In the Listening to Black Californians study, one group that stands out is black women with Medi-Cal coverage, who are more likely to report negative experiences and discrimination in the health care system than black Californians in general.
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The Takeaway Listening to black women with Medi-Cal in interviews, focus groups, and a statewide survey reveals a shared story of women who are engaged with the health care system but all too often face discrimination or other negative experiences during their health care visits . Providers and policymakers have immediate opportunities to make sure these women can have relationships of trust with providers and can get the care they need without discrimination. |
Medi-Cal, California’s Medicaid program, provides health coverage to low-income people. It covers one in three Californians, and black Californians make up 6.9% of Medi-Cal enrollees in 2022.
This study included one-hour interviews with 13 Medi-Cal women, two focus groups with Medi-Cal participants, and 383 female Medi-Cal survey respondents.
Key findings
Black women with Medi-Cal are actively engaged in their physical and mental health
The majority of black women with Medi-Cal (93%) reported having at least one health care visit in the past year. The majority of women surveyed with Medi-Cal (80%) say they devote “a lot” or “quite a bit” of effort to getting checkups or preventive care, focusing on their mental health (82%), and actively reducing of stress (82%). Women of childbearing age with Medi-Cal (85%) are more likely to make a “great deal” or “quite a bit” of effort to focus on their mental health than women over 50 with Medi-Cal (73%) .
Almost half of women with Medi-Cal (46%) put “a lot” or “quite a bit” of effort into seeking non-Western approaches to health care.
Women with Medi-Cal reported many negative health care experiences, including inadequate pain treatment
In each phase of the Black Californian Hearing, women with Medi-Cal shared similar stories of discrimination and negative treatment from the health care system and spoke of being “rejected, ignored or spoken to rudely” by doctors and nurses. Women with Medi-Cal were significantly more likely to report specific negative experiences during health care visits than other respondents. Women surveyed with Medi-Cal were among the groups most likely to report being treated poorly because of their race/ethnicity (43% compared to 31% of respondents overall).
In individual interviews and focus groups, participants repeatedly shared instances where their pain was neglected, untreated, or the cause was misdiagnosed. Half of black respondents with Medi-Cal (52%) reported not having enough pain treatment, significantly more than female respondents with other types of insurance coverage.
Black women avoid care because of concerns about abuse
Given their high rates of negative health care experiences, it may not be surprising that black women with Medi-Cal often avoid care. Almost four in 10 respondents with Medi-Cal (39%) reported avoiding going to the doctor or hospital because they felt they would not be treated fairly or with respect, compared to one in four respondents overall (26 %).
Key areas for action
Providers and policymakers have the opportunity to take concrete and comprehensive actions to address the inequalities outlined by the women in this study, including these:
- Make sure women with Medi-Cal can find and have reliable access to a regular provider or nursing home.
- Create incentives for providers to build trust and maintain caring relationships with Medi-Cal patients.
- Focus on pain management in women with Medi-Cal, especially those of childbearing age.