Sacramento, CA – According to a new report released today by the California Pan-Ethnic Health Network (CPEHN), the share of Californians enrolled in Medi-Cal who accessed behavioral health care remained low between 2020 and 2023. The report also found persistent, and sometimes worsening, disparities in access to mental health services by racial and ethnic group. Despite a surge of covid-era funding and the widespread adoption of telehealth which were intended to improve access, the data do not show a commensurate change in access to care, particularly for communities of color, during this period. The report calls for California to strengthen linguistically and culturally responsive behavioral health care, boost outreach and engagement to Medi-Cal members, and address workforce shortages to fully support Californians’ behavioral health needs.
“CPEHN’s new report illustrates in data what we hear from people in communities across California: it’s still too hard for Californians covered by Medi-Cal to access the behavioral health care they need. This is particularly true for Asian and Pacific Islander (API) Medi-Cal members,” said Kiran Savage-Sangwan, CPEHN Executive Director. “Our report shines a light on disparities that state leaders must commit to addressing as several new behavioral health initiatives are implemented.”
Read the report, “Landscape of Access: Mental Health Disparities in Medi-Cal,” here.
The report draws on data provided under the Mental Health Equity Act (AB 470- Arambula), legislation CPEHN sponsored in 2017 to shine a light on where gaps exist in behavioral health services for Medi-Cal members and ultimately reduce such mental health disparities. Medi-Cal provides care to more than 14 million Californians who are low-wage workers, children, seniors and people with disabilities. At least two out of three Medi-Cal members are people of color.
Access to Behavioral Health Stagnates
The report reviewed access and continued engagement rates in California’s two distinct mental health delivery systems, finding rates were low and relatively unchanged between 2020-2023 in both systems:
- “Non-Speciality” services delivered primarily through Medi-Cal managed care plans for “mild to moderate” mental health conditions. This may include testing, psychotherapy, and medication.
- “Specialty” services delivered by county mental health plans for more serious mental illness, this may include crisis intervention and inpatient treatment.
Because Medi-Cal members may move between levels of care over time, coordination between managed care and county mental health plans is critical to ensuring continuity of services and preventing disruptions in care. Understanding who is accessing and remaining engaged in care at various points is essential in evaluating whether the state’s behavioral health system is meeting the needs of historically underserved communities.
Inequities in Behavioral Health Access Persist
- Across both non-specialty mental health services and specialty mental health services, the report found that Asian and Pacific Islander (API) members had the lowest access and continued engagement rates between 2020 and 2023.
- Black and American Indian or Alaskan Native (AI/AN) members had the highest access and continued engagement rates of specialty mental health services, though access rates in non-specialty mental health services among AI/AN members decreased from 2020-2023.
- Medi-Cal members whose preferred written languages were an API language generally had the lowest access rates of non-specialty mental health services.
Report authors pointed to several potential factors that may contribute to these disparities, including the impacts of systemic inequities and adverse social determinants of health that contribute to more acute behavioral health needs.The report also identifies to opportunities for California to strengthen early intervention and culturally responsive community- based services, reaching people with services before conditions become more severe.
Access Varies Between Medi-Cal Health Plans
In both the non-specialty and specialty systems, wide variation existed in the share of Medi-Cal members who access mental health care from among 10 counties selected for study. For example:
- In non-specialty services provided by Medi-Cal managed care plans, data show San Diego’s access rate at 16%, or more than double Santa Clara County’s 7.6% rate.
- Out of the ten largest Medi-Cal managed care plans, Community Health Group, which serves San Diego County, had the highest access rates of non-speciality mental health services.
- In specialty services delivered by county mental health plans, access rates for Orange (1.6%) and San Bernardino (2.4%) were less than half of Butte’s (5.0%) rate.
Lack of Step-Down Services Illustrate a Fragmented System
CPHEN’s analysis found that fewer than half of Medi-Cal patients receive outpatient mental health services within 30 days of discharge from inpatient stays (known as “step down” services.) This share has changed little since 2020, raising questions about how effectively Medi-Cal members are being connected to ongoing care after a period of intensive treatment.
Peer Support Specialists Surge; Workforce Investment Must Continue
Disparities highlighted in the report point to the need for a California behavioral health workforce that is representative of the state’s diverse population. Expanding the ranks of peer support specialists with lived experience helps reduce stigma and bridge cultural divides that are barriers to care.
According to data analyzed for this report, the peer support specialist workforce within Medi-Cal increased significantly from fiscal years 2023 to 2025, with growing representation of communities of color and the majority of them working full time as peers. However, California’s behavioral workforce is still not completely representative of the state’s diverse population, particularly for Latine and API communities, pointing to the need for further investment in diversifying the workforce.
Data Access Vital as Major Behavioral Health Initiatives Unfold
The report analyzed data for years 2020-2023, which precedes several major state behavioral health initiatives. These include the No Wrong Door policy, which aims to bridge gaps between non-specialty and specialty mental health services. In 2022, peer support services became an optional Medi-Cal benefit, intended to expand access to behavioral health services delivered by people with lived experience. Additionally, voters in 2024 passed the Behavioral Health Services Act which steers more resources into housing for people experiencing severe mental illness, and raises questions about how changing funding priorities will impact culturally responsive services. As the impact of these initiatives unfold, access to timely and comprehensive data will be vital to ensure solutions can be identified for emerging needs and evaluate whether reforms are reaching the Californians who need them most.
“Medi-Cal transparency matters because it shows us where to focus our fight to expand access to life-saving care; that’s why CPEHN and partner advocates championed the law that requires reporting on behavioral health utilization by population group,” Savage-Sangwan concluded. “We will continue to shine a light on the data to highlight how reforms made in more recent years, including Medi-Cal’s ‘No Wrong Door’ policies, the Peer Support Specialist benefit in Medi-Cal, and the Behavioral Health Services Act impact communities’ access to behavioral health care.”