CALIFORNIA, USA — This story was originally published by CalMatters.
To boost COVID-19 vaccination rates among California’s low-income residents, last year the state launched a $350 million incentive program. But since then, the gap between those Medi-Cal members and the general population has actually grown wider.
While 84% of all Californians 5 years and older have received at least one dose of the COVID-19 vaccine, only about 57% of those in Medi-Cal, the health insurance program for low-income residents, have done so as of 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 bigger than the gap recorded last summer.
In September, the state rolled out a six-month incentive program for Medi-Cal health plans to boost Covid vaccination rates among their 14 million members. CalMatters compared those health plans’ most recently published vaccination rates to what they looked like in August of 2021, before the start of the incentive program, to see how much each plan’s vaccination rates had grown in that time. This comparison looks at the 12 and over age group because vaccines for younger children were not available last summer.
Between last August and this April, the most improved Medi-Cal plan, CalViva in Fresno, Kings and Madera counties, went from 42% to 54% vaccinated members ages 12 and over. The plan with the lowest gains, United Healthcare Community Plan in San Diego County, went from 46% to 48%. Five Medi-Cal plans still have Covid vaccination rates under 50% — although that’s an improvement from last summer, when 11 plans were under the half mark.
The fact that rates are trending up is a good thing, but the growing gap between Medi-Cal members and the general population is concerning, said Kiran Savage-Sangwan, executive director at the California Pan-Ethnic Health Network. “They’re not making the type of progress that one would hope for,” she said. “I think it’s possible that health plans may need to reevaluate their strategies.”
Data has persistently shown that people living in the poorest zip codes and enrolled in the Medi-Cal program are vaccinated at lower rates, leaving them more susceptible to serious disease from an infection. People who are not vaccinated 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 paid Medi-Cal plans some money upfront to roll out efforts to get more of their members vaccinated. The plans would then get additional dollars if they met certain targets, such as increasing vaccination among their homebound members and among Latino and African American members, who have been vaccinated at lower rates than other racial and ethnic groups.
The incentive program has now ended, and the state’s Department of Health Care Services is still analyzing data provided by the health plans to determine whether targets were met. “Final performance and financial data for the current program will be evaluated before considering whether a follow-up future program would be helpful,” Carol Sloan, a department spokesperson, said in an email.
In general, a health plan’s vaccination rate reflects that of the region it serves. For example, plans serving the Bay Area — where vaccination has typically 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 lower to begin with, Medi-Cal plans there saw the most growth in the six months of the state’s incentive program.
Officials at health plans interviewed for this story said that while they were already doing their own outreach to members prior to the incentive program, state dollars allowed them to ramp up those efforts and get creative.
Some plans increased the number of vaccination events — one even hired an event planner to redesign its pop-up clinics, bringing in balloon artists and bubblegum machines in hopes of attracting more people. Plans have offered Medi-Cal members gift cards and free days at a local museum in exchange for a vaccine. They’ve teamed up with celebrities on social media campaigns and partnered with local organizations like churches to set up clinics in zip codes with the lowest Covid vaccination rates. Plans also used the money to boost their efforts in combating vaccine misinformation via mailers and phone calls.
Dr. Takashi Wada, chief medical officer at Inland Empire Health Plan, which serves 1.5 million people in Riverside and San Bernardino counties, said a key component of its vaccination strategy was to pass on incentive dollars to the health providers they contract with. “Because we really wanted our providers to be talking to their patients about the importance of the vaccine…and administer the vaccine themselves,” he said.
The percentage of the plan’s providers administering the vaccines in their offices, rather than referring out, went from 40% to 60% during the six months of the incentive program, Wada said.
Still, despite the ongoing efforts and an improvement of about 8 percentage points since August, less than half of Inland Empire Health’s members 12 and older have received a shot.
“There are still absolutely opportunities (to grow), and that’s why we’ve been working so hard to come up with ways to try to make the vaccine more accessible and to gain trust,” Wada said.
Early in the vaccine distribution process, access was often cited as the primary challenge — supply was scarce, especially in the state’s rural or more remote areas. Now health plans hear a lot more about hesitancy due to mistrust, misinformation and political ideology, Wada said.
Jake Hall, deputy director of provider contracts at Kern Health Systems, which covers about 330,000 people in Kern County, said a common reason members give for turning down the vaccine is that they’ve already had a COVID-19 infection. Pregnancy is also another common reason, Hall said. Officials at the Centers for Disease Control and Prevention recommend vaccination for people who are pregnant and for those who’ve had a previous infection.
Officials at health plans with higher Covid vaccination rates said one of their focus points now is to increase vaccination among young children. As of mid-April, 28% of California children 5 to 11 enrolled in Medi-Cal had received at least one dose, according to the Medi-Cal data. By comparison, 40% of all children statewide in this age group had received a shot.
“I think in our community there has been a lot of support for getting kids vaccinated, but it’s short of a mandate. It makes it tricky,” said Christine Tomcala, chief executive officer at Santa Clara Health Plan.
Last month state legislators pulled back a bill that would have required vaccination for kids to attend school. That same day, the Newsom administration also postponed its proposed vaccine mandate for school children until at least July 2023.
In the coming months, health insurance plans will also face a change in their membership numbers as California expands Medi-Cal to undocumented people 50 and over — adding new people who might not yet be vaccinated.
Also, during the declared federal COVID-19 public health emergency, the state suspended efforts to verify Medi-Cal eligibility. Assuming the emergency declaration ends as expected this summer, about 2 million people are estimated to lose their Medi-Cal coverage if they no longer qualify for the program either because their income has increased or they’ve gained access to other types of health coverage in the last two years.
“We’re adding people who may not be vaccinated, but we could also be losing people who are, so it might look like we’re going backwards,” Tomcala said.
Update: A chart within this story has been corrected to reflect that Blue Shield of California’s Promise Health Plan does not cover Medi-Cal patients in Alameda County.
CalMatters COVID and health care coverage is supported by grants from the Blue Shield of California Foundation, the California Health Care Foundation and the California Wellness Foundation.
CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.
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