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COVID vaccinations lag for people on Medi-Cal

An East Palo Alto resident is inoculated during a COVID-19 vaccination clinic run by Ravenswood Family Health Network at Facebook headquarters in Menlo Park on April 10, 2021. Ravenswood clinics serve low-income populations with more than half of their patients participating in Medi-Cal and other public health care programs. Photo by Anne Wernikoff, CalMatters.

Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, according to state data.

The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.

About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of 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 health care program for low-income people.

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 poses a major obstacle to the state's efforts to try to reach herd immunity.

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Jacey Cooper, the state's Medicaid director, called the vaccination disparity a "stark reminder of the inequities within our delivery system."

Medi-Cal vaccination rates are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.

In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county's residents have been vaccinated but only 33% of Medi-Cal enrollees. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.

"It is problematic that this gap exists, but it is consistent with national trends that show people with low incomes are less likely to be vaccinated," said Laurel Lucia, director of the Health Care Program at UC Berkeley's Labor Center.

State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.

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The state's Department of Health Care Services said it's doing several things to increase vaccination among Medi-Cal patients, including sharing ​​data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.

Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.

"Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they're worried about missing work, not just for the appointment but also if they have symptoms from the vaccine," Lucia said.

'Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack child care, spend a lot of time commuting.'

-Laurel Lucia, UC Berkeley's Labor Center

Amy Jester, a program director at the Humboldt Area Foundation, said it's particularly a problem among seasonal employees like farmworkers.

For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.

Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent Kaiser Family Foundation poll.

In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It's more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.

Alpine County shows the biggest gap — a difference of almost 53 percentage points 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. Dr. Rick Johnson, the county's public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county's population lives on a reservation.

In the Eastern Sierra's Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.

But the disparity is not just happening 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 Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.

San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that's eclipsed by its overall rate of 84%.

"We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal," a spokesperson for the state health care services agency told CalMatters in an email.

Last month, Ohio's governor, noting a similar disparity in his state's Medicaid population, challenged health plans to get 900,000 more Medicaid members vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.

Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks vaccination by ZIP code has shown a similar lag in lower-income neighborhoods.

"This is a reflection of decades of issues with inequities" in health care, said Dr. Ilan Shapiro, a pediatrician and medical director for the AltaMed health system in Southern California.

"We saw similar trends with testing — which group was lacking? People in underserved communities," he said. "We saw it with cases — which group got hit the hardest? People in underserved communities."

One challenge is the mixed messaging, said Dr. James Kyle, medical director for quality, diversity, equity, and inclusion at L.A. Care Health Plan. He said one of the most successful strategies is direct phone calls to members because it gives people the opportunity to ask questions and ease some of their confusion.

"People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we've reopened businesses, and I think people have genuine confusion… they're trying to decide what's the right thing to do, so they're doing nothing."

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COVID vaccinations lag for people on Medi-Cal

by / CalMatters

Uploaded: Sun, Aug 1, 2021, 8:50 am

Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, according to state data.

The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.

About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of 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 health care program for low-income people.

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 poses a major obstacle to the state's efforts to try to reach herd immunity.

Jacey Cooper, the state's Medicaid director, called the vaccination disparity a "stark reminder of the inequities within our delivery system."

Medi-Cal vaccination rates are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.

In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county's residents have been vaccinated but only 33% of Medi-Cal enrollees. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.

"It is problematic that this gap exists, but it is consistent with national trends that show people with low incomes are less likely to be vaccinated," said Laurel Lucia, director of the Health Care Program at UC Berkeley's Labor Center.

State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.

The state's Department of Health Care Services said it's doing several things to increase vaccination among Medi-Cal patients, including sharing ​​data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.

Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.

"Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they're worried about missing work, not just for the appointment but also if they have symptoms from the vaccine," Lucia said.

Amy Jester, a program director at the Humboldt Area Foundation, said it's particularly a problem among seasonal employees like farmworkers.

For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.

Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent Kaiser Family Foundation poll.

In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It's more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.

Alpine County shows the biggest gap — a difference of almost 53 percentage points 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. Dr. Rick Johnson, the county's public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county's population lives on a reservation.

In the Eastern Sierra's Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.

But the disparity is not just happening 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 Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.

San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that's eclipsed by its overall rate of 84%.

"We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal," a spokesperson for the state health care services agency told CalMatters in an email.

Last month, Ohio's governor, noting a similar disparity in his state's Medicaid population, challenged health plans to get 900,000 more Medicaid members vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.

Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks vaccination by ZIP code has shown a similar lag in lower-income neighborhoods.

"This is a reflection of decades of issues with inequities" in health care, said Dr. Ilan Shapiro, a pediatrician and medical director for the AltaMed health system in Southern California.

"We saw similar trends with testing — which group was lacking? People in underserved communities," he said. "We saw it with cases — which group got hit the hardest? People in underserved communities."

One challenge is the mixed messaging, said Dr. James Kyle, medical director for quality, diversity, equity, and inclusion at L.A. Care Health Plan. He said one of the most successful strategies is direct phone calls to members because it gives people the opportunity to ask questions and ease some of their confusion.

"People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we've reopened businesses, and I think people have genuine confusion… they're trying to decide what's the right thing to do, so they're doing nothing."

Email Ana B. Ibarra at [email protected]

CALmatters.org is a nonprofit, nonpartisan media venture explaining California's policies and politics.

Comments

Cassie Verdugo
Registered user
Mountain View
on Aug 1, 2021 at 10:09 am
Cassie Verdugo, Mountain View
Registered user
on Aug 1, 2021 at 10:09 am

Simple solution...just go into these low-vax neighborhoods with a mobile innoculation center on weekends and during off-hours.

Something along the lines of bookmobile except with vaccines and nurses.

Next question?


Jennifer
Registered user
another community
on Aug 1, 2021 at 11:53 am
Jennifer, another community
Registered user
on Aug 1, 2021 at 11:53 am

A mobile vaccine unit makes sense. It's time to get creative and do something that will increase the vaccination rates. If you lack access to transportation, bribing people with cash incentives -- people see through the manipulation. If blood drives can be done, you can do vaccine drives. They're doing them in Alberta, Canada at work sites, rural areas, etc. No wonder Canada is ahead of all countries. Some people are confused, and answering questions and educating people is a more effective approach.


Cam Willard
Registered user
Menlo Park
on Aug 1, 2021 at 12:52 pm
Cam Willard, Menlo Park
Registered user
on Aug 1, 2021 at 12:52 pm

Another approach...notify all local Medi-Cal recipients that they have 30 days to provide proof of vaccination or they will lose their health benefits and be relegated to Valley-Med in the event of a medical emergency or required medical treatments.


vmshadle
Registered user
Meadow Park
on Aug 2, 2021 at 4:00 pm
vmshadle, Meadow Park
Registered user
on Aug 2, 2021 at 4:00 pm

Cam Willard's response above smacks of arrogance, condescension, and blaming Medi-Cal recipients for their own fate.

As a former recipient of Medi-Cal, I can assure you that people can lose their private health insurance and go on public insurance for a wide variety of reasons. My three post-secondary degrees did not prevent me from two major illnesses leading to the loss of my own private health insurance for several years.

We are not unruly children who need to be threatened with deadlines lest we be "stuck" with public hospitals. First of all, Valley Med is affiliated with Stanford and also provides some kinds of innovative care not offered elsewhere. Second of all, many private providers do accept Medi-Cal. I suggest you examine your conscience before making such ugly assumptions about your fellow citizens.


Henry Beamon
Registered user
another community
on Aug 2, 2021 at 4:11 pm
Henry Beamon, another community
Registered user
on Aug 2, 2021 at 4:11 pm

Reluctance to get vaccinated might also be culturally or intellectually related.

Of the many Central American refugees detained at the southern U.S. border, nearly 2/3 of them have declined Covid-19 innoculations even if it assured them of an eventual and scheduled asylum appointment with immigration services.

How dumb is that?


Bethany Giftos
Registered user
Los Altos
on Aug 2, 2021 at 4:38 pm
Bethany Giftos, Los Altos
Registered user
on Aug 2, 2021 at 4:38 pm

- "How dumb is that?"

Perhaps more along the lines of distrustful...America has never been known to instill the public's trust in its legal system, the police, or its politicians.


Marcie Hanson
Registered user
Barron Park
on Aug 2, 2021 at 5:12 pm
Marcie Hanson, Barron Park
Registered user
on Aug 2, 2021 at 5:12 pm

[Post removed due to same poster using multiple names.]


William Hitchens
Registered user
Mountain View
on Aug 2, 2021 at 6:43 pm
William Hitchens, Mountain View
Registered user
on Aug 2, 2021 at 6:43 pm

Simple solution: Just tell them "Your overly generous MediCal benefits will be canceled soon if you and all of your immediate family don't get fully vaccinated. After all, we're giving you this free medical care."
In response we have two demands. Get everyone near you fully vaxed and SHOW PROOF. And BEHAVE RESPONSIBLY, no matter how irresponsible you are. This is called a quid pro quo, but I don't expect any of you to understand that simple phrase, or even that simple concept.


John B. Sails
Registered user
Midtown
on Aug 2, 2021 at 6:45 pm
John B. Sails, Midtown
Registered user
on Aug 2, 2021 at 6:45 pm

no, please tell them where they can go to get their $100.

you guys want to help, that will do more than scolding them, and
FAR more than masking the already vaxxed (which won't convince the unvaxxed to vax AT ALL).


The Voice of Palo Alto
Registered user
Crescent Park
on Aug 2, 2021 at 7:49 pm
The Voice of Palo Alto, Crescent Park
Registered user
on Aug 2, 2021 at 7:49 pm

1. “One challenge is the mixed messaging. People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we've reopened businesses, and I think people have genuine confusion… they're trying to decide what's the right thing to do, so they're doing nothing."

I don’t buy into this premise of “mixed messaging” at all. The vaccine has been widely available for months now and we have all been suffering through this pandemic for about 18 months. The fact that people are that confused and “doing nothing” seems implausible and seems like an excuse, but if it actually is true then it’s just sad. The only questions anyone should have right now potentially, are questions about the vaccines themselves if they have any concerns. Wake up please! This scenario is actually why Biden wanted to start literally going door to door to get vaccinations done and answer any questions.

2. “This is called a quid pro quo, but I don't expect any of you to understand that simple phrase, or even that simple concept.”

Agreed. This concept is too difficult for many of these simpletons. Great point!

3. “No, please tell them where they can go to get their $100.”

I’m not criticizing your post(this time), I just think it’s sad in a general sense that we have to pay people $100 to you know, potentially save their own lives or lives of their family members. Especially, when many poorer nations won’t have access to any vaccine until 2023 at the earliest.
American elitism at its finest.

4. FAR more than masking the already vaxxed (which won't convince the unvaxxed to vax AT ALL).

Just to inform you (as you seem really stuck on this point based on previous posts), the CDC announced the new masking guidance for those vaccinated to mask up because they found vaccinated people can spread the Delta to others. Delta has changed the equation and people will have to adjust. Finally, this isn’t about “individual freedoms.” It’s about public health.


John B. Sails
Registered user
Midtown
on Aug 3, 2021 at 8:48 am
John B. Sails, Midtown
Registered user
on Aug 3, 2021 at 8:48 am

Everything the CDC has announced has not been equally based on good science. Perhaps Delta changed the equation, but I don't see why punishing the fully vaxxed really promotes getting the un-vaxxed vaxxed. It instead seems to inspire the opposite, as we as a society are changing our minds, and now making allowances and adjustments for the powerful unvaxxed. So, in this case, I disagree with the conclusion that "It's about public health." Clearly, that's not all that it's about. It's also sometimes about counter-productive pose.


Bob Hernandez
Registered user
Charleston Meadows
on Aug 3, 2021 at 9:03 am
Bob Hernandez, Charleston Meadows
Registered user
on Aug 3, 2021 at 9:03 am

Another simple solution...

No proof of vaccination > NO ENTRY.

NYC has recently implemented this rule for gyms and restaurants.

It should also be applied regionally to sports arenas, churches and all public gatherings throughout the country.

This is how you will get more folks vaccinated...by law.

And the only resistance will come from red states where the people aren't too bright.


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