Medi-Cal: California has a rare opportunity to improve health care equity

Wealthy Californians come from affluent enclaves to take vaccine shots meant for at-risk frontline workers. In the same state but a world away, Californians haven’t heard that a safe, effective COVID-19 vaccine exists because the news hasn’t yet reached them in their language.

Unequal access to quality health care allowed the virus to cut a path of devastation through communities of color over the past year. Like the murder of George Floyd and acts of violence that sparked a national reckoning on race last year, inequalities in health care are rooted in a set of rules stacked against Black and brown communities.

To heal, we must rewrite the rules. One big place to start is Medi-Cal.

Medi-Cal is a crucial pillar of the state’s health care system and its importance is widely recognized by a strong majority of Californians. Two-thirds of the children, adults, workers, people with disabilities and seniors enrolled in the program are people of color. Most enrollees — about 10 million Californians to be exact — get their health care through a Medi-Cal managed care plan. But the contracts between the state and these health plans fail to ensure that these Californians get the high-quality care they deserve. The rules simply aren’t strong enough.

This year the Newsom administration has an extraordinary opportunity to fix the problem when the state opens the bidding process for commercial health plans to participate in Medi-Cal. This process only comes around once a decade. The decisions that are made will determine whether millions of Californians receive equitable care for years to come.

Consequences of weak contracts

Right now, Medi-Cal managed care plans are paid regardless of the quality of care they deliver. As a result, plans consistently lag on several key measures of health care performance. Too many children are going without proper vaccinations and well-child visits; too many women are not receiving timely prenatal care or breast and cervical cancer screenings and too many people with conditions like diabetes are left without adequate care to manage diseases that put them at a higher risk of severe illness from COVID-19.

The California Health Care Foundation recently partnered with the California Pan-Ethnic Health Network to interview Medi-Cal enrollees across the state and to hear their real-life experiences. We heard that they experience discrimination in the system because of their race, disability, sexual orientation, language or cultural background. These experiences make them leery of seeking care and ultimately lead to preventable illness. For that to change, Medi-Cal managed care plans — and the providers, hospitals and clinics in their network — have to be a much bigger part of the solution.

California purchasing power

The best opportunity to induce improvement is when Medi-Cal managed care contracts are written. With the right set of rules and incentives, California can use its purchasing power to help eliminate widespread inequities.

If they want to be part of the Medi-Cal program, health plans should have to meet higher standards for access, quality and health equity. Plans that demonstrate progress and meet specific goals should be rewarded financially for their performance. Plans that miss the mark should not receive full payment. Other states have effectively used this “carrot and stick” approach to improve the quality of care and expand health equity.

California should also use these contracts to remove language and cultural barriers and expand access to care. Contracts should be written to encourage plans to hire a more diverse health workforce and to use tools like telehealth to make specialty and mental health care more available in places where there are provider shortages.

The rules California sets for Medi-Cal managed care plan will shape how care is delivered for millions of families for many years. We can’t miss this once-in-a-decade opportunity to make our health care system more just.