In 2014, thanks to the Affordable Care Act, more Californians than ever were eligible to access Medi-Cal, California’s free or low-cost health insurance, which includes mental health coverage. Medi-Cal currently serves 14 million Californians, the majority of whom are people of color, people with low incomes, and people with limited English proficiency. People who are Latinx make up a third of Medi-Cal members and people who are Black account for 28 percent.
The COVID-19 pandemic has disproportionately impacted low-income communities of color. And in all California communities, it’s resulted in increased rates of anxiety, depression and substance use. I work as a primary-care physician in a safety-net clinic and can treat mild to moderate psychiatric conditions with medications. My clinic also offers visits with a mental health clinician for therapy, but due to staff shortages we have struggled to meet the increased need for this service amid the pandemic.
One of my patients, a Spanish-speaking woman and a survivor of domestic violence, suffered from depression and post-traumatic stress. She sought mental health care through her Medi-Cal insurance. However, it took her over six months to get an appointment with a therapist due to challenges she had navigating the system, getting information and her limited English proficiency.
In any given year, 1 in 5 people enrolled in Medi-Cal will experience mental health symptoms, and that number is likely an underestimate given the pandemic and its disproportionate impact on people of color. Even though Medi-Cal provides mental health coverage, people of color are less likely than white people to use them, partially due to systemic inequities in the system. The same is true of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) youth, of whom 70 percent reported having “poor” mental health either most of the time or always during the COVID-19 pandemic. Yet data on LGBTQ+ usage of mental health services is so low that sexual orientation and gender identity data is not publicly available.
In 2021, the California Pan-Ethnic Health Network sought to understand why Medi-Cal mental health services continue to be severely underutilized. The report examined public data collected about Medi-Cal mental health managed care plan usage and retention, invited staff at community-based organizations across California to navigate Medi-Cal websites and resources, and asked primary care providers about their awareness of coverage and benefits.
Shockingly, they found that primary care providers, often the first line of contact for many Medi-Cal members and the person who would direct someone seeking mental health care to resources, were often not aware of the benefits available. Additionally, our coalition partners found the Medi-Cal website to be very difficult to use. It took members using the site an average of 45 minutes to find a mental health provider who spoke Spanish.
Most Medi-Cal members are people of color, people with low incomes, and people who speak limited English. It is crucial that mental health services and resources be offered in an accessible, linguistically and culturally appropriate way. Millions of Californians do not have reliable broadband and, if they do, they are not always technologically savvy or they work full time and cannot sit on a website for 45 minutes or more to find a provider. Once they get an appointment, service can be stigmatizing or non-validating such that patients do not want to return.
Medi-Cal members might have mental health coverage in theory, but using it is a different story. Our communities care greatly about their mental health and the mental health of their loved ones, yet California’s promises to provide care fall short.
To address these unfulfilled promises, SB 1019 by Senator Lena Gonzalez would require Medi-Cal managed care plans to have culturally and linguistically relevant outreach materials for Medi-Cal members that inform them of their right to timely mental health services, right to respectful and non-discriminatory care, how to find a provider, and how to access and maintain their mental health services.
This outreach is all the more important given the impending expansion of Medi-Cal to people ages 50 and over who are undocumented, and the state’s new focus on whole-person care under the California Advancing and Innovating Medi-Cal (CalAIM) initiative.
Mental health is a key component of overall health. We all deserve equitable access to mental health services that are reaffirming and empowering.
Melody Tran-Reina is a general internal medicine physician who practices primary care at the Sacramento County Health Center.
Jess Baker is Lead Organizer at API Equality-LA, a grassroots organization centered on building power in the queer and trans Asian Pacific Islander community to achieve LGBTQ+, racial and social justice.