By: Nathaniel Greene, Community & Culture Reporter

Despite California reaching its lowest uninsured rate in 2022, significant barriers to timely, quality, and equitable healthcare persist, especially for low-income individuals and people of color. These access gaps result in stark health disparities, leading to higher rates of illness and death among underserved groups. Over the past decade, the Department of Health Care Services (DHCS) has made historic strides in addressing these disparities by transforming Medi-Cal. With the completion of the first phase of the Health Equity Roadmap, DHCS leaders and community health providers gathered to discuss the future of a more equitable Medi-Cal system during a briefing hosted by Ethnic Media Services on June 18.

Advocating for Comprehensive and Culturally Competent Care

Dr. Pamela Riley, Chief Health Equity Officer and Assistant Deputy Director of Quality and Population Health Management at DHCS, emphasized the ongoing challenges and the progress made.

“At its core, health equity is based on a simple premise: who you are and where you live should not determine whether you live or how well you live,” Riley stated. She highlighted the initiatives taken by DHCS to ensure that every individual, regardless of race, ethnicity, language, or citizenship status, has access to compassionate and comprehensive care.

One of the significant steps was expanding Medi-Cal eligibility to all income-eligible individuals, regardless of immigration status. Riley underscored the importance of culturally competent care, mentioning that “health equity goes well beyond access to care. We need to ensure that we can provide culturally competent, culturally humble, comprehensive, and accessible healthcare.”

Riley also discussed the implementation of community supports that address social determinants of health, such as housing aid, nutritious meals, and transportation to medical appointments. These services aim to provide holistic care that meets the physical and mental health needs of Medi-Cal members.

Bridging Health Access Gaps Through Community Engagement

Debbie Toth, President and CEO of Choice in Aging, shared her organization’s experiences in collaborating with DHCS during the Health Equity Roadmap’s listening sessions. Toth described the historic nature of these engagements, stating, “There has never been anything like this in my 22 years. DHCS came in with an open mind and an open book, ensuring the voices of our participants were heard.”

Choice in Aging serves a diverse population, including frail older adults, people with multiple comorbidities, and those from immigrant backgrounds. Toth emphasized the need for programs that are inclusive and responsive to the unique needs of these communities. She praised DHCS for their humble approach, likening it to scientific inquiry: “There’s a humility in their approach, learning what’s wrong with something so they can figure out how to make it right.”

Toth shared a poignant story about the importance of culturally sensitive programming. She recounted an instance where her assumption that Spanish-speaking individuals would benefit from a separate program backfired. Participants from various Spanish-speaking countries felt that while they shared a language, their cultural experiences were distinct. This experience underscored the necessity of understanding and respecting the diverse backgrounds of Medi-Cal members.

On-the-Ground Perspectives and Future Challenges

Michael Whalen, Program Director at the Bedford Center, provided insights from the ground level. The Bedford Center, which offers adult day healthcare services, was one of the sites for the DHCS listening sessions. Whalen highlighted the diverse needs of the center’s participants, many of whom have histories of homelessness, substance abuse, and severe mental health issues.

Whalen stressed the importance of creating a supportive environment where individuals feel recognized and valued.

“One of our biggest jobs here is developing strong relationships with caregivers and primary care physicians so that we can make recommendations and coordinate care when we see problems,” Whalen explained. He pointed out that the center’s mission is to keep people as independent as possible and living at home for as long as possible, a goal that aligns with DHCS’s broader health equity objectives.

Looking ahead, Riley emphasized the need for ongoing engagement with Medi-Cal members to refine and implement the Health Equity Roadmap. “We want to proactively engage all of our members in our processes, from developing policy and programs to really thinking through solutions that will result in people getting the care they need,” she said.

The Medi-Cal transformation is a multi-year initiative, and the co-design phase will be crucial in ensuring that the roadmap reflects the real-world experiences and needs of its members. By partnering with community-based organizations and leveraging member feedback, DHCS aims to create a more equitable and person-centered healthcare delivery system.

In conclusion, the briefing highlighted the transformative efforts underway to make Medi-Cal more equitable. As Dr. Riley aptly put it, “Expanding Medi-Cal and developing the Health Equity Roadmap addresses gaps in healthcare access and outcomes by providing care for people who have been historically left out.”

The journey toward health equity is ongoing, and with the commitment of DHCS and its partners, the future of Medi-Cal looks promising for all Californians.