In summary
In all California counties, people enrolled in Medi-Cal have been vaccinated at substantially lower rates than the general population. Experts point to several factors for this economic divide, such as the inability of low-income people to take time off from work.
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Low-income Californians enrolled in Medi-Cal have been vaccinated at much lower rates than the general population in all 58 counties, according to state data.
The disparity reveals a sharp economic divide between vaccinated and unvaccinated throughout California.
About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (ages 12 and older) would have received at least one dose by July 18, compared to about 70% of all eligible Californians state officials said Thursday.
Nearly 14 million Californians are enrolled in Medi-Cal, the state’s low-income health care program.
The gap in their vaccination rate leaves low-income people once again highly vulnerable to the virus, particularly the more contagious Delta variant. And it represents a major obstacle to the state’s efforts to try to achieve herd immunity.
Jacey Cooper, the state’s Medicaid director, called the immunization disparity a “stark reminder of the disparities within our delivery system.”
Medi-Cal vaccination rates they are below 50% in most counties, but rates are especially low in rural far north counties. In Lassen, Shasta, Tehama, Trinity, and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low vaccination rates for their entire general population.
In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of county residents have been vaccinated, but only 33% of those enrolled in Medi-Cal. In Los Angeles County, 70% of its total population is vaccinated, of which only 49% receive Medi-Cal.
“It is problematic that this gap exists, but it is consistent with national trends that show that low-income people are less likely to be vaccinated, ”said Laurel Lucia, director of the UC Berkeley Labor Center Health Care Program.
State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are testing mobile vaccination clinics, door-to-door campaigns, and monetary incentives.
The state Department of Health Care Services said it is doing several things to increase vaccinations among Medi-Cal patients, including sharing data with health plans about members who have not yet been vaccinated, encouraging more Medi-Cal providers to sign up to administer vaccinations and work with hospital associations to improve access to vaccinations in emergency rooms.
Experts said that one of the main reasons many people on Medi-Cal may not be vaccinated is that it is more difficult for them to get away from work.
“Low-income workers face significant practical challenges. They are often limited in time due to multiple jobs, may lack childcare, and spend a lot of time traveling. And they are concerned about missing work, not only for the appointment, but also if they have symptoms from the vaccine, ”said Lucia.
“Low-income workers face significant practical challenges. They are often limited in time due to multiple jobs, they may lack childcare and spend a lot of time traveling.
Laurel Lucia, UC Berkeley Labor Center
Amy Jester, program director for the Humboldt Area Foundation, said it’s a particular problem among seasonal employees, such as farm workers.
For example, in Humboldt and surrounding counties, agricultural and tourism workers are in the midst of one of their busiest seasons. For many of them, taking time off during peak season means losing income.
Across the country, adults whose employers encouraged them to get vaccinated or gave them paid time off to recover from side effects were more likely to be immunized, according to an eRecent Kaiser Family Foundation Survey.
In most California counties, only 25% to 35% of people who receive Medi-Cal are vaccinated. It’s more than half in just 11 counties, mostly in the Bay Area, but also in Orange and Imperial counties.
Alpine County shows the largest gap – a nearly 53% difference between Medi-Cal recipients and the county’s total population. The rural county is home to about 1,100 people, so even a few unvaccinated people can make a big difference. State public health official Dr. Rick Johnson said Alpine is experiencing high resistance to vaccines on American Indian reservations; approximately 20% of the county’s population lives on a reservation.
In Inyo County of the Eastern Sierra, the vaccination rate is almost double among the general population than among people on Medi-Cal: 58% compared to 32%.
But the disparity doesn’t just happen in rural, remote, or less affluent counties. Marin County has the highest vaccination rate in California – 88% of all eligible residents. But only 61.5% of its residents with Medi-Cal would have received at least one injection by July 18. About one in five Marin County residents is enrolled in Medi-Cal.
San Francisco has the highest percentage of Medi-Cal enrollees vaccinated at 65%, but that is dwarfed by its overall rate of 84%.
“We believe we can do better, and must do better, to prevent greater disparities in COVID infection and death among people served by Medi-Cal,” a spokesperson for the state health services agency told CalMatters in an email. .
Last month, the governor of Ohio, noting a similar disparity in his state’s Medicaid population, challenged health plans to get 900,000 more Medicaid members vaccinated before September 15. Now, every Ohio Medicaid member who receives a vaccine receives a $ 100 gift card.
Health care providers say they are not surprised that Medi-Cal members have been late in getting vaccinated. The state tracks data from vaccination by zip code, which have shown a similar lag in lower-income neighborhoods.
“This is a reflection of decades of problems with inequities in health care. We saw it with the cases: which group was the most affected? People in underserved communities ”.
Dr. Ilan Shapiro, AltaMed Health System
“This is a reflection of decades of problems with health care inequities,” said Dr. Ilan Shapiro, pediatrician and medical director for AltaMed Health System in Southern California.
“We saw similar trends with the tests, which group was missing? People from marginalized communities ”, he stated. “We saw it with the cases: which group was the most affected? People in underserved communities ”.
One challenge is mixed messages, said Dr. James Kyle, medical director of quality, diversity, equity and inclusion at LA Care Health Plan. He said that one of the most successful strategies is direct phone calls to members because it gives people a chance to ask questions and alleviate some of their confusion.
“People are hearing about the Delta variant, about the increase in hospitalizations, but at the same time, we have reopened businesses and I think people have genuine confusion and are trying to decide what is the right thing to do.”
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