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AB-2199 Birthing Justice for California Families Pilot Project.(2021-2022)

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Date Published: 09/01/2022 09:00 PM
AB2199:v94#DOCUMENT

Enrolled  September 01, 2022
Passed  IN  Senate  August 29, 2022
Passed  IN  Assembly  August 30, 2022
Amended  IN  Senate  August 25, 2022
Amended  IN  Senate  June 06, 2022
Amended  IN  Assembly  March 31, 2022
Amended  IN  Assembly  March 17, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 2199

Introduced by Assembly Member Wicks
(Coauthor: Assembly Member Mia Bonta)

February 15, 2022

An act to add and repeal Article 2.1 (commencing with Section 123450) of Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, relating to doula care.


LEGISLATIVE COUNSEL'S DIGEST


AB 2199, Wicks. Birthing Justice for California Families Pilot Project.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the department to convene a workgroup to examine the implementation of the Medi-Cal doula benefit, as specified. Existing law also requires the department, no later than July 1, 2024, to publish a report that addresses the number of Medi-Cal recipients utilizing doula services and identifies barriers that impede access to doula services, among other things.
This bill would establish the Birthing Justice for California Families Pilot Project, which would include a 3-year grant program to provide grants to specified entities, including community-based doula groups, to provide doula care to members of communities with high rates of negative birth outcomes who are not eligible for Medi-Cal and incarcerated people. The bill would require the State Department of Public Health to take specified actions with regard to awarding grants, including awarding grants to selected entities on or before July 1, 2024. The bill would require a grant recipient to use grants funds to pay for the costs associated with providing doula care to eligible individuals and to establish, manage, support, or expand doula services, including technical assistance to nascent doulas or doula groups. The bill would require a grant recipient, in setting the payment rate for a doula being paid with grant funds, to comply with specified parameters, including that the payment rate not be less than the Medi-Cal reimbursement rate for doulas or the median rate paid for doula care in existing local pilot projects providing doula care in California, whichever is higher. The bill would require the department, on or before January 1, 2029, to submit a report to the appropriate policy and fiscal committees of the Legislature on the expenditure of funds and relevant outcome data for the pilot project. The bill would repeal these provisions on January 1, 2029.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Reproductive justice is a framework created by Black women in 1994 to address the intersectional and multifactored issues that women of color and their families face in society.
(b) Reproductive justice is the human right to control our bodies, sexuality, gender, work, and reproduction. That right can only be achieved when all people, particularly women and girls, have the complete economic, social, and political power and resources to make healthy decisions about their bodies, families, and communities in all areas of their lives. Two of the core tenets of reproductive justice are the right to have children and the right to parent the children we have with dignity and respect in safe and sustainable communities.
(c) Reproductive justice affirms that every birthing person is entitled to dignity and demands that they are equipped with the necessary supports for a safe, joyous, and positive birthing process.
(d) With the overturning of Roe v. Wade, the maternal mortality rate is projected to increase by more than 33 percent for Black birthing people and 21 percent overall. Birthing people need the supports necessary to support positive birth outcomes and cost should not be a barrier to obtain these critical supports.
(e) Where 60 percent of pregnancy-related deaths are preventable and structural racism and implicit bias have been identified as root causes for disparities in adverse birth outcomes for Black, Indigenous, and people of color (BIPOC) women and birthing people, a multileveled approach to address this persistent crisis is necessary.
(f) Growing evidence indicates that expanding access to doula care during the perinatal period is a critical step toward advancing maternal health equity, as this approach has been shown to improve birth outcomes and reduce medical costs.
(g) While proving to be a beneficial and integral aspect of care for pregnant, birthing, and postpartum people, particularly pregnant, birthing, and postpartum people of color, the cost of doula care poses a barrier to access for a significant percentage of the population.
(h) Research demonstrates that doulas can be particularly beneficial for pregnant and birthing women of color, women with low incomes, and women living in underserved communities. While not all birthing people identify as women, research suggests that the same findings would likely be applicable to all birthing people. It is clear, though, that research that contemplates or specifically accounts for the birthing experiences of transgender, nonbinary, and gender nonconforming birthing people is necessary.
(i) Expanding access to doula care can help reduce health disparities by ensuring that pregnant people who bear the greatest risks for adverse birth outcomes have the added support they need to have a positive birthing experience.
(j) A growing body of evidence reveals that support from a doula during labor and delivery is associated with improved birth outcomes that include, among others, lower cesarean rates, lower preterm birth rates, fewer obstetric interventions, fewer complications, higher infant Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores, and a more positive, self-reported birth experience.
(k) Although California has made advancements in providing health care coverage and doula care for low-income birthing people, there are birthing people who experience deep disparities in birth outcomes that do not have access to these advancements, including Black birthing people that have incomes just above the level required to be eligible for Medi-Cal and incarcerated birthing people. For Black birthing people, the increased risk of pregnancy related death persists regardless of socioeconomic status or income level and education.
(l) Although California’s overall maternal mortality rate has declined by 65 percent since 2006, mortality and morbidity for Black and Indigenous pregnant people remain considerably higher than the state’s average.
(m) In California, Black women are overrepresented in pregnancy-related deaths from all causes and the data shows that racial and ethnic disparities in pregnancy-related mortality ratios (PRMR) has widened such that the PRMR for Black women is four to six times greater than their counterparts.
(n) In California, the rate of preterm births among Black and Indigenous birthing people is 40 percent higher than preterm births for their White counterparts, while Latinx birthing people have the second highest rate of low birthweight babies in the state.
(o) Approximately 210,595 women were in state or federal prison or jail in the United States at the end of 2015, a 645-percent increase since 1980. Additionally, almost three-quarters of incarcerated women fall within the prime childbearing age range of 18 to 44 years of age, inclusive. This means that it is likely that a number of people who are capable of giving birth will enter prison or jail while pregnant or during the postpartum period.
(p) Chapter 321 of the Statutes of 2020, the Reproductive Dignity for Incarcerated People Act, expanded incarcerated pregnant people’s access to a support person, including a doula, during labor, childbirth, and during postpartum recovery while hospitalized.
(q) The Minnesota Prison Doula Project discovered that incarcerated participants had healthier pregnancies and babies than those who did not participate in the program. Doula care for incarcerated people has been found to promote a more satisfying birthing experience overall.
(r) An integral component of care in the perinatal period, doula care can easily add up to over 100 hours of care for each client during the perinatal period. Compensation for doula care services should adequately reflect the level of care that doulas provide each client, support the provision of high-quality care to clients, provide a sustainable living wage for doulas, and encourage uptake and doula participation in service provision or the profession.
(s) A stated goal of the State Department of Public Health is to reduce health and mental health disparities among vulnerable and underserved communities to achieve health equity throughout California. This should extend to ensuring health equity for all birthing people and babies.
(t) In an effort to maintain accuracy, when referring to existing research, the categories and identifiers use gendered terms such as, “women” or “female.” It is recognized, though, that not all people capable of giving birth identify as women or female.

SEC. 2.

 Article 2.1 (commencing with Section 123450) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read:
Article  2.1. Birthing Justice for California Families Pilot Project

123450.
 For the purposes of this article, the following definitions apply:
(a) “Community-based doula” means a birth worker who provides doula care throughout the perinatal period, who is a trusted member of the community they serve, and who specializes in the provision of culturally congruent care, addressing discrimination, and meeting language gaps. A community-based doula is one that provides doula care in alignment with the State Department of Health Care Services definitions.
(b) “Community-based doula group” means a group or collective of community-based doulas working together that prioritizes access to doula care for underserved populations. The doula care that is provided by community-based doula groups often goes beyond doula services provided during prenatal and postpartum care, to encompass a broader and more holistic vision of support for the pregnant and birthing person and their family or supporting loved ones. Many community-based doula groups draw their membership directly from the communities that they serve. This often allows community-based doula groups to offer culturally congruent care, and not simply culturally appropriate care.
(c) “Department” means the State Department of Public Health.
(d)  “Perinatal period” means the period including pregnancy, labor, delivery, and postpartum.
(e)  “Postpartum” means the one-year period following the end of a pregnancy.

123450.1.
 (a) The Birthing Justice for California Families Pilot Project is hereby established. The pilot project shall, upon an appropriation by the Legislature for this purpose, include a three-year grant program to fund community-based doula groups, local public health departments, and other organizations to provide doula care to members of communities with high rates of negative birth outcomes who are not eligible for Medi-Cal and incarcerated people. The pilot project shall be administered by the department.
(b) In awarding grants pursuant to this article, the department shall do all of the following:
(1) On or before January 1, 2024, post applications for grants on its internet website and solicit applications.
(2) On or before July 1, 2024, award grants to selected entities based on the eligibility criteria.
(3) Require grant recipients to submit data to evaluate the pilot project, as determined by the department or its contractor, and establish standard metrics to ensure consistency in data collection.
(c) The department shall not spend more than 15 percent of the funds appropriated for the purposes of this article on administrative costs.
(d) All of the following entities shall be eligible to apply for grant funding under the pilot program:
(1) Community-based doula groups.
(2) Community-based organizations serving pregnant, birthing, and postpartum people with accurate information that is generally accepted and approved of within the doula profession.
(3) Birthing centers.
(4) Local public health departments.
(5) Public and district hospitals with programs serving birthing people.

123450.2.
 (a) A grant recipient shall use grant funds to pay for costs associated with providing doula care to individuals identified in subdivision (c). Grant funds shall be used to establish, manage, support, or expand doula services, including technical assistance to nascent doulas or doula groups established by community-based doula groups. Initial or on-going trainings funded through the grant shall align with the core competencies described in subdivision (d) to people who want to become doulas or community-based doulas. Costs associated with providing doula care include, but are not limited to, all of the following:
(1) Payment for doulas.
(2) Expenses incurred while engaged in doula professional practice. Expenses may include, but are not limited to, travel, supplies, professional liability insurance, rent, and licenses and educational and training fees.
(3) Educational materials and materials and credentialing fees to qualify under the Medi-Cal program’s doula benefit.
(4) Building, enhancing, or increasing community capacity to provide care.
(5) Costs associated with obtaining clearance to enter detention facilities.
(6) Administrative costs associated with providing doula care. However, no more than 15 percent of grant funds may be used for administrative costs.
(b) All of the following shall apply to a grant recipient in setting the payment rate for a doula who is being paid with grant funds:
(1) A grant recipient shall include within the payment rate payment for perinatal care, including doula care support at three prenatal appointments or visits, doula care support throughout labor and delivery, postpartum care, including doula care support at a minimum of two postpartum appointments or visits, and additional services that encompass a broader and more holistic vision of support for the pregnant person and their family or supporting loved ones.
(2) A grant recipient shall not set the payment rate at an amount less than the Medi-Cal reimbursement rate for doulas or the median rate paid for doula care in existing local pilot projects providing doula care in California, whichever is higher.
(3) A grant recipient shall consider all of the following when determining the payment rate for a doula:
(A) The cost of living within the community served by the grant recipient.
(B) The market rate for doula care in the community served by the grant recipient.
(C) The minimum sustainable living wage in the community served by the grant recipient.
(c) A grant recipient may use grants funds to provide doula care to pregnant and birthing people in communities that experience high rates of birth disparities with incomes less than 600 percent of the federal poverty level who do not qualify for Medi-Cal, including, but not limited to, people incarcerated in jail, prison, or other institutions.
(d) Doulas who are paid with grant funds shall demonstrate the core competencies required to provide services under the Medi-Cal program’s doula benefit.

123450.3.
 On or before January 1, 2029, the department shall submit a report to the appropriate policy and fiscal committees of the Legislature on the expenditure of funds and relevant outcome data for the pilot project. The report shall examine the impact of the pilot program on a range of outcomes, including those focused on client and client family experience, prenatal and postpartum care engagement, doula workforce retention, cost savings, and clinical outcomes.

123450.4.
 This article shall remain in effect only until January 1, 2029, and as of that date is repealed.