In the Listening to Black Californians study, one group that stood out was Black women with Medi-Cal coverage, who are more likely to report negative experiences and discrimination in the health care system than Black Californians overall.
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 yet too often encounter discrimination or other negative experiences during their health care visits. Providers and policymakers have immediate opportunities to make sure these women can have trusting relationships with providers and can receive the care they need without discrimination.
Medi-Cal, California’s Medicaid program, provides health coverage to people with low incomes. It covers one in three Californians, and Black Californians made up 6.9% of Medi-Cal enrollees in 2022.
This study included hour-long interviews with 13 women with Medi-Cal, two focus groups with Medi-Cal participants, and 383 female survey respondents with Medi-Cal.
Key Findings
Black Women with Medi-Cal Are Actively Engaged in Their Physical and Mental Health
The vast majority of Black women with Medi-Cal (93%) report having had at least one health care visit in the last year. The majority of female respondents with Medi-Cal (80%) say they devote “a great deal” or “quite a bit” of effort to getting screenings or preventive care, to focusing on their mental health (82%), and to actively reducing their stress (82%). Women of childbearing age with Medi-Cal (85%) are more likely to put “a great deal” or “quite a bit” of effort into focusing on their mental health than women over age 50 with Medi-Cal (73%).
Nearly half of women with Medi-Cal (46%) put “a great deal” or “quite a bit” of effort into seeking non-Western approaches to health care.
Women with Medi-Cal Report Many Negative Health Care Experiences, Including Inadequate Treatment for Pain
In each phase of Listening to Black Californians, women with Medi-Cal shared similar stories of discrimination and negative treatment from the health care system and spoke of being “dismissed, ignored, or spoken to rudely” by physicians and nurses. Women with Medi-Cal are significantly more likely to report specific negative experiences during health care visits than other respondents. Female respondents with Medi-Cal are among the groups most likely to report being treated poorly because of their race/ethnicity (43% compared to 31% of respondents overall).
In the individual interviews and focus groups, female participants repeatedly shared instances where their pain was dismissed, not treated, or the cause was misdiagnosed. Half of Black female respondents with Medi-Cal (52%) report experiencing insufficient pain treatment, significantly higher than female respondents with other types of insurance coverage.
Black Women Avoid Care Due to Concerns About Mistreatment
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 female respondents with Medi-Cal (39%) report avoiding going to a 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 an opportunity to take specific and comprehensive action to address the inequities outlined by the women in this study, including these:
- Ensure women with Medi-Cal can find and reliably access a regular provider or a medical home.
- Create incentives for providers to build trust and maintain caring relationships with female patients with Medi-Cal.
- Focus on pain management for women with Medi-Cal, especially those of childbearing age.
Authors & Contributors
Linda Cummings
Health Services Research Consultant
