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After Years of Transformation, Where is Medi-Cal Headed?

-Editorial

Although California reached its lowest uninsured rate in 2022, access barriers to timely, quality, and equitable health care 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.

Over the last decade, the Department of Health Care Services (DHCS) has made historic investments to eliminate health disparities by transforming Medi-Cal, including: expanding Medi-Cal to all low-income Californians, regardless of immigration status; eliminating the “asset test” requirement so only income is considered when determining Medi-Cal eligibility; expanding language access so members can receive interpretation services; and creating new Community Supports that provide culturally responsive care well beyond the doctor’s office, including housing aid, medically tailored meals, and personal care services. 

Furthering this commitment to health equity, DHCS leaders went on a statewide tour to listen to Medi-Cal members who have experienced health inequity firsthand. These listening sessions, hosted by community-based organizations, were the first phase of the DHCS Health Equity Roadmap, a new multi-year initiative to create a more member-driven whole-person Medi-Cal.

With the first phase complete, the Health Equity Roadmap will now be developed through a co-design phase that will use member feedback to make Medi-Cal more equitable.

During this fifth in a series of Medi-Cal media briefings, DHCS leaders and community healthcare providers will discuss the Health Equity Roadmap, what it looks like implemented on the ground, and the road ahead for a more equitable Medi-Cal.

Pamela Riley, Chief Health Equity Officer at the Department of Health Care Services, emphasized that “who you are and where you live should not determine whether you live or how well you live.” Speaking at a recent conference, Riley underscored the urgent need for comprehensive and compassionate healthcare that transcends barriers of race, ethnicity, age, gender, language, sexuality, income, and citizenship.

Riley highlighted pervasive disparities within the healthcare system, particularly affecting communities of color and those historically underserved. “People of color experience higher rates of illness and death across various health conditions,” she stated, attributing these outcomes to deep-rooted structural racism and inequities.

Acknowledging the shortcomings of the current healthcare framework, Riley outlined significant steps taken by the Department of Health Care Services (DHCS) to advance health equity for all Californians. “Our primary objective this year was to expand medical coverage to all income-eligible individuals, irrespective of age or immigration status,” she noted, pointing out that this initiative has already enrolled nearly 15 million Californians in critical health services under Medi-Cal.

Beyond mere access, Riley stressed the importance of culturally competent and comprehensive healthcare. DHCS has initiated a transformative process aimed at broadening healthcare services beyond traditional settings. This includes community support programs addressing social determinants of health such as housing support, healthy meals, and transportation to medical appointments.

Furthermore, Riley emphasized the pivotal role of direct member engagement in shaping healthcare policies. “We have established a medical member advisory committee to enhance engagement and gather direct feedback,” she explained. This inclusive approach aims to foster trust and ensure that healthcare services meet the diverse needs of all members, particularly those in marginalized communities.

Looking ahead, Riley outlined the DHCS Health Equity Roadmap initiative, a multi-phase endeavor designed in collaboration with caregivers, advocacy groups, and community-based organizations. The initiative’s first phase, a statewide listening tour, gathered invaluable feedback from hundreds of Californians, particularly from black and indigenous communities of color.

“As we move forward with our co-design phase later this year,” Riley remarked, “we aim to incorporate this feedback into actionable steps outlined in our Health Equity Roadmap.” This roadmap seeks to create a more equitable and person-centered healthcare delivery system, addressing disparities in access, quality, and outcomes across the state.

Riley emphasized that achieving health equity is an ongoing commitment requiring continued collaboration and innovation. “Our goal is to ensure that all Californians receive the healthcare they need, regardless of where they live or their background,” she affirmed. “This initiative marks just the beginning of our efforts to advance health equity and create a healthcare system that truly serves all its members.”

Debbie Toth, President and CEO of Choice in Aging, is enthusiastic about the transformative strides being made in healthcare equity, particularly through their collaboration with the Department of Healthcare Services (DHCS). In a recent interview, Toth emphasized the significance of this partnership and its impact on underserved communities across California.

Choice in Aging, renowned for its comprehensive services tailored to older adults and vulnerable populations, has been at the forefront of community-based long-term support and services. “We provide medical services like adult day healthcare and complex case management,” Toth explained, highlighting their commitment to addressing diverse needs regardless of age, ability, or background.

The collaboration with DHCS marks a pivotal moment for Choice in Aging, as DHCS engaged in profound discussions with participants to better understand their healthcare experiences. “There has never been anything like this in my 22 years at Choice in Aging,” Toth remarked, underscoring the historical significance of DHCS’s proactive approach.

Toth elaborated on the diversity within their programs, catering to a wide array of cultural and linguistic backgrounds. “We serve a wide variety of folks,” she noted, stressing the importance of culturally sensitive care and tailored programming for conditions like Alzheimer’s disease and dementia.

Reflecting on the recent initiatives led by DHCS, Toth commended their humility and commitment to listening to community voices. “There’s a humility in their approach, akin to scientific inquiry, where they seek to understand and improve,” she remarked. This approach, according to Toth, has been instrumental in identifying gaps and enhancing services for underserved populations.

During the listening sessions facilitated by DHCS, Toth acknowledged challenges, particularly in engaging participants with cognitive impairments effectively. “We had to adapt our methods to ensure everyone could participate meaningfully,” she explained, highlighting the importance of inclusive practices in gathering valuable insights.

Toth expressed optimism about the future of healthcare equity initiatives. “This collaboration isn’t just about improving access; it’s about transforming lives,” she affirmed. She emphasized the ongoing commitment to filling gaps in mental health services and other critical healthcare needs identified through these sessions.

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