Home Health Medi-Cal Company’s New Head Needs to Deal with Disparities and Racism

Medi-Cal Company’s New Head Needs to Deal with Disparities and Racism

When Will Lightbourne regarded on the statistics behind California’s coronavirus instances, the disparities have been “blindingly clear”: Blacks and Latinos are dying at increased charges than most different Californians.

As of Monday, Latinos account for 45.6% of coronavirus deaths in a state the place they make up 38.9% of the inhabitants, according to data collected by the California Division of Public Well being. Blacks account for 8.5% of the deaths however make up 6% of the inhabitants.

Lightbourne, who led California’s Division of Social Providers underneath Gov. Jerry Brown, describes this pandemic as one which “rips the bandage off” a well being care system lengthy riddled with inequity.

So, when Gov. Gavin Newsom requested Lightbourne, 70, to come back out of retirement in June to guide the Division of Well being Care Providers, he mentioned, he couldn’t say no.

“He has dedicated his complete skilled life to public service,” mentioned Mike Herald, director of coverage advocacy on the Western Middle on Legislation & Poverty. “He’s not joking when he talks in regards to the significance of those points and the necessary function that authorities performs in addressing societal inequities.”

The Division of Well being Care Providers oversees the state’s Medicaid program for low-income folks, referred to as Medi-Cal, which gives well being care to some 12.5 million Californians.

Lightbourne mentioned he sees the job as an opportunity to refocus Medi-Cal on lowering disparities — enhancing folks’s well being not solely by offering higher entry to medical doctors, but additionally by linking them with behavioral well being packages and utilizing well being care {dollars} to get them into housing.

He mentioned the division additionally plans to amend contracts with well being suppliers and use routine efficiency opinions to ensure suppliers are addressing disparities.

Well being care advocates say Lightbourne has a monitor report of getting issues executed.

On the Division of Social Providers, he persuaded Brown, a identified penny pincher, to extend money help to low-income households, restoring cuts lawmakers had made within the Nice Recession. And he was instrumental behind the scenes within the repeal of the contentious coverage that had prohibited Californians from receiving elevated welfare earnings if that they had extra kids whereas receiving public help, Herald mentioned.

“Will may be very purpose-driven and has made substantive adjustments in each function he has ever had,” mentioned Graham Knaus, government director of the California State Affiliation of Counties.

Earlier than embarking on state service, Lightbourne served as director of the Santa Clara County Social Providers Company, the Human Providers Company of the Metropolis & County of San Francisco and the Santa Cruz County Human Providers Company.

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Lightbourne’s native and state expertise give him a precious ability set as state and county officers grapple with offering well being care to a few of California’s most weak residents throughout a pandemic, Knaus and different advocates mentioned.

The duty received’t be straightforward. The earlier director of the Division of Well being Care Providers, Brad Gilbert, left the job after lower than 4 months.

Lightbourne talked to California Healthline about why he returned to state authorities, how the division is responding to COVID-19 and the way he hopes to enhance entry to well being care for many who want it. The interview has been edited for size and readability.

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Q: Why did you come out of retirement to take a job that’s troublesome underneath regular circumstances — and even harder throughout a pandemic?

Occasions of the previous six months have made it blindingly clear that we’ve acquired structural inequities that aren’t simply immoral however are, at an existential degree, unsurvivable. It’s a pandemic that landed on high of a pandemic of inequalities, alternative and earnings that’s been raging because the 1980s. And that pandemic has been enabled by a pandemic of racism that has rotted in our society for generations.

I feel we’ve to make use of the second to insist that our publicly financed well being care system actually companions up with our public well being community and with our social safety-net system to deal with group and inhabitants well being with a laser concentrate on lowering disparities.

Q: How has the division responded to COVID-19 to deal with probably the most weak Californians?

The expansion in telehealth is one thing that will not have occurred with out this expertise. There’s work nonetheless underway to have a look at how we will provide you with some approaches to scale back the variety of folks in expert nursing amenities, the place the speed of unfold is a lot extra extreme and with actually mortal outcomes.

I’ve the suspicion that we’re by no means actually going to get to some extent the place we are saying the impact of COVID is over. The mere incontrovertible fact that a lot well being care utilization is down now, notably down within the locations the place individuals who begin at an obstacle usually search care, we’re going to search out long-term well being penalties into the longer term, even post-vaccine.

Q: In January, Gov. Newsom outlined a proposal to broaden a Medi-Cal program referred to as CalAIM that addresses bodily and behavioral well being wants in sufferers’ care, and even pays for his or her housing with well being care cash. Can your division nonetheless transfer ahead with these objectives although there isn’t cash within the funds for it?

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We could also be delayed to some extent. It was by no means supposed initially as a big-bang system change. It was at all times going to be a level of iterative growth, and that continues to be true — whether or not some issues need to go a bit of slower due to cash causes.

Q: You have got talked about entry to well being care and the way COVID-19 has actually highlighted systemic disparities. In Medi-Cal, lack of entry to care has lengthy been an issue, particularly in rural areas. So has insufficient look after children. Are these points you propose to deal with?

One of many issues we’d like is an ample community of suppliers that basically covers the medically underserved areas of the state. We have to work successfully with our rural well being clinics, in addition to our city Federally Certified Well being Facilities to broaden entry, notably to the populations that traditionally haven’t had that entry.

When it comes to companies for kids, that’s a giant a part of that agenda each in bodily and behavioral well being and likewise the dental well being system. There’s a giant concentrate on the way to enhance entry and preventive companies for kids.

Q: Within the Nice Recession, California lawmakers made many deep cuts to safety-net packages, a few of which have been restored solely not too long ago. The governor proposed a lot of well being care-related cuts this yr that have been in the end rejected by the legislature. How will you make sure that Medi-Cal enrollees received’t see their advantages scaled again sooner or later?

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It’s going to be my job to make the case to not cut back companies that poor folks depend on. That mentioned, we stay in the true world and if we ever have to scale back issues, my method can be to attempt to say, “How can we cut back issues we will readily rebuild slightly than destroy issues which are foundational?”

Aim No. 1 at this level is to work very carefully with our congressional delegation to actually encourage the federal authorities to assist the core companies and actions in order that we will meet the wants of the folks of the state.

This KHN story first printed on California Healthline, a service of the California Health Care Foundation.

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