The California Pan-Ethnic Health Network (CPEHN) applauds Governor Newsom for proposing historic investments to achieve health equity. While the Governor’s budget proposal is a great first step, we call on the Governor and Administration to work with local, regional and state leaders to prioritize action on the key health equity recommendations outlined below in order to improve health outcomes for ALL Californians.
Who we are: CPEHN is a statewide multicultural health advocacy organization. Founded over 25 years ago, CPEHN unites communities of color to achieve health and wellness, and to eliminate persistent health inequities. We derive our strength from our mobilizing arm, the Having Our Say (HOS) coalition which consists of over 30 community-based organizations across California working together to improve access to care and health outcomes as well as through our Behavioral Health Equity Collaborative (BHEC) and California Oral Health Network (COHN) partners.
Why now? California is one of the most diverse states in the nation with communities of color comprising the majority, 60% of state residents. Latinos constitute 38% and Asian Pacific Islanders and African Americans make up another 20%. Of the 14 million lives enrolled in Medi-Cal in California, an overwhelming majority (80%) are from communities of color, with 30% speaking Spanish as a primary language. In addition, a majority of individuals enrolled in Covered California (66%) are from communities of color, with 10% speaking Spanish as a primary language. Shortly, the nation as a whole will see similar demographic shifts. By 2045, people of color will represent a majority of the nation’s population. Already 11 other states are at or close to a majority population of color.
California has been a leader in advancing health equity and expanding access to health care under the Affordable Care Act. Yet we still have a long way to go in living up to our promise of quality, affordable health care for all. Persistent health disparities exist for communities of color, with no signs of decreasing without appropriate health system interventions targeted to reducing them. In California for example, Latinos and African Americans have twice the prevalence of type 2 diabetes and are twice as likely to die from the disease as non-Hispanic Whites. The prevalence of current asthma among American Indians and Alaska Natives is three times greater than the state average. African Americans have four times higher asthma emergency department visits and hospitalization rates. Black women and infants are far more likely to die than their counterparts.
Mental and oral health is additionally a pressing issue for communities that have faced historic trauma and discrimination and those who face current traumas related to immigration, community violence, and poverty. American Indians and Alaska Natives are 40% more likely than Whites to have experienced serious psychological distress during the past year, and though it is estimated that Asians and Pacific Islanders have a rate of serious mental illness similar to that of Whites, this overlooks important differences between Asian ethnic groups. And while California has the largest percentage of dentists in the country, thousands of Californians continue to depend on emergency room departments for preventable dental conditions while there remains 53 dental Health Professional Shortage Areas (HPSAs) in California.
Priority Actions:
1. Improve health care quality and reduce disparities: California has made great strides in providing health care coverage for the state’s diverse communities. However, communities of color continue to experience vast disparities in health outcomes, particularly for asthma, diabetes, and maternal health. California should utilize innovative strategies to provide the right care for each consumer. We call on the Governor to:
- Hold Medi-Cal managed care plans accountable for improving quality and achieving health equity by establishing a consumer driven stakeholder process and requiring plans to set year-over-year targets for improvement in these areas.
- Provide financial incentives including shared savings for plans that meet quality and disparities reduction targets as long as those savings are invested in related interventions.
- Improve readability and translations of key informing documents in Medi-Cal so beneficiaries can understand their rights and how to access health care coverage.
- Adequately measure and enforce California timely access and language access laws so consumers obtain appointments and interpreter services in a timely manner.
- Fund the collection and reporting of data on additional Asian & Pacific Islander subpopulations in health and public health care as required under AB 1726 (Bonta,2016).
- Ensure the Medi-Cal Managed Care Ombudsman reports quarterly on calls received by race, ethnicity, language, and complaint type as required by law.
2. Strengthen oral and mental health care: Disparities in access to care and outcomes are particularly stark for oral and mental health care. Consumers must navigate a complex delivery system that is often not responsive to cultural and linguistic needs. CPEHN was instrumental in the development of the California Reducing Disparities Project’s strategic plan to achieve mental health equity for communities of color. California can be a leader in ensuring that critical mental and oral health services meet the needs of all, including people of color, immigrants, and the LGBTQ+ community. We call on the Governor to:
- Hold counties accountable for improving the cultural and linguistic competency of care provided by county mental health plans.
- Ensure robust implementation of the Mental Health Services Act so all underserved Californians, regardless of immigration status, can access mental health care in their communities.
- Enforce language access laws for recipients of dental services in Medi-Cal so beneficiaries are better able to understand their rights and treatment options.
- Support workforce and employment training for mental health providers, in particular, as the statewide Workforce, Employment, and Training (WET) funding provided by the Mental Health Services Act ends.
- Ensure robust implementation of the restored adult dental benefit and evaluation of the Proposition 56 supplemental dental payments.
- Ensure robust implementation of the mid-level mental health benefit in Medi-Cal and evaluate utilization and outcomes.
- Integrate dental benefits into Medi-Cal and remove unnecessary barriers to care so that consumers are able to access dentists and maintain their oral health.
3. Address the social determinants of health through a statewide approach: Where people live, work, and play has a dramatic impact on health outcomes and well-being. CPEHN was instrumental in creating the Office of Health Equity to provide a statewide approach to integrating these factors into health care. We remain committed to strengthening this effort. We call on the Governor to:
- Strengthen and support the work of California’s Health in All Policies Taskforce charged with identifying priority programs, policies, and strategies from natural resources to housing to public health to improve the health of Californians.
- Provide for meaningful stakeholder input in the development of goals and activities of the new California Surgeon General through the establishment of an advisory committee with consumer and community representation.
- Improve Access to healthy, fresh foods by incentivizing healthy food retail in low-income neighborhoods.
- Fund education and assistance programs through fees or taxes on sugary, sweetened beverages while encouraging a decrease in the consumption of high calorie, non-nutritious food and beverages.
- Continue to set aside dedicated funding for planning and community engagement for active transportation, particularly in disadvantaged communities.
- Ensure full implementation of the California Values Act (SB 54) as enacted January 2018, to curtail the role of state and local police agencies in federal immigration enforcement.
4. Fund proven health prevention strategies: California has an opportunity to increase access to preventive and community-based care and to prevent many chronic and costly health conditions. Proven strategies, such as community health workers, should be embraced and funded. We call on the Governor to:
- Increase access for Medi-Cal beneficiaries to asthma preventive services, as well as minor to moderate remediation services by enabling DHCS to draw down federal funds for services provided by qualified professionals, including community health workers.
- Increase the availability of peer providers and community health workers to better support underserved communities in accessing care, including mental health and prenatal care.
- Adequately fund community-based care navigators that are providing culturally and linguistically appropriate outreach, enrollment, utilization and retention in Medi-Cal and Covered California.
5. Protect the Affordable Care Act (ACA), expand health care access and improve affordability: California has an opportunity to fight back against federal efforts to sabotage the ACA including attempts to weaken non-discrimination protections for vulnerable communities while threatening access to health care services for immigrants. The state can be a national leader, by expanding health care access and improving affordability for ALL Californians. We call on the Governor to:
- Challenge federal regulations aimed at weakening the ACA’s non-discrimination protections for communities of color, Limited English Proficient (LEP) and LGBTQ+.
- Challenge federal efforts to expand the types of benefits that could be considered in a “public charge” determination to include key programs such as health care, housing and nutrition assistance.
- Prioritize Health4All by expanding Medi-Cal to cover the more than 1 million Californians who lack access to affordable health insurance due to immigration status, including both seniors and young adults up to age 26.
- Provide subsidies and cost-sharing assistance for all Californians, including lower income families with incomes up to 250% FPL, many of whom struggle to pay current Covered California premiums.