One third of all Californians and nearly half of California children depend on Medi-Cal, California’s public health coverage program, for health care. A majority of those enrolled in Medi-Cal are people of color, and a third have limited English proficiency. With that in mind, it is clear that Medi-Cal is a foundation for advancing health equity in California, but we must seize the opportunity.
With so many people relying on Medi-Cal for health care, the state must do more to protect the rights of Californians and ensure access to every service they are entitled to.
Historically, the state exerts limited oversight of Medi-Cal, even when the program performs poorly — Medi-Cal recipients bear the burden in the form of inequitable access to care. A state audit released in 2018 revealed that every year, 2.4 million children do not receive necessary preventive health services like dental care, immunizations and developmental screenings from the Medi-Cal program. More recently, barely half of those enrolled in the Medi-Cal program received COVID-19 vaccines while more than 80 percent of Californians did overall.
This inequitable access to and utilization of services has a disparate and disproportionate racial impact.
Currently, the vast majority of Medi-Cal members receive health care through managed health care plans, which are responsible for the delivery of health care services. When compared to Medicaid plans nationally, California’s plans perform below average, but the state is slow to hold plans accountable for poor performance or to contract with different plans to provide better service.
Over the past year, Gov. Gavin Newsom has embraced the opportunity to reform Medi-Cal through the California Advancing and Innovating Medi-Cal, or CalAIM, initiative. Recently approved by the federal government, CalAIM is a five-year demonstration project designed to address individuals’ unique health needs by identifying and offering services that mitigate risks, including those driven by social conditions like housing insecurity. Medi-Cal will now be able to provide additional community services to its members, like housing supports, medically tailored meals and recuperative care programs.
This year, California will recruit health plans to deliver the care envisioned in CalAIM. The model contract released by the state includes mechanisms for improved oversight and accountability, including a requirement that plans invest a portion of their net profits in community health.
The new contract is a huge step in the right direction. Yet, we believe more must be done. Here are some action steps the state should take:
- Utilize payment to enforce accountability of managed care plans: While the state’s new initiatives indicate a desire to reform how Medi-Cal services are paid in order to drive quality, there are no specifics. Medi-Cal is a multi-billion-dollar program; using funding to hold plans accountable for the services they provide is imperative for changing behavior, reducing disparities and enhancing the Medi-Cal experience for members.
- Double down on identifying and addressing racial disparities: It is difficult to fix what we don’t measure. Currently, information about racial disparities is limited by a lack of standardized data collection and gaps in the data. This fundamental issue must be addressed.
- Give Medi-Cal members more voice: The state indicated its intention to focus the Medi-Cal program more squarely on the needs and desires of its members, yet leaves much to be desired in terms of how that will happen. Ultimately, the experiences and views of members should drive future goals and changes in the program.
We commend Newsom for his administration’s significant investments in reforming the Medi-Cal program. Moving forward, we hope the state continues its path of transformative innovation in Medi-Cal so it can serve as a true foundation of health equity in California.
Kiran Savage Sangwan is the executive director of the California Pan-Ethnic Health Network, a statewide multicultural health advocacy organization dedicated to closing racial and ethnic disparities.
Crystal D. Crawford is the executive director of Western Center on Law and Poverty, which advocates on behalf of Californians experiencing poverty in every branch of government — from the courts to the Legislature.