California’s Race-Based Pregnancy Funding
DOJ could cut funding to programs exclusively for “Black Women and Birthing People”
In April 2026, a pregnant woman in Pasadena sued the Los Angeles Department of Public Health after they denied her medical services because she was not black.
After learning that Mrs. Jimenez is not black, a BIH program coordinator informed Mrs. Jimenez that the program was not for her … Mrs. Jimenez was denied publicly funded services for healthy pregnancies and early childhood development – services available to others solely because they fit the government’s preferred race.
California birth and motherhood programs continue to deny medical care based on race. Three discriminatory California programs — the CalAIM Enhanced Care Management Birth Equity Population of Focus (“Birth Equity”), the Black Infant Health Program, and the Perinatal Equity Initiative — spend millions in federal Medicaid funding annually, making them susceptible to DOJ enforcement.
| Program | Violation | Quote |
|---|---|---|
| CalAIM Enhanced Care Management — Birth Equity Population of Focus | The Fourteenth Amendment’s Equal Protection Clause, race discrimination by State actors Title VI, 42 USC. § 2000d, race discrimination in federally assisted programs ACA § 1557, 42 USC. § 18116, race discrimination in federally assisted health programs 42 USC. § 2000d-4a, race discrimination in a state or local “program or activity” 45 C.F.R. § 92.4, race discrimination in all operations of a state or local health agency | “MCPs are expected to partner closely with … Organizations serving Black, AI/AN [American Indian / Alaska Native] and Pacific Islander individuals” |
| California Black Infant Health Program | “We Serve: Black women and birthing people who are 16 years or older, pregnant, or up to six months postpartum at the time of enrollment, regardless of income.” | |
| California Perinatal Equity Initiative | “The California Perinatal Equity Initiative (PEI) is a community-driven and implemented initiative designed to address racial disparities in infant mortality by providing meaningful support and resources to Black families.” |
All three programs receive federal Medicaid funding and matching funds from the State of California. Based on state records, Effort estimates that Birth Equity bills $32.17 million per year,1 including an estimated $16.08 million in federal Medicaid funding.2
Sources: CDPH BIH award notice; CDPH PEI funding page; Fresno County agreement; San Diego County PEI agreement.
CDPH lists annual spending of $24.8M for BIH and $7.2M for PEI, respectively.3 BIH’s spending includes $3.9 million in federal Title V block grants, in addition to Medicaid.
Authors of the Civil Rights Act and its expansions promised that it granted equal protection against anti-white discrimination.
No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.
Civil Rights Act of 1964, § 601, 42 USC. § 2000d
However, the prohibition on anti-white discrimination was rarely enforced in practice. That changed in 2025, when the Department of Justice issued new policy guidance.
Federal antidiscrimination laws apply to programs or initiatives that involve discriminatory practices, including those labeled as Diversity, Equity, and Inclusion (“DEI”) programs.
Department of Justice, July 30, 2025
Federal funding recipients may also be liable for discrimination if they knowingly fund the unlawful practices of contractors, grantees, and other third parties.
Attorney General guidance, July 29, 2025, p. 4
In 2026, the DOJ Civil Rights Division began to act on anti-white discrimination. It closed a Minnesota Department of Health review after the state ended a grant favoring organizations “serving and led by people of color”, and closed an Illinois review after the state removed a 30 percent racial set-aside from a loan-repayment program.
If the State of California does not remove racial requirements from its programs, Title VI or Section 1557 review could suspend their federal Medicaid funding.
As this investigation shows, California’s racial preference system is not going down without a fight.
1 Applying Partnership HealthPlan’s public contracted rate of $400 per enrolled member per month as a benchmark to DHCS’s Q3 2025 ECM members-by-population data (6,702 publicly countable enrolled members in the third quarter of 2025) produces an estimated annual Medi-Cal payment of $32.17 million. ↩
2 California receives 50 percent federal reimbursement for traditional Medicaid expenditures, 90 percent for ACA expansion adults, and 65 percent for CHIP expenditures. DHCS budgets these rates separately. The public Birth Equity enrollment data omit members’ underlying eligibility and aid codes, so the program’s weighted federal percentage cannot be calculated from the enrollment count. The 50 percent rate is a conservative, base-rate scenario. ↩
3 CDPH’s BIH award notice lists the program’s annual spending, and its PEI funding page states the annual PEI award. Fresno County Board of Supervisors agenda item 25-0896 assigns Black Infant Health $535,990 in federal Medicaid reimbursements—37.2 percent of its $1,439,990 budget—and PEI $127,180—17.6 percent of its $722,824 budget. Not all counties provided this breakdown, so these percentages are estimates for statewide federal Medicaid reimbursement. Effort estimated Title XIX spending for both programs from county-level disclosures. ↩