Health benefits

How to Make Sure Medical Members Can Access Their Mental Health Benefits – California Health Report

Photo by fizkes/iStock.

In 2014, thanks to the Affordable Care Act, more Californians than ever were eligible to access Medi-Cal, California’s free or low-cost health insurance, which includes mental health coverage. Medi-Cal currently serves 14 million Californians, the majority of whom are people of color, low-income people, and people with limited English proficiency. Latinx people make up one-third of Medi-Cal members and black people make up 28%.

The COVID-19 pandemic has had a disproportionate impact on low-income communities of color. And across California communities, it has led to increased rates of anxiety, depression, and substance use. I work as a primary care physician in a welfare clinic and can treat mild to moderate psychiatric conditions with medication. My clinic also offers visits with a mental health clinician for therapy, but due to staffing shortages we have struggled to meet the increased need for this service amid the pandemic.

One of my patients, a Spanish-speaking woman and survivor of domestic violence, suffered from depression and post-traumatic stress. She sought mental health care through her Medi-Cal insurance. However, it took her more than six months to get an appointment with a therapist due to difficulties navigating the system, obtaining information and her limited command of English.

In any given year, 1 in 5 people enrolled in Medi-Cal will experience mental health symptoms, and this number is likely an underestimate given the pandemic and its disproportionate impact on people of color. Even though Medi-Cal offers mental health coverage, people of color are less likely than white people to use it, in part because of systemic inequities in the system. The same is true for lesbian, gay, bisexual, transgender and queer (LGBTQ+) youth, 70% of whom reported having “poor” mental health most or always during the COVID-19 pandemic. Yet data on the use of mental health services by LGBTQ+ people is so weak that data on sexual orientation and gender identity is not publicly available.

In 2021, the California Pan-Ethnic Health Network sought to understand why Medi-Cal mental health services continue to be severely underutilized. The report examined public data collected on Medi-Cal mental health care plan utilization and retention, invited staff from community organizations across California to browse Medi-Cal websites and resources , and asked primary care providers about their knowledge of coverage and benefits.

Surprisingly, they found that primary care providers, often the first line of contact for many Medi-Cal members and the person who refers someone seeking mental health care to resources, were often unaware benefits available. Additionally, our coalition partners found the Medi-Cal website very difficult to use. It took members using the site an average of 45 minutes to find a mental health care provider who spoke Spanish.

Most Medi-Cal members are people of color, low-income people, and people who speak limited English. It is crucial that mental health services and resources are offered in an accessible, linguistically and culturally appropriate way. Millions of Californians don’t have reliable broadband and if they do they aren’t always tech savvy or they work full time and can’t sit on a website for 45 minutes or more to find a supplier. Once they get an appointment, the service can be stigmatizing or non-validating, so patients don’t want to come back.

Medi-Cal members can have mental health coverage in theory, but using it is another story. Our communities care deeply about their mental health and the mental health of their loved ones, but California’s promises to provide care fall short.

To address these broken promises, Senator Lena Gonzalez’s SB 1019 would require Medi-Cal managed care plans to have culturally and linguistically relevant awareness materials for Medi-Cal members that inform them of their right to timely mental health services, their right to respectful and non-discriminatory care, how to find a provider and how to access and keep their mental health services.

This awareness is all the more important given the impending expansion of Medi-Cal to undocumented people ages 50 and older, and the state’s new focus on whole-person care in as part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative.

Mental health is a key component of overall health. We all deserve equitable access to mental health services that reaffirm and empower.

Melody Tran-Reina is a general practitioner in internal medicine and practices primary care at the Sacramento County Health Center.

Jess Baker is the lead organizer of API Equality-LA, a grassroots organization focused on empowering the Pacific Islander queer and trans-Asian community to achieve LGBTQ+, racial and social justice.