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To boost COVID-19 vaccination rates among low-income California residents, the state launched a $350 million incentive program last year. But since then, the gap between these Medi-Cal members and the general population has actually widened.
While 84% of all Californians ages 5 and older have received at least one dose of the COVID-19 vaccine, only about 57% of those on Medi-Cal, the health insurance program for low-income residents, l did in April. , according to the latest vaccination update from the California Department of Health Care Services.
That’s a gap of 27 percentage points, and it’s slightly larger than the gap recorded last summer.
In September, the state launched a six-month incentive program for Medi-Cal health plans to increase Covid vaccination rates among their 14 million members. CalMatters compared these health plans’ most recently released vaccination rates to what they looked like in August 2021, before the incentive program began, to see how much each plan’s vaccination rates had increased during this period. This comparison is for the 12+ age group, as vaccines for young children were not available last summer.
Between last August and April, the most improved Medi-Cal plan, CalViva in Fresno, Kings and Madera counties, increased from 42% to 54% of vaccinated members ages 12 and older. The plan with the lowest gains, United Healthcare Community Plan in San Diego County, fell from 46% to 48%. Five Medi-Cal plans still have Covid vaccination rates below 50% – although this is an improvement from last summer, when 11 plans were below half.
That rates are rising is good, but the growing gap between Medi-Cal members and the general population is concerning, said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network. “They’re not making the kind of progress you’d hope for,” she said. “I think it’s possible that health plans need to re-evaluate their strategies.”
Data has consistently shown that people living in poorer ZIP codes and enrolled in the Medi-Cal program are vaccinated at lower rates, making them more susceptible to serious illness from infection. Unvaccinated people are 8.6 times more likely to be hospitalized than those who have been vaccinated and boosted, according to the state’s public health department.
Through the incentive program, the state provided Medi-Cal with funds up front to support efforts to get more of its members vaccinated. The plans would then get additional dollars if they met certain goals, such as increasing vaccination among their homebound members and among Latino and African American members, who were vaccinated at lower rates than those other racial and ethnic groups.
The incentive program has now ended, and the State Department of Health Services is still analyzing the data provided by the health plans to determine whether the goals were met. “Final performance and financials of the current program will be evaluated before determining whether a future follow-on program would be useful,” department spokeswoman Carol Sloan said in an email.
In general, a health plan’s immunization rate reflects that of the region it serves. For example, plans serving the Bay Area — where vaccination has generally been more popular — report higher Covid vaccination rates than those serving the San Joaquin Valley or the Inland Empire. But because vaccination rates in the Valley were initially lower, Medi-Cal plans there saw the greatest growth during the six months of the state incentive program.
Health plan officials interviewed for this story said that while they were already doing their own outreach to members before the incentive program, the state dollars allowed them to scale up those efforts and demonstrate of creativity.
Some plans increased the number of vaccination events – one even hired an event planner to redesign its pop-up clinics, bringing balloon artists and chewing gum machines into the venue. hope to attract more people. The plans offered Medi-Cal members gift cards and free days at a local museum in exchange for a vaccine. They’ve partnered with celebrities on social media campaigns and partnered with local organizations like churches to set up clinics in postcodes with the lowest Covid vaccination rates. The plans also used the money to bolster their efforts in combating vaccine misinformation through letters and phone calls.
Dr. Takashi Wada, chief medical officer for the Inland Empire Health Plan, which serves 1.5 million people in Riverside and San Bernardino counties, said a key part of his vaccination strategy was to pass along incentive dollars to the health providers with whom they contracted. “Because we really wanted our providers to talk to their patients about the importance of the vaccine…and administer the vaccine themselves,” he said.
The percentage of plan providers administering the vaccines in their offices, rather than referral, rose from 40% to 60% over the six months of the incentive program, Wada said.
Yet despite continued efforts and an improvement of about 8 percentage points since August, less than half of Inland Empire Health members aged 12 and older have received an injection.
“There are still absolutely opportunities (for growth), and that’s why we’ve worked so hard to find ways to try to make the vaccine more accessible and gain trust,” Wada said.
Early in the vaccine distribution process, access was often cited as the main challenge – supplies were scarce, especially in rural or more remote areas of the state. Now health plans are hearing a lot more about hesitation due to mistrust, misinformation and political ideology, Wada said.
Jake Hall, assistant director of vendor contracts at Kern Health Systems, which covers about 330,000 people in Kern County, said a common reason members give for declining the vaccine is that they’ve already had a COVID-19 infection. Pregnancy is also another common reason, Hall said. Centers for Disease Control and Prevention officials recommend vaccination for pregnant women and for those who have had an infection in the past.
Officials of health plans with higher COVID vaccination rates have said one of their focus points now is to increase vaccination among young children. As of mid-April, 28% of California children ages 5 to 11 enrolled in Medi-Cal had received at least one dose, according to Medi-Cal data. In comparison, 40% of all children in this age group statewide had received an injection.
“I think in our community there’s been a lot of support to get kids vaccinated, but it lacks a mandate. That makes it difficult,” said Christine Tomcala, executive director of Santa Clara Health Plan.
Last month, state lawmakers withdrew a bill that would have required children to be vaccinated to attend school. On the same day, the Newsom administration also postponed its proposed vaccination mandate for school children until at least July 2023.
In the coming months, health insurance plans will also face shifting enrollment numbers as California expands Medi-Cal to undocumented people age 50 and older, adding new people who may not still be vaccinated.
Additionally, during the declared federal public health emergency COVID-19, the state suspended efforts to verify eligibility for Medi-Cal. Assuming the emergency declaration ends as planned this summer, it is estimated that approximately 2 million people will lose their Medi-Cal coverage if they are no longer eligible for the program, either because their income has increased or because have had access to other types of health coverage in the past two years.
“We’re adding people who might not be vaccinated, but we might also lose people who are, so it might feel like we’re slipping back,” Tomcala said.
CalMatters COVID and Healthcare Coverage is supported by grants from the Blue Shield of California Foundation, California Health Care Foundation, and California Wellness Foundation.