Medi-Cal, California’s Medicaid program, is responsible for providing comprehensive health care for approximately half of all children and half of all pregnant people in California – over 6 million lives. Roughly 80% of pregnant people and 60% of infants covered by Medi-Cal are people of color, making the Medi-Cal program a key driver in reducing and eliminating racial/ethnic health disparities in perinatal and child health. However, data show deep racial disparities in access to care. As the state engages in efforts to redesign Medi-Cal to promote health care access, quality, and equity, leaders must prioritize innovations that reverse these troubling trends and are responsive to the unique needs of infants and pregnant people.