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Medi-Cal Agency’s New Head Wants to Tackle Disparities and Racism

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When Will Lightbourne regarded on the statistics behind California’s coronavirus circumstances, the disparities had 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 Department of Public Health. Blacks account for Eight.5% of the deaths however make up 6% of the inhabitants.

Lightbourne, who led California’s Department of Social Services below 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 Department of Health Care Services, he mentioned, he couldn’t say no.

“He has committed his whole professional life to public service,” mentioned Mike Herald, director of coverage advocacy on the Western Center on Law & Poverty. “He’s not joking when he talks about the importance of these issues and the important role that government plays in addressing societal inequities.”

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The Department of Health Care Services oversees the state’s Medicaid program for low-income individuals, 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 individuals’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.

Health care advocates say Lightbourne has a monitor report of getting issues completed.

At the Department of Social Services, he persuaded Brown, a recognized penny pincher, to extend money help to low-income households, restoring cuts lawmakers had made within the Great 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 youngsters whereas receiving public help, Herald mentioned.

“Will is very purpose-driven and has made substantive changes in every role he has ever had,” mentioned Graham Knaus, govt director of the California State Association of Counties.

Before embarking on state service, Lightbourne served as director of the Santa Clara County Social Services Agency, the Human Services Agency of the City & County of San Francisco and the Santa Cruz County Human Services Agency.

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

The activity received’t be straightforward. The earlier director of the Department of Health Care Services, 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 individuals who want it. The interview has been edited for size and readability.

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

Events 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 now have 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 handle neighborhood and inhabitants well being with a laser concentrate on lowering disparities.

Q: How has the division responded to COVID-19 to handle essentially the most susceptible Californians?

The progress in telehealth is one thing that may not have occurred with out this expertise. There’s work nonetheless underway to have a look at how we are able to provide you with some approaches to scale back the variety of individuals 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 a degree 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 seek 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 generally known 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 finances for it?

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

Q: You have 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 plan to handle?

One of the issues we’d like is an satisfactory community of suppliers that actually 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 Qualified Health Centers to develop entry, notably to the populations that traditionally haven’t had that entry.

In phrases of companies for youngsters, 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 tips on how to enhance entry and preventive companies for youngsters.

Q: In the Great Recession, California lawmakers made many deep cuts to safety-net packages, a few of which have been restored solely lately. The governor proposed numerous well being care-related cuts this yr that had 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?

It’s going to be my job to make the case to not scale back companies that poor individuals depend on. That mentioned, we dwell in the true world and if we ever have to scale back issues, my method could be to attempt to say, “How can we reduce things we can readily rebuild rather than destroy things that are foundational?”

Goal No. 1 at this level is to work very carefully with our congressional delegation to essentially encourage the federal authorities to help the core companies and actions in order that we are able to meet the wants of the individuals of the state.

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

Samantha Young: syoung@kff.org”>syoung@kff.org, @youngsamantha

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