California’s DHCS Breaks Down Barriers with Listening Sessions: Medi-Cal Members Want Respect & Culturally Competent Providers

As California grapples with persistent healthcare inequities, the Department of Health Care Services (DHCS) has embarked on a transformative journey to create a more equitable and inclusive Medi-Cal system. This initiative aims to address the systemic disparities that have long plagued the state’s healthcare landscape, particularly among communities of color and underserved populations.

“Who you are and where you live should not determine how you live,” said Dr. Pamela Riley, Chief Health Equity Officer at DHCS. “Too often, people in communities of color face larger health disparities and are more likely to distrust healthcare providers. These experiences reflect deep-seated racism and structural inequities within our healthcare system.”

Expanding Access and Services

In a landmark move, California expanded Medi-Cal earlier this year to cover all residents, regardless of immigration status or income level. This bold step towards universal healthcare coverage is part of a broader effort to dismantle barriers to care and ensure that all Californians have access to the services they need.

“Health equity goes beyond access,” Dr. Riley emphasized. “We are committed to providing culturally competent and accessible healthcare. This includes expanding services beyond the doctor’s office to address physical and mental health needs as well as social support, such as home modifications, healthy meals, and transportation to medical appointments.”

Additionally, DHCS has made significant strides in enhancing service accessibility. The department’s online services are now available in multiple languages, including Arabic, Armenian, Cambodian, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, and Vietnamese. This expansion ensures that more Californians can access information and services in their preferred language.

“Language interpretation services are critical,” Dr. Riley explained. “By making our services available in multiple languages, we are breaking down one of the key barriers to accessing care.”

Listening to the Community

Central to DHCS’s strategy is the Health Equity Roadmap initiative, a phased, multi-year process designed to create a more person-centered Medi-Cal system. The initiative’s first phase, a statewide listening tour, began in September 2023 and concluded in March 2024. During this tour, DHCS officials engaged directly with Medi-Cal members, particularly those from Black and Indigenous communities, to hear about their healthcare experiences and needs.

Choice in Aging and The Bedford Center were among the many partnered organizations that facilitated these listening sessions. “We hosted 11 listening sessions, both in person and virtually, with hundreds of participants,” said Debbie Toth, CEO of Choice in Aging. “The feedback was invaluable. Members want to feel respected and heard, and they need language accessibility and culturally relatable healthcare providers.”

Co-Design and Implementation

The insights gathered from these sessions are now informing the second phase of the initiative: co-designing solutions with members and stakeholders. This phase aims to identify common themes and develop actionable steps to improve Medi-Cal services.

“The biggest challenge during the listening sessions was engaging populations with cognitive impairments,” Toth noted. “We had to find innovative ways to facilitate these conversations, often involving caregivers to ensure all voices were heard.”

Tangible Steps Ahead

According to Dr. Riley, the Health Equity Roadmap is structured into three key phases:

Phase 1: Listening Tour

Began in September 2023 and concluded in March 2024.

Engaged directly with Medi-Cal members across the state.

Phase 2: Co-Design

Using feedback to identify common themes and solutions.

Collaboration with experts, advocates, providers, members, and stakeholders.

Phase 3: Health Equity Roadmap

Developing a comprehensive plan with actionable steps.

Ongoing process with continued feedback and engagement.

“We’re committed to making sure that the benefits we offer meet the diverse needs of our members,” said Michael Whalen, Program Director at The Bedford Center. “Our clients repeatedly express the importance of having a place to go during the day where they can feel seen, recognized, and supported. Building strong relationships with caregivers and physicians is crucial for advocating for our clients’ needs.”

A Call for Collaboration

The Health Equity Roadmap is part of California’s broader strategy to create a more equitable healthcare system. This includes initiatives like the CalAIM waiver, which aims to transform Medi-Cal into a more coordinated, person-centered, and equitable program. Governor Newsom’s administration has also taken steps such as eliminating the asset test for Medi-Cal eligibility and establishing a $700 million primary care provider practice transformation program.

“We need everyone’s input to make Medi-Cal more equitable and accessible,” Dr. Riley urged. “If you have ideas or feedback, please share them with us at healthequityroadmap@dhcs.ca.gov.”

As DHCS continues to implement these changes, the department remains committed to its mission of ensuring that all Californians have a fair and just opportunity to attain their highest levels of health. The road ahead is long, but with continued collaboration and dedication, California is poised to set a new standard for equitable healthcare.