White people enrolled in Medi-Cal access mental health treatment at about twice the rate of other ethnic groups, even though they make up fewer than a quarter of plan enrollees, new state data suggests.
Between July 2016 and June 2017, approximately 38 out of every 1,000 patients receiving mental health services through Medi-Cal managed care plans were white, a quarterly report released by the Department of Health Care Services (DHCS) shows. That’s almost 25 percent more than the number of black Medi-Cal enrollees who sought those services, and more than double the number of Hispanics, Asians and Pacific Islanders who got mental health treatment, the report indicates.
The discrepancy is even more significant when taking into account the ethnic breakdown of people enrolled in Medi-Cal, the public health insurance plan for low-income people in the state. Out of the 10.9 million people enrolled in Medi-Cal managed care plans during the 2016 to 2017 fiscal year, less than a quarter – or 2.2 million – were white. Meanwhile, Hispanics made up half of all enrollees, but had the second-lowest rate of access to mental health treatment.
Asians were the least likely of any ethnic group to receive mental health services, even though they enrolled in Medi-Cal at the same rate as blacks, who accessed mental health care about three times as often, the data shows.
“It’s unacceptable,” said Kiran Savage-Sangwan, health integration policy directorfor the California Pan-Ethnic Health Network (CEPHN). “Our mental health is critical to our overall health and wellbeing and it’s important that people are able to get the services that are right for them at the right time in order to maintain health. So when we see disparities in mental health care, we know that that’s not happening.”
In an email, Department of Health Care Services spokesperson Carol Sloan said the information in the report – officially called a “dashboard” – does not show whether a statistically significant disparity exists, and the department has not done an analysis of the data to determine this.
“Based on the Dashboard, it does appear that White members have increased utilization of mild to moderate mental health services. Higher utilization, without any other context, does not necessarily reflect disparity,” she wrote. “The reason(s) for the differences in access to services could range from having easier access to services to cultural barriers that limit participation in mental health therapy.”
Imelda Padilla-Frausto, a research scientist at the UCLA Center for Health Policy Research, said the data does appear to show a disparity, an observation that is consistent with other research on mental health utilization among people of color. She agreed cultural and language barriers may play a role. Also, in the past, communities of color have often had trouble accessing mental health services because of cost. While the expansion of Medi-Cal and changes in health care law have made mental health services more affordable, some families aren’t used to seeking this type of treatment, she explained.
Health officials need to do more to address mental health access differences, said Savage-Sangwan.
“We think the state and stakeholders need to be working together to come up with both more culturally appropriate ways of delivering mental health care, and better outreach strategies to communities of color,” she said. “What we need to be doing is using different ways of talking about mental health and wellness that resonate with specific communities based on their culture and historical traumas.”
A bill signed into law last October will require DHCS to collect more detailed data on the quality of mental health care treatment Medi-Cal enrollees receive, and the types of challenges they face. Data collection on managed care plans won’t start until 2019, but it should eventually help shed new light on mental health treatment disparities, Savage-Sangwan said.
Sloan said DHCS is committed to ensuring all Medi-Cal members have equal access to mental health treatment, including linguistic and culturally appropriate care.