{"id":65668,"date":"2024-06-26T13:54:37","date_gmt":"2024-06-26T20:54:37","guid":{"rendered":"https:\/\/lapost.us\/?p=65668"},"modified":"2024-06-26T13:54:37","modified_gmt":"2024-06-26T20:54:37","slug":"how-medi-cal-is-closing-health-access-gaps","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=65668","title":{"rendered":"How Medi-Cal is Closing Health Access Gaps"},"content":{"rendered":"
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By<\/span>Selen Ozturk<\/a><\/div>\n<\/div>\n<\/div>\n
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Over the last few years, California has been on the national front lines of closing health care access gaps through transforming Medi-Cal, its version of Medicaid.<\/p>\n

Although California reached its lowest uninsured rate in 2022, health care access barriers still remain for many Californians, resulting in higher rates of illness and death \u2014 particularly for low-income individuals and people of color. In response, Department of Health Care Services (DHCS) staff went on a statewide tour to listen to Medi-Cal members who experienced health inequity firsthand, and use the feedback to re-design Medi-Cal.<\/p>\n

At a Tuesday, June 18\u00a0Ethnic Media Services Briefing<\/a>, a DHCS representative and two health care providers from a community-based organization that hosted one of the listening sessions discussed Medi-Cal\u2019s transformation and the road ahead.<\/p>\n

Medi-Cal and equity<\/h2>\n

\u201cWho you are and where you live should not determine whether or how well you live,\u201d said Pamela Riley, chief health equity officer and assistant deputy director of quality and population health management at DHCS.<\/p>\n

\u201cWith nearly 15 million Californians enrolled, Medi-Cal has already taken significant steps to advance equity,\u201d she continued, \u201cour first step being to make Medi-Cal coverage available to all income-eligible people, regardless of age or immigration status\u201d as of January 1, 2024.<\/p>\n

Other historic measures include eliminating asset limits so only income is considered when determining Medi-Cal eligibility; establishing a\u00a0Member Advisory Committee<\/a>\u00a0to give feedback on Medi-Cal programs; expanding language access so members can receive interpretation services in 18 languages; and creating new Community Supports that provide services well beyond the doctor\u2019s office, like housing aid, home accessibility modifications, healthy meals and transportation to and from medical appointments.<\/p>\n

\u201cTo listen to our members more directly to understand where our greatest health disparities lie and how we can improve them, DHCS also launched its three-phase\u00a0Health Equity Roadmap Initiative<\/a>,\u201d said Riley.<\/p>\n

For the first phase, begun in November 2023 and now complete, DHCS staff held 11 listening sessions hosted by community-based organizations statewide, to listen to hundreds of Medi-Cal members about the challenges that prevented them from getting the health care they need \u2014 particularly for members from communities of color, those with disabilities, those in rural areas and those with behavioral health issues like substance abuse disorder.<\/p>\n

\u201cWe often heard from members that they wanted Medi-Cal to cover certain services which were already covered \u2014 like dental, vision or mental health care \u2014 which told us that our communication could be improved,\u201d said Riley.<\/p>\n

\u201cThey also wanted to feel respected and listened to in their native language,\u201d she continued, so we have required all our health care facilities to have interpretation services available in threshold languages,\u201d numbering 18 statewide as of 2021 \u2014 including Arabic, Chinese, Hindi, Hmong, Russian, Spanish and Vietnamese.<\/p>\n

Alongside a report about listening tour feedback, to be released next year, \u201cthe second phase will involve using this feedback to identify common themes,\u201d she added, while the third will outline specific steps to make Medi-Cal more accessible on the ground.<\/p>\n

Closing health access gaps on the ground<\/h2>\n

\u201cIn my 22 years here, there has never been anything like this. This is historic,\u201d said Debbie Toth, president and CEO of Choice in Aging, one of the listening session hosts.<\/p>\n

\u201cDHCS reached out to us about talking with patients at our Bedford Center in Antioch\u201d \u2014 which primarily provides Alzheimer\u2019s day health care and transition care out of\/from nursing facilities \u2014 \u201cbecause you could see the social determinants of health at play. We have elderly adults, but also younger low-income participants who may be in their 50s, yet their physical health is like somebody in their 80s,\u201d she explained. \u201cThey may be unhoused, or have substance use or mental health support needs.\u201d<\/p>\n

\u201cOur biggest challenge was that we\u2019re working with a population with a lot of cognitive impairments, like mid-to-late-stage dementia, who can\u2019t always express what they need directly,\u201d Toth continued, \u201cso Michael, our program director, broke the participants into small tables while also engaging their caregivers as to what everyone\u2019s needs were for easier health care and language access.\u201d<\/p>\n

\u201cAnother challenge is that we\u2019d always like to enroll more people, but we\u2019re the only adult day health care center in the area,\u201d added Michael Whalen, program director of The Bedford Center. \u201cAs many of our at-home caregivers themselves can be quite elderly, we had a unique opportunity to coordinate solving the challenges both they and their patients faced.\u201d<\/p>\n

\u201cAnother big challenge is financial,\u201d said Toth. \u201cWe have the DHCS Health Equity Roadmap, we have the California\u00a0Master Plan for Aging<\/a>, these policy frameworks set up to support people in their communities \u2026 but if we have a recession, a change in administration, if we can\u2019t pay livable wages, we lose the infrastructure like we are already, with the massive closures of adult day health care centers.\u201d<\/p>\n

As of\u00a0June 2024<\/a>, California has less than 300 adult day health facilities \u2014 compared to 365 before the Great Recession, when the statewide closures began.<\/p>\n

\u201cOur greatest marker of success is keeping people out of skilled nursing facilities who don\u2019t want to be there,\u201d Toth said. \u201cOur current de facto long-term care system is warehousing folks as they age or become disabled \u2026 and what\u2019s so incredible is the community focus that DHCS has, rather than an institutional focus. They\u2019re not just giving out questionnaires to clinics, but actually learning from the community whether their needs are being met.\u201d<\/p>\n

\u201cAs an example of the humility needed in asking these questions \u2026 When I started at Choice in Aging, there were Russian, Farsi, and English programs, but no Spanish program for the needs of our Spanish-speaking community members \u2014 so I made one, and quickly discovered that they did not want it,\u201d she continued. \u201cThere were people from El Salvador, Mexico, Argentina, Spain, and their message was: \u2018Just because we share a language, we don\u2019t necessarily share a combined interest.\u2019\u201d<\/p>\n

\u201cIt was a lesson to be learned \u2026 that our needs aren\u2019t necessarily based on one characteristic we share,\u201d Toth added. \u201cIt\u2019s important to ask with humility what everyone\u2019s needs really are, and then adapt \u2014 which is how DHCS is leading Medi-Cal right now.\u201d<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

BySelen Ozturk Jun 26, 2024 Screenshot...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,16],"tags":[],"class_list":["post-65668","post","type-post","status-publish","format-standard","hentry","category-ca-local","category-health"],"_links":{"self":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/65668","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=65668"}],"version-history":[{"count":1,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/65668\/revisions"}],"predecessor-version":[{"id":65669,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/65668\/revisions\/65669"}],"wp:attachment":[{"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=65668"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=65668"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=65668"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}