Transforming Medi-Cal: California's Bold Journey to Health Equity

In recent years, California has taken significant strides in addressing health disparities that disproportionately affect communities of color. The transformation of Medi-Cal, the state’s Medicaid program, has emerged as a pivotal initiative in this ongoing battle. Palav Babaria, deputy director of quality and population health management at the Department of Health Care Services (DHCS), shared insights on how Medi-Cal is making a difference.

Strategies for Achieving Health Equity

“We are tackling health equity through two main approaches,” explained Babaria. “First, we've been tracking disparities by race and ethnicity for over a decade, setting ambitious, measurable goals to reduce them. However, simply reporting on these inequities isn't enough. Therefore, we are also expanding access through initiatives like CalAIM.”

• CalAIM: This comprehensive, multi-year initiative aims to reduce health disparities by introducing innovative services such as:
• Street medicine
• Home accessibility modifications
• Medically tailored meals
• Sobering centers
• Housing support, including rent assistance

Additionally, Medi-Cal is offering waivers for many of these services, making them available to Californians who may not otherwise qualify. A notable program, the Birthing Care Pathway, focuses on reducing maternal mortality and morbidity by coordinating services throughout the pregnancy and postpartum period, including access to:

• Doula care
• Nutrition assistance
• Mental health screenings

Empowering Communities Through Participation

Babaria emphasized the importance of involving community members in shaping these programs. “Starting in 2024, all our medical plans in each county will include Advisory Committees that consist of community and Medi-Cal members. This allows those experiencing health disparities to directly inform how the system can better meet their needs,” she said.

She further noted, “Our healthcare system excels in emergency situations but falls short when it comes to preventive care.” Many individuals lack regular primary care providers, which can lead to unmanaged health conditions like diabetes and hypertension.

Tracking Progress and Setting Goals

Medi-Cal's 50x25 Initiative, launched in 2022, aims to enhance care by 50% in three critical areas: children's preventive health, maternity care, and behavioral health. While some goals have already been met, significant disparities remain, particularly in:

• Prenatal depression screening
• Substance use disorder treatment engagement

Recent metrics indicate that disparities persist, particularly among racial and ethnic groups. However, updated data reflecting Medi-Cal's progress is expected to be released soon, providing a clearer picture of the ongoing efforts.

Listening to the Voices of the Community

Recognizing the need for direct feedback from members, Medi-Cal launched the Health Equity Roadmap Initiative, a three-phase, five-year plan. The first phase involved listening sessions across the state, where Medi-Cal members voiced their challenges in accessing healthcare.

“A consistent piece of feedback we received is that navigating Medi-Cal is often overwhelming,” Babaria noted. “Long wait times for appointments and a complicated system make it difficult for members to know about available services.”

As Medi-Cal prepares for the second phase, Babaria emphasized the importance of member input in developing solutions: “It’s crucial that those directly impacted by health disparities have a voice in shaping policy.”

Moving Forward

In conclusion, California's Medi-Cal program is making significant strides in addressing health disparities, but there is still much work to be done. By centering the experiences of community members, the state aims to create a more equitable healthcare system that meets the diverse needs of all Californians.

What do you think?

• Are the current efforts to reduce health disparities in California sufficient, or do you think more radical changes are necessary?
• How effective do you believe the CalAIM initiative will be in the long run?
• What additional services should be prioritized to address systemic health challenges?
• Do you think community involvement in healthcare policy is genuinely impactful?
• Is it fair to place the responsibility of