member of the Sankofa Birthworkers Collective in the Inland Empire.

Amber is a board member of Tru Evolution, a direct service health equity nonprofit organization that prioritizes the LGBTQ+ community by providing HIV, health, housing and community services.

The post Shifting the Narrative About Black Birthing Experiences appeared first on California Health Care Foundation.

View the Report

Midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries with better birth outcomes than California and the United States, midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and then transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery).

California licenses two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both LMs and NMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with NMs also offering broader gynecologic services.

To better understand the midwife workforce, the University of California, San Francisco, with funding from the California Health Care Foundation, conducted the Survey of California Nurse Practitioners and Nurse-Midwives and the Survey of California Licensed Midwives from July 18, 2022, to March 31, 2023. This brief describes the scope of practice and integration of midwives; their relationships with physicians, hospitals, and health plans; and their levels of career satisfaction and burnout.

Key Findings

Many midwives in California experience restrictions to practicing to their full scope of legal authority and to their level of expertise.

Allowing each member of the maternity care workforce to use all their skills to the maximum extent permitted by their license and knowledge expands the capacity for high-quality patient care.

Many midwives, especially LMs, identify their lack of integration into the health care system as a problem in their practice.

Ninety-one percent of LMs identify “poor integration of midwifery with other health care services” as a “major problem” (58%) or “minor problem” (33%) in their practices. In a list of 20 potential problems they face in practice, poor integration was second only to denial of coverage of care by insurance companies. Among NMs, 13% say this is a “major problem” and 33% a “minor problem” in their practices.

LMs face significant challenges contracting with and billing health plans, including Medi-Cal.

The ability to contract with and receive adequate reimbursement from insurers, including Medi-Cal, is critical to serving as a maternity care provider. Eighty-five percent of LMs do not accept Medi-Cal insurance, with 70% of LMs reporting the lack of adequate Medi-Cal reimbursement and 43% citing the bureaucratic challenges of provider enrollment among the top reasons for not accepting Medi-Cal.

A majority of LMs identify billing and reimbursement from insurance plans as problems in their practices, especially denial of coverage and other care decisions by insurance companies, with 62% reporting that as a “major” and 27% as a “minor” problem. Fewer NMs identify billing and reimbursement as problems interfering with the care they provide.

Authors & Contributors

Philip R. Lee Institute for Health Policy Studies at UCSF

Jen Joynt

Jen Joynt is an independent health care consultant based in Berkeley, California. Her areas of expertise include quality of care; hospital organization, strategy, and operations; health care workforce trends; and the California health care marketplace. She has authored several reports and policy briefings.

The post Midwives Speak: Integration Challenges in California’s Health System appeared first on California Health Care Foundation.

View the Report

Community Supports, a key component of CalAIM (California Advancing and Innovating Medi-Cal), represents a transformative approach to whole-person care for Medi-Cal enrollees. The initiative enables managed care plans to offer 14 health-related social services, ranging from medically tailored meals to housing support, with the goal of addressing social drivers of health and improving outcomes for Californians with low incomes.

A critical yet underutilized element of Community Supports is the Nursing Facility Transition / Diversion to Assisted Living Facilities program. This service helps eligible enrollees either transition out of nursing facilities or avoid nursing facility placement altogether by instead moving to more home-like assisted living settings. Despite its potential to enhance quality of life, save money, and optimize the use of limited nursing facility beds, implementation has been limited, with only 765 people accessing this service statewide between July 2023 and June 2024.

To address these implementation challenges, some managed care plans are partnering with external organizations that serve as community care hubs. These intermediaries bring specialized expertise and established networks to facilitate connections between plans, assisted living facilities, and eligible Medi-Cal enrollees.

This paper examines how the hub model can help overcome barriers to implementation and highlights three organizations successfully using this approach to expand access to community-based living options for older adults and people with disabilities across California.

Authors & Contributors

Robin Buller

Robin Buller is an Oakland-based writer, researcher, and editor. She has reported on harm reduction, maternal health, migration, housing, and policing for The Guardian, The Oaklandside, and other publications.

Originally from Canada, she holds a doctorate in history from UNC Chapel Hill and has lived in California since 2018.

The post Strengthening CalAIM’s Assisted Living Transitions: The Role of Community Care Hubs appeared first on California Health Care Foundation.

Behavioral Health

The burden of untreated behavioral health conditions — encompassing mental health and substance use disorders — is both a major public health problem and a delivery system challenge. CHCF works to improve systems of behavioral health care and to focus on integrating mental health, substance use, and physical health services to achieve the best outcomes for Californians with low incomes.

Facts and Data

Our research provides essential information on California’s health care landscape to drive improvement. We collect, analyze, and share timely data to inform policymaking, identify disparities, and support evidence-based solutions for a more equitable health system.

Health Care Costs/Affordability

Rising health care costs remain a major challenge in California and across the nation. CHCF’s work sheds light on trends in state and national health care spending, as well as on the affordability of health care for consumers, to spur dialogue and action toward policy solutions.

Health Equity

All Californians should have the opportunity to achieve their fullest potential for health. CHCF is working with a wide range of partners to remove structural barriers to care and build a just and equitable health care system that is designed to redress, not perpetuate, the inequities that too many of our fellow Californians face.

Health Insurance Coverage

During the COVID-19 pandemic the percentage of Californians with insurance has hit an all-time high. However, much work remains to ensure that all Californians can get and stay covered. CHCF produces data and analyses to inform efforts to protect coverage gains and further expand coverage so that all Californians can get the health care they need.

Health Workforce

Over the next decade, California faces a number of health workforce challenges, including a population that is growing, aging, and becoming more diverse. To meet these and other challenges, California must develop a modern health workforce that delivers smarter, more affordable care. That will require a new generation of health professionals with roles, skills, and workflows that match our latest understanding of how best to deliver high-quality, high-value care.

Homelessness

On any given day, more than 150,000 people experience homelessness in California. Being homeless is dangerous to your health: People who live on the streets die an average 20 years earlier than people who are housed. CHCF has launched work to improve the delivery of health and social services to people experiencing homelessness, with the goal of promoting care that is responsive, person-centered, and focuses on the patient’s emotional, physical, and psychological needs.

Maternal Health

Giving birth is the primary reason for hospitalizations in the US and California.  Annually, 500,000 babies are born in the state, with half paid for by Medi-Cal. There are significant, unwarranted variations in maternity care quality, alarming disparities, and wasted resources. CHCF aims to improve quality and lower the costs of maternity care in California, especially for birthing people with low incomes, by ensuring appropriate care and reducing disparities in outcomes. 

Medi-Cal

Medi-Cal is the state’s health insurance program for Californians with low incomes, including over 40% of all children, half of those with disabilities, over a million seniors, and one in five workers. CHCF reports provide data and analysis on how well Medi-Cal is serving Californians.

Older Adults

Too many older adults with complex health issues face multiple obstacles to getting the care and support they need. There are nearly three million Californians over age 50 who struggle to make ends meet while also facing significant health challenges. These adults, who get their care through Medi-Cal and, in some instances, Medicare, describe themselves as being in fair or poor health, and two-thirds report a disability due to a physical, mental, or emotional condition.

Primary Care

Our work in primary care strengthens the foundation of California’s health system. We support initiatives to expand access, enhance quality, address workforce shortages, and promote team-based care models that deliver comprehensive, culturally responsive services.

Technology and Innovation

From ending the opioid crisis to making care affordable for all, solving health care’s most intractable challenges will require innovative solutions. Through direct investments, grants, and partnerships, CHCF helps innovations succeed and scale in the safety net.

The post Topics appeared first on California Health Care Foundation.

Goal 1. Improving Access to Coverage and Care

We work to broadly strengthen California’s health care safety net so all Californians — especially those who qualify for Medi-Cal — have access to the care they need when they need it.

Key Focus Areas:

• Affordable Coverage: Ensuring that all with low incomes have affordable health insurance coverage and that all who are eligible for Medi-Cal are enrolled.
• Medi-Cal Improvement: Driving improvement and ensuring accountability around access, quality, and equity in Medi-Cal.
• Health Workforce: Developing a health workforce that reflects the diversity of California. Streamlining education and training options to reduce the cost and time it takes to become a health care worker. And cultivating the next wave of clinical leaders through the CHCF Health Care Leadership Program.
• Primary Care: Ensuring that all Medi-Cal members have access to high- quality, linguistically and culturally responsive primary care. Focusing on specific improvement related to primary care payment and financing, equity in primary care, and transforming the way primary care is delivered.
• Black Health Equity: Improving care and outcomes for Black Californians by working with health care partners to interrupt racism, build transparency and accountability around equitable care, and diversify the health care workforce. Includes work to advance Black birth equity in California.

Goal 2. Advancing People-Centered Care

We work to ensure that Californians — particularly those enrolled in Medi-Cal — receive responsive, comprehensive, and coordinated care that supports their health and well-being, and reduces inequities.

Key Focus Areas:

• Behavioral Health: Transforming mental health and substance use treatment so wherever and however care is delivered, it is effective, appropriate, and accessible, thereby improving outcomes and reducing inequities. Includes work to improve detection and treatment of maternal mental health conditions.
• People with Complex Needs: Helping Medi-Cal enrollees with challenging health or social circumstances get high-quality medical care and supportive services that improve their lives. Particular focus on people experiencing homelessness and older adults with low incomes, and supporting implementation of CalAIM.

Goal 3. Laying the Foundation

We invest in people, knowledge, and networks that are necessary for making meaningful change possible in California’s health care system.

Key Focus Areas:

• Market Analysis and Insight: Providing facts and data so decisionmakers have a market-wide view of California’s complex health care ecosystem.
• High-Quality Health Journalism: Supporting health journalism so Californians have
  access to timely, relevant information about the most pressing health care issues.
• State Policy Leadership: Developing the leadership and skills of California’s health state policy sector.
• Technology and Innovation: Enabling safety-net organizations and entrepreneurs to
  work together to bring needed innovation to the delivery system. Includes CHCF’s program-related investments aimed at innovation in Medi-Cal, promoting data exchange to support whole person care, and harnessing the power of AI to improve care and outcomes in the safety net.

The post Goals & Strategy appeared first on California Health Care Foundation.

View the Report

Doulas are non-medically trained professionals who provide health education, advocacy, and physical and emotional support for pregnant and postpartum people before, during, and after childbirth. A critical part of the maternity care workforce, doulas are not licensed as clinical providers and do not deliver babies. Nevertheless, the inclusion of doulas on labor and delivery teams is strongly correlated with positive health outcomes, especially for Black birthing people.

Empowering Birthing People and Improving Perinatal Outcomes

Research suggests doula care is associated with lower rates of c-sections, birth complications, and preterm births, as well as higher patient satisfaction and rates of breastfeeding. Because doulas center the needs and voices of their clients, doulas can be especially beneficial for birthing people of color, who face the greatest inequities in birthing outcomes.

• Medi-Cal coverage for doulas. In 2023, California’s Medi-Cal program began paying for doula services for the first time, opening the door for doula-attended births and related services for Medi-Cal enrollees. Because Medi-Cal covers 40% of California births, this represents a significant opportunity to advance birth equity.
• An expanding doula workforce. Today, nearly 250 doulas provide support for Medi-Cal enrollees giving birth across the state.
• Tracking doula-attended births. Doulas attended 11% of Medi-Cal births in 2018 and 8% of births covered by private insurance. These numbers climb to 15% of total births for Black mothers.

Californians Are Increasingly Interested in Doula Care

Studies show growing appreciation among mothers for care provided by doulas:

• 57% of women overall express interest in having doula support in a future birth, including 18% who “definitely” want a doula and 39% who would consider it.
• 66% of Black women prefer doula care — the highest rate of any racial/ethnic group — including 27% who say they would “definitely” want doula support for their next birth.

Policy Considerations: What Can State Leaders Do to Continue Expanding Access to Doulas?

• Promote expanded insurance coverage for doula care. Most insurance plans do not cover doulas, which is a major obstacle to birth equity.
• Raise awareness about the doula workforce. As evidence of the positive impact doulas can have on maternity care grows, more information is needed on how to attract people to this workforce and offer adequate compensation.
• Expand training opportunities through doula hubs. Support is also needed to expand doula hubs, which are centralized repositories of resources and training tools that are critical for helping doulas enroll to become Medi-Cal providers.

To learn more:

• DHCS: Doula Services as a Medi-Cal Benefit
• National Health Law Program: California Doula Workforce Analysis 2024 (PDF)
• The CHCF Blog: More Doulas Are Needed in California’s Health Workforce
• CHCF: Listening to Mothers in California survey (2018)

The post What Is a Doula? — Policy at a Glance appeared first on California Health Care Foundation.

At the California Health Care Foundation (CHCF), we know that health care is a basic human necessity. All Californians should have the opportunity to achieve their fullest potential for health. This includes not only access to health care, but also other social factors like housing, food, and jobs that contribute to a person’s well-being.

Why This Work Matters

One in three Californians lives in or near poverty. Because Californians with low incomes face the biggest health burden and the greatest barriers to care, our priority is to make sure they have access to high-quality care.

Income, however, is not the only factor that limits access to health care in California. Too many Californians face structural barriers to care based on factors like the color of their skin, their ethnic background, where they live, or the language they speak. Like the nation as a whole, California has long maintained policies, practices, and norms that are biased against people of color. Health care is just one of many systems —including housing, education, and employment —that perpetuate this structural racism and engender stark inequities in care and outcomes.

As the most culturally diverse state in the country, California can’t succeed without removing these barriers. We all have a stake in eliminating racism from California’s health care system. For these reasons, health equity is the primary lens through which we focus our work at CHCF.

Our Vision for Health Equity

A just and equitable health care system is one that is designed to redress, and not perpetuate, the inequities that too many of our fellow Californians face.

We envision a health care system where…

• All Californians get the care they need when they need it
• Care is responsive, respectful, comprehensive, and coordinated
• The health care team represents the diversity of California and is trained and supported to deliver culturally and linguistically appropriate care without bias

Our Strategy for Advancing Health Equity

CHCF works on many different fronts to make California’s health care system more just. Specifically, there are five ways we are working to drive change across California’s health care system.

1. Using data to monitor both inequity and improvement
2. Driving improvement through state policy
3. Dismantling racism in the health care delivery system
4. Ensuring that the health workforce reflects California’s diversity
5. Investing in community leaders and organizations

To support the strategies above, CHCF has specific initiatives to improve health equity among Black and Latino/x Californians.

Some examples of our work:

1. Using data to monitor both inequity and improvement

• Listening to Black Californians. CHCF commissioned a major study on Black Californians’ experiences of racism and health care.  
• Measuring Equity. CHCF has partnered with the National Committee for Quality Assurance to develop a standard framework for health equity measurement for state Medicaid agencies to use.

2. Driving improvement through state policy

• Removing Coverage Barriers. CHCF has supported research, advocacy, and outreach efforts aimed at removing all remaining barriers to Medi-Cal based on immigration status.  
• Medi-Cal Procurement. CHCF supported research and advocacy to strengthen procurement of Medi-Cal managed care, with a goal of improving quality of care and eliminating inequities by race and ethnicity. 

3. Dismantling racism in the health care delivery system

• Implicit-Bias Training. CHCF helped develop an evidence-based online course to teach maternity care providers to identify and address bias. The training includes identifying unconscious biases and misinformation, power dynamics, impact of historical oppression of minority communities, and local perspectives on provider–community relations.
•  Anti-Racism Tools. Through the California Improvement Network, CHCF is helping health care delivery organizations understand anti-racism as a legitimate health intervention, develop communication tools for confronting racism denial, and use tools to combat racism. 

4. Ensuring that the health workforce reflects California’s diversity

• Community-Based Workforce. CHCF has been developing tools and providing technical assistance to integrate community health workers and promotores in the delivery and coordination of care in Medi-Cal.  
•  Pipeline Programs. CHCF has also partnered with other health funders to support the California Medicine Scholars Program, which taps into the diversity of the California Community Colleges to support and increase the numbers of underrepresented minority physicians. 

5. Investing in community leaders and organizations

• Entrepreneurs of Color. The CHCF Innovation Fund has provided investment dollars and technical assistance to bring more health tech entrepreneurs with valuable lived-experience into the Medi-Cal space.  
•  Community Resilience. CHCF has been providing support to statewide and regional organizations — like the Latino Community Foundation and Black Equity Collective — for community resilience, disaster preparedness, and disaster recovery. The emphasis of this initiative is building under-resourced communities’ ability to respond to and recover from emergencies by providing support before a disaster occurs. 

The post Our Approach to Health Equity appeared first on California Health Care Foundation.

At the California Health Care Foundation (CHCF), we know that health care is a basic human necessity. All Californians should have the opportunity to achieve their fullest potential for health. This includes not only access to health care, but also other social factors like housing, food, and jobs that contribute to a person’s well-being. Read more about our values as an organization.

Why This Work Matters

One in three Californians lives in or near poverty. Because Californians with low incomes face the biggest health burden and the greatest barriers to care, our priority is to make sure they have access to high-quality care.

Income, however, is not the only factor that limits access to health care in California. Too many Californians face structural barriers to care based on factors like the color of their skin, their ethnic background, where they live, or the language they speak. Like the nation as a whole, California has long maintained policies, practices, and norms that are biased against people of color. Health care is just one of many systems —including housing, education, and employment —that perpetuate this structural racism and engender stark inequities in care and outcomes.

As the most culturally diverse state in the country, California can’t succeed without removing these barriers. We all have a stake in eliminating racism from California’s health care system. For these reasons, health equity is the primary lens through which we focus our work at CHCF.

Our Vision for Health Equity

A just and equitable health care system is one that is designed to redress, and not perpetuate, the inequities that too many of our fellow Californians face.

We envision a health care system where…

• All Californians get the care they need when they need it
• Care is responsive, respectful, comprehensive, and coordinated
• The health care team represents the diversity of California and is trained and supported to deliver culturally and linguistically appropriate care without bias

Our Strategy for Advancing Health Equity

CHCF works on many different fronts to make California’s health care system more just. Specifically, there are five ways we are working to drive change across California’s health care system.

1. Using data to monitor both inequity and improvement
2. Driving improvement through state policy
3. Dismantling racism in the health care delivery system
4. Ensuring that the health workforce reflects California’s diversity
5. Investing in community leaders and organizations

To support the strategies above, CHCF has specific initiatives to improve health equity among Black and Latino/x Californians.

Some examples of our work:

1. Using data to monitor both inequity and improvement

• Listening to Black Californians. CHCF commissioned a major study on Black Californians’ experiences of racism and health care.  
• Measuring Equity. CHCF has partnered with the National Committee for Quality Assurance to develop a standard framework for health equity measurement for state Medicaid agencies to use.

2. Driving improvement through state policy

• Removing Coverage Barriers. CHCF has supported research, advocacy, and outreach efforts aimed at removing all remaining barriers to Medi-Cal based on immigration status.  
• Medi-Cal Procurement. CHCF supported research and advocacy to strengthen procurement of Medi-Cal managed care, with a goal of improving quality of care and eliminating inequities by race and ethnicity.  

3. Dismantling racism in the health care delivery system

• Implicit-Bias Training. CHCF helped develop an evidence-based online course to teach maternity care providers to identify and address bias. The training includes identifying unconscious biases and misinformation, power dynamics, impact of historical oppression of minority communities, and local perspectives on provider–community relations.
•  Anti-Racism Tools. Through the California Improvement Network, CHCF is helping health care delivery organizations understand anti-racism as a legitimate health intervention, develop communication tools for confronting racism denial, and use tools to combat racism. 

4. Ensuring that the health workforce reflects California’s diversity

• Community-Based Workforce. CHCF has been developing tools and providing technical assistance to integrate community health workers and promotores in the delivery and coordination of care in Medi-Cal.  
•  Pipeline Programs. CHCF has also partnered with other health funders to support the California Medicine Scholars Program, which taps into the diversity of the California Community Colleges to support and increase the numbers of underrepresented minority physicians. 

5. Investing in community leaders and organizations 

• Entrepreneurs of Color. The CHCF Innovation Fund has provided investment dollars and technical assistance to bring more health tech entrepreneurs with valuable lived-experience into the Medi-Cal space.  
• Community Resilience. CHCF has been providing support to statewide and regional organizations — like the Latino Community Foundation and Black Equity Collective — for community resilience, disaster preparedness, and disaster recovery. The emphasis of this initiative is building under-resourced communities’ ability to respond to and recover from emergencies by providing support before a disaster occurs. 

The post Our Approach to Health Equity appeared first on California Health Care Foundation.

The Bay Area’s vibrant communities of Latino/x and indigenous Mayan immigrants have been underserved by and underrepresented in mainstream media coverage for many years — a situation that contributes to immigrants’ hesitancy to trust institutions that could provide lifesaving help to them. 

In 2018, Oakland native Madeleine Bair founded an innovative participatory journalism model in which members of these immigrant communities — whose numbers include Spanish-speaking Latinos/x as well as those belonging to the city’s growing population of indigenous, Mam-speaking Mayan immigrants from Guatemala — help to shape the content it produces. 

Pulling its name from the Spanish word for “eardrum,” El Tímpano responds directly to information gaps identified by readers, many of which relate to health and health care. Using innovative methods — a text-messaging service that sends information directly to subscribers, for example, and a misinformation defense program that educates community members to identify and combat false narratives — Bair’s team has helped El Tímpano readers understand vaccine safety, Medi-Cal eligibility, and more. While El Tímpano is not the first and certainly not the only media outlet that serves the Latino/x and indigenous populations in California or even the Bay Area, important insights about trust and misinformation can be learned from Bair’s innovative approach.

Bair built her career by bridging the worlds of journalism and participatory media. She cut her teeth in news as a youth reporter in Oakland. She later completed a master’s degree in journalism at UC Berkeley, ran a program helping media activists and eyewitnesses around the world document human rights abuses, and led an initiative dedicated to advancing the use of citizen video as a tool for human rights. 

She believes that developing a reliable and thriving information ecosystem for and with the Bay Area’s Spanish-speaking immigrants requires that trust be established between journalists and community members. “Trust is at the foundation of our work,” Bair told me in a recent interview. The following transcript of our conversation has been lightly edited for clarity and length.  

Q: How is El Tímpano different from other journalism models?  

A: Broadly speaking, our objective is to foster a more informed and engaged community by crafting verified, impactful journalism. Our newsroom does in-depth reporting based on and powered by what we hear from our community, and we publish that on our website. We partner with other media outlets and trusted institutions like schools and churches. It’s all very participatory. We work to meet people where they are. 

Q: Why did you want to reach this community in particular?  

A: As someone who grew up in a very diverse city, I’ve always been frustrated that news media outlets don’t portray the diversity of the communities they purport to cover. As an eight-year-old in a local youth media program, I was taught to analyze the media and ask questions like: Who do media serve? Who is harmed by the media? Whose perspectives are portrayed and whose are left out in news coverage? I’ve carried those questions with me throughout my career.  

When I moved back to Oakland in 2017 after many years away, I learned that Latino/x immigrants were the fastest-growing group in the city. But you would have no idea that was true by consuming local media. You simply didn’t see their voices, stories, or concerns reflected in local narratives and civic conversations.  

I am neither Latina/x nor an immigrant, but I married into a Latino/x immigrant family. That experience has given me a much closer view of the inequities that exist within and are perpetuated by local media. While I — a White, college-educated, digitally savvy English speaker — have so many sources of information at my fingertips, my in-laws’ experience is completely different. Through them, I’ve witnessed the consequences of having limited access to news and information. El Tímpano seeks to address this gap, so those who don’t necessarily speak English or have access to email or a smartphone can still get the news they need to make informed decisions.  

Q: Describe the process of launching this media organization.  

A: El Tímpano was established through building relationships of trust with the communities that we wanted to serve. Most news outlets start with a newsroom with reporters and editors and then create content and build an audience. We flipped that model on its head. 

Before launching, we spent nearly a year just listening to Oakland’s Latino/x and Mayan immigrant community leaders and community members to learn what they wanted to see in local Spanish-language media. In those conversations, we heard many critiques of the existing Spanish-language media landscape: that it was sensational, that it only covered attacks on their community, and that it didn’t give people enough information they could use. When we asked people what they wanted from local media, the most common answer was “más información” (PDF) — more information.  

Before hiring reporters, we hired community outreach workers to introduce El Tímpano to community members, have conversations with them, and respond to their questions. We developed content strategies and distribution mechanisms, but to this day, the number one way that community members learn about and subscribe to El Tímpano is by meeting someone from our team. We’ve taken time to invest in and maintain the community’s trust, and I think that’s why we have such an engaged and loyal audience.  

Q: How does El Tímpano distribute information to that audience?  

A: Our primary vehicle is a text-messaging platform through which we provide Spanish-language news and information. We adopted this approach because so many of our community members don’t have a home computer or home internet, but pretty much everyone has a phone.  

Critically, subscribers can respond to those text messages. They can write back just to say “thank you,” or they can respond with a question or to share their story. Whenever someone writes to us, they get a response, so they know that there’s someone listening on the other end. That ongoing two-way communication has really helped us develop a relationship of trust with our audience.  

Q: How do you guide community members to reliable health information? 

A: We developed this platform at the onset of the pandemic, when people had a lot of questions. In these underinsured communities, people didn’t necessarily have a doctor they could call. That lack of relationship with a health institution is one reason immigrant communities are reluctant to trust public health officials.  

During the rollout of COVID vaccines, El Tímpano answered more than 1,500 questions from text subscribers, which gave us insight into the reasons behind vaccine hesitancy. Their reluctance mostly stemmed from people having nowhere to go for answers to very personal health questions, like whether vaccines were safe for cancer survivors, or if a child with asthma would be eligible. Many people told us that our information helped them to make the decision to get a vaccine.  

People are very conscious that they don’t have all the health information they need. El Tímpano works to fill that gap by being an ongoing source of verified information, as well as a platform that people can go to if they have questions and can’t get answers elsewhere. 

Q: With all this in mind, how does your newsroom operate?  

A: We produce two different types of journalism: conventional in-depth reporting, which is what is on our website; and service journalism, which is news you can use and is in response to the needs expressed by community members. It helps readers access resources to make informed decisions for their families and communities. It’s produced for our Spanish- and Mam-speaking audiences through text messages and through a Mam-language video series that we distribute on Facebook.  

Health has always been the number one topic of interest for our community. For two years now, we’ve been covering the expansion of Medi-Cal to immigrants regardless of legal status. We let people know what policies have changed, who is eligible, and what phone number to call to register or learn more.  

We also just published a long story about the ongoing chilling effect that Trump’s 2019 “public charge” policy has had on immigrant communities. Although this policy was reversed by Biden, the community has remained hesitant to access certain government benefits that they are entitled to and that impact their health. Hopefully, by being that source of information, we can help combat those fears.  

Q: Can you tell me more about the types of misinformation that target El Tímpano’s community?  

A: Immigrant communities have long been the targets of disinformation and scams that take advantage of their vulnerabilities and of the structural challenges they face — from financial precarity, to housing insecurity, to inequitable health access. People receive letters in the mail with false ATM cards, or individuals seeking housing are asked to pay a security deposit in cash, which then disappears. A lot of these scams proliferate on social media.  

There are many deeper reasons people might fall victim to health-related scams or misinformation, one of which is being underinsured. They often have fewer options for care and must wait longer to see a provider, which means they may turn to other, less reliable sources of health care or information. Recently, a community member told us she had to wait so long to get a doctor’s appointment that she just gave up and used home remedies. For similar reasons, others have told us they have turned to supplements advertised online.

Q: How does El Tímpano help subscribers fight back? 

A: One of our most important innovations is our misinformation defense training program, through which we have trained more than 100 Spanish-speaking immigrants and community leaders across the Bay Area to identify misinformation, so they can halt its spread. The program takes inspiration from the promotora model of community health education — a practice with deep roots in Latino/x cultures, where community members serve as trusted messengers of health information. We started the program at the height of COVID-19 vaccine misinformation.  

As a small organization, we lack the capacity to debunk or verify every piece of misinformation. Instead of taking a fact-checking approach, we train community members to be more informed, more judicious consumers of information. The program focuses on the tactics of spreading and identifying misinformation, because those techniques are the same whether the topic is health, politics, or finance. While great resources have been developed around how to verify online information, most have been developed for professional journalists, not average consumers — not to mention non-English speakers. We also created a series of text messages that share key takeaways with our thousands of text-messaging subscribers. Recipients of those texts are asked to send us examples of potential misinformation they’ve come across, so we can look into it. In that way, we are fostering a healthy skepticism among community members.  

The response has been great. It’s something people are hungry for. Community members tell us that with so much misinformation swirling around, it’s impossible to know what to believe. That uncertainty is a core objective of targeted disinformation, so by providing this program, we are helping to mitigate that. 

Q: After the 2024 election, you reconfirmed El Tímpano’s commitment to being a trusted source of information for immigrant communities. Will the platform approach the second Trump administration any differently?  

A: El Tímpano started during the first Trump administration. In the participatory design process, many immigrants told us they were avoiding news because it focused on attacks on their community or because it caused them to panic. A lot of us can relate to that feeling, but avoiding the news also can leave people fearful and vulnerable to misinformation.  

We are providing people with information that gives them agency and doesn’t leave them feeling powerless. Trump has already said his administration will be targeting immigrant communities for massive deportations. Our core values will remain unchanged: We want to support people to have the knowledge and confidence they need to make informed decisions during the next Trump administration.

Authors & Contributors

Robin Buller

Robin Buller is an Oakland-based writer, researcher, and editor. She has reported on harm reduction, maternal health, migration, housing, and policing for The Guardian, The Oaklandside, and other publications.

Originally from Canada, she holds a doctorate in history from UNC Chapel Hill and has lived in California since 2018.

Carolyn Fong

Carolyn Fong is a commercial, editorial, brand, and portrait photographer working throughout the San Francisco Bay Area. She specializes in imagery that celebrates the craft, the people, and the spaces that create community. She earned a Bachelor of Fine Arts in photography and imaging from the Art Center College of Design in Pasadena, California, and has practiced photography since 2005. Fong is a proud member of two important organizations, Diversify Photo and Women Photograph.

The post Civic Media Pioneer Builds Trusted Information Source for Immigrants appeared first on California Health Care Foundation.

Case Study

Innovation Landscape: Services to Support Independent Living in the Community

In this report, the authors survey the current landscape of organizations to help plans navigate the emerging market for Community Supports. The analysis considers a range of large regional nonprofits, smaller venture-backed companies, and a few organizations that provide adjacent or enabling services.

April 18, 2023

Older Adults

Innovation Landscape: School-Based Access to Behavioral Health Care for Youth

February 15, 2023

Behavioral Health

Medi-Cal and Opportunities for Health Tech in Home-Based Medical Care

March 9, 2022

Technology and Innovation

Innovation Landscape — Solving Shortages: How Technology Can Help Meet California’s Immediate Health Workforce Needs

November 23, 2021

Health Workforce

Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know

July 9, 2021

Technology and Innovation

Report

Innovation Landscape: Maternity Care in Medi-Cal

This paper examines the opportunities for technology-enabled innovations to improve the value and quality of the maternity care that Medi-Cal delivers.

August 28, 2020

Maternal Health

Innovation Landscape: Telehealth MAT

June 5, 2019

Technology and Innovation

The post Innovation Landscape appeared first on California Health Care Foundation.

In her previous role as a senior program officer, Kathryn managed the California Improvement Network and led the foundation’s efforts to advance primary care, including modernizing payment for Federally Qualified Health Centers and public health care systems, accelerating the adoption of integrated behavioral health care statewide, and improving population health management capabilities among providers that serve Medi-Cal members. She continues to lead programming to improve health equity by fostering greater investment in primary care systemwide.

Before joining CHCF, Kathryn was the program director for practice transformation at Qualis Health (now Comagine Health), a nonprofit population health consulting firm. She directed regional and national quality improvement projects, including the landmark Safety Net Medical Home Initiative, which developed and tested an evidence-based framework to guide primary care redesign efforts. Her portfolio also included initiatives to advance care integration and the capacity of primary care practices to deliver behavioral health and oral health services.

Previously, Kathryn worked at the National Business Group on Health, where she built public-private partnerships to create evidence-based purchasing guidelines and workplace health programs to advance clinical preventive services, maternal and child health, and behavioral health. Kathryn holds a bachelor’s degree in anthropology from the University of Oregon and a master’s degree in public health from the University of Michigan.

The post Kathryn Phillips appeared first on California Health Care Foundation.