Access gaps remain for Californians
California’s Medicaid program, Medi-Cal, stands at a pivotal juncture after years of ambitious reforms and expansions. As the state pushes forward with its vision of comprehensive, equitable healthcare for all eligible Californians, the program faces both promising opportunities and significant challenges.
Although California reached its lowest uninsured rate in 2022, access barriers to timely, quality, and equitable health care still remain for many Californians. These access gaps result in health disparities, as people from underserved groups — particularly low-income individuals and people of color — experience higher rates of illness and death.
Currently, Medi-Cal covers about 15.28 million people, with over 50% of enrollees being Latino.
The CalAim Initiative
The CalAIM initiative, launched by Governor Gavin Newsom as a $12 billion experiment to transform Medi-Cal into a more comprehensive social services provider, is at the forefront of this evolution. Over the past decade, the Department of Health Care Services (DHCS) has made historic investments to eliminate health disparities by transforming Medi-Cal disparities and creating a more equitable healthcare landscape in California.
At an Ethnic Media Services’ briefing on June 18th, DHCS leaders and community health care providers discussed the Health Equity Roadmap, what it looks like implemented on the ground, and the road ahead for a more equitable Medi-Cal.
This comprehensive overhaul has been marked by several groundbreaking initiatives. In a landmark move, Medi-Cal eligibility has been extended to all low-income Californians, irrespective of immigration status, ensuring that vulnerable populations previously excluded from healthcare coverage can now access vital medical services.
The elimination of the “asset test” represents a significant shift in Medi-Cal’s approach to eligibility determination, streamlining the application process by focusing solely on income. “Too often, people in communities of color face larger health disparities and are more likely to distrust healthcare providers. These experiences reflect deep-seated racism and structural inequities within our healthcare system ” explains Pamela Riley, Chief Health Equity Officer and Assistant Deputy Director, Quality and Population Health Management, Department of Health Care Services.
Language access expanded
After conducting numerous listening sessions, the DHCS has dramatically expanded language access services, ensuring that Medi-Cal members can receive interpretation services in their preferred language, “breaking down communication barriers that have historically impeded quality care,” adds Riley.
DHCS has launched the Health Equity Roadmap, a strategic initiative aimed at transforming Medi-Cal into a more person-centered system. This phased, multi-year process began with a statewide listening tour from September 2023 to March 2024, during which DHCS officials engaged directly with Medi-Cal members, particularly those from Black and Indigenous communities.
Community Supports
Perhaps the most revolutionary change is the introduction of Community Supports, which extend far beyond traditional medical care, offering culturally responsive solutions that address the social determinants of health.
“Adult day care centers like The Bedford Center in Antioch provide essential services for frail, disabled, and impaired adults with a medical model approach,” explains Debbie Toth, President and CEO, Choice in Aging. Toth feels strongly that it is important that we approach this shift with questions and humility, which is the way that DHCS is leading this.
“We make assumptions because people share something, one characteristic (like language) that they are all the same. So, a woman from El Salvador and a woman from Mexico and one from Argentina may share a language, but not a culture,” adds Toth underscoring the need for a supportive environment that enhances the quality of life for its participants.
Medical and social services
One success story in this transformation is the Bedford Center in Antioch, which has been at the forefront of providing comprehensive care to Medi-Cal beneficiaries. The center has embraced CalAIM’s vision by offering a range of services that address both the medical and social needs of its patients, demonstrating the potential of this ambitious reform when implemented effectively.
Michael Whalen, Program Director, The Bedford Center, Choice in Aging is on the floor every day. “We’re committed to making sure that the benefits we offer meet the diverse needs of our members.”
“He’s helping participants go to the restroom, he’s helping them walk, he’s helping them engage and activities, and he’s working with his direct care staff. This is the most critical piece, his direct care staff to help determine the best way to communicate and work with this population,” says Pamela Riley.
A proactive, holistic model
These comprehensive reforms reflect a paradigm shift in Medi-Cal’s approach, moving from a reactive healthcare model to a proactive, holistic system that addresses the multifaceted needs of California’s diverse population. By tackling both medical and social determinants of health, DHCS is setting a new standard for Medicaid programs nationwide, paving the way for more equitable, effective, and compassionate healthcare delivery.
The goal is to keep people out of costly emergency rooms and support them in their homes and communities. Health workers who speak the language of the community they serve and are trusted by them are proving to be essential in reaching linguistically or culturally isolated people.
“Our clients repeatedly express the importance of having a place to go during the day where they can feel seen, recognized, and supported. Building strong relationships with caregivers and physicians is crucial for advocating for our clients’ needs,” stresses Whalen.
This sentiment encapsulates the optimism surrounding Medi-Cal’s future, despite the challenges that lie ahead. As Medi-Cal continues to evolve, its success will depend on addressing systemic inefficiencies, improving coordination among stakeholders, and ensuring that expanded coverage translates into better health outcomes for all Californians. The transformation represents a significant shift towards a more proactive, holistic approach to healthcare, with the potential to improve the lives of millions of Californians.
Image by Mohamed Hassan from Pixabay
