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Excerpted From: Adrian Slipski, Staying Healthy in a Pandemic: How the Covid-19 Emergency Has Strengthened Barriers to Healthcare for California's Vulnerable Populations, 68 UCLA Law Review Discourse 176 (2020) (48 Footnotes) (Full Document)


AdrianSlipskiThe COVID-19 crisis has laid bare the huge disparities already present in this country's healthcare system. In "normal times"--those not marked by a global pandemic--low-income Americans face enormous barriers to healthcare, which disproportionately impact people of color. The COVID-19 crisis has further jeopardized the health and safety of many individuals by enhancing these barriers.

Throughout California, one-third of all Californians rely on Medi-Cal, California's Medicaid program, to access healthcare. The pandemic has created tension in the need to sustain Medi-Cal programs and services without interruption while still taking critical steps to protect the health of both the state employees who administer these benefits and the Californians who receive them. Beyond the scope of Medi-Cal, California's marginalized populations are endangered by other risks created by COVID-19 as well. Latinx people make up over half of all COVID-19 patients, and communities of color generally bear a disproportionate number of COVID-19-related deaths. Low-income individuals and those experiencing homelessness have decreased access to basic essential items, food, and sanitation supplies, and they are disproportionately impacted by the limited availability and accessibility of COVID-19 testing services.

This Article will explore these issues based on cases that come to the Health Consumer Center (HCC) of Neighborhood Legal Services of Los Angeles County (NLSLA). Specifically, it will examine issues surrounding Medi-Cal eligibility, the process of transitioning between Covered California and Medi- Cal, and barriers to healthcare caused by the COVID-19 crisis. Given the glaring intersectionality between California's low-income populations and its communities of color, and in light of ongoing national unrest as a result of widespread violence against Black people, it will also examine ways in which the pandemic has emphasized longstanding racial divides in the accessibility of adequate healthcare. Overall, this Article will show how the pandemic has seriously jeopardized the health and wellbeing of marginalized Californians, regardless of whether they had COVID-19.

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This Article has explored barriers to health insurance coverage and access to healthcare services based on the experiences of HCC's clients. It has identified key issues California's marginalized populations face in securing healthcare access during a pandemic. Going forward, there need to be stronger protections to ensure that these Californians have uninterrupted access to healthcare. This will reduce the likelihood of disparate impacts on the health and income of such a huge portion of the population.

In particular, the state should develop a protocol to quickly and efficiently communicate whatever safeguards it puts in place to prevent loss of health benefits because of sudden economic changes. During the COVID-19 crisis, policies were enacted to suspend negative actions for Medi-Cal beneficiaries and to provide more subsidies for those on Covered California plans. Even so, many eligible recipients did not learn about these protections until well into the emergency period, and many of these policies consequently failed to protect people. Beneficiaries of these programs are generally low-income and therefore are less likely to have reliable access to internet service, computers, and cell phones. If notices are not sent out via mail or posted at social service offices, many beneficiaries are unlikely to find out about program changes. Even with safeguards in place, beneficiaries experienced negative actions like Medi-Cal terminations at a time when negative actions were suspended. Clearly, there were communication issues on both ends--to the agencies administering benefits and to Californians receiving benefits. The state should improve its communications protocol to avoid these errors moving forward.

The COVID-19 crisis has greatly impacted the health of low- and middle-income Californians, often without them even coming into contact with the virus. It has illuminated how the health of low-income Californians and communities of color is most at risk during a health crisis. As the pandemic rages on, the state must take immediate action to prepare for future crises and to resolve longstanding inequities in the way it administers healthcare.

Adrian Slipski is a Staff Attorney with the Health Consumer Center at Neighborhood Legal Services of Los Angeles County and is a 2018 graduate of UC Davis School of Law

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