COVID-19: Serving the Most Vulnerable

April 16, 2020

From individuals experiencing homelessness or living in poverty to those suffering from mental illnesses, California’s most vulnerable residents are disproportionately affected by the COVID-19 pandemic. More than 150,000 Californians are currently homeless, while nearly 7 million live in poverty. Many of these residents have long struggled to receive the health care they need and now face increased risks of contracting severe cases of the coronavirus. The Little Hoover Commission has recommended ways the Governor and Legislature can strengthen California’s health care programs, especially with regard to mental health and dental care. Strengthening these programs is critical to mitigating the spread of COVID-19 and saving the lives of the state’s most vulnerable residents, not only during this crisis but as we move forward and prepare for crises to come.

The COVID-19 pandemic has created new stress, anxiety, and fear for many Californians, particularly those already suffering from mental illness. According to the California Health Care Foundation, “nearly 1 in 6 California adults experience a mental illness of some kind, and 1 in 24 have a serious mental illness that makes it difficult to carry out major life activities.” Calls to mental distress helplines and internet searches for mental health information have increased as the pandemic takes its toll on American communities; WellSpace Health in Sacramento has reported a 40 percent increase in calls and texts to its suicide prevention line from February to March, while the federal Substance Abuse and Mental Health Services Administration “saw an 891 percent increase in call volume compared with March 2019.” Google searches for “panic attack symptoms” have doubled since last year. The difficulties these residents face make them more likely to contract severe cases of COVID-19. Similarly, mental illnesses affect about one third of those experiencing homelessness, who lack essential provisions such as sanitation and shelter to protect them during this pandemic. Even those living in shelters are not protected from the coronavirus, for the high rates of transmission have increased the risk that these crowded shelters may become completely infected with sick patients.

To stem the spread of COVID-19 and protect these at-risk populations, state officials have taken steps aimed at providing more care and shelter during this time of crisis. Project Roomkey is a first-of-its-kind effort to house vulnerable residents in hotel rooms and provide them with essential services such as food, laundry, and behavioral health care as needed. Recruitment of health care professionals, including behavioral specialists such as psychiatrists, therapists, and psychologists, has been ramped up through the creation of the California Health Corps, a statewide initiative calling upon medical students and recently retired medical professionals to join the fight against COVID-19 by providing essential care to those who need it the most. Shortly after creating the Health Corps, Governor Newsom signed an Executive Order expanding legal protections to medical providers, including mental health professionals, as they turn to video chats and phone calls for routine and non-emergency medical appointments. The Department of Health Care Services and the California Telehealth Resource Center are providing informational webinars and memos to providers explaining best practices for helping patients remotely. In addition to this, the Governor and Surgeon General are promoting a list of online resources for Californians to help manage anxiety and stress that may be caused by the pandemic.

These steps are critical, but during and after the crisis the state will also rely deeply on county- based mental health programs funded by Proposition 63, the state income-tax surcharge on incomes of more than $1 million that voters approved in 2004. The Commission focused on those programs in reports in our 2015 report, Promises Still to Keep: A Decade of the Mental Health Services Act, and 2016 report, Promises Still to Keep: A Second Look at the Mental Health Services Act, recommending greater transparency, accountability, and public engagement. The Commission recommended greater transparency not only of fiscal expenditures but also of data to identify underserved areas of the state. This data would enable officials to direct resources and mental health professionals to communities facing the highest needs. We recommended that the state encourage replication of successful programs by sharing model systems and ideas beyond county borders. Strengthening these programs was already one of Governor Newsom’s goals even before the pandemic, and that effort has only taken on greater importance amid the crisis.

The economic effects of the COVID-19 pandemic may make access to health care more difficult for low-income residents. Dentists participating in Denti-Cal serve the poorest Californians. In our 2018 Letter to Governor Brown and Legislature on Denti-Cal Update, the Commission found that many dentists were dissuaded from participating in the program due to low reimbursement rates and unnecessary bureaucratic procedures such as excessive paperwork and overly burdensome enrollment processes. The number of Denti-Cal providers steadily decreased between 2013 and 2017, and while recent efforts by the Department of Health Care Services to streamline the enrollment process have resulted in an uptick of applicants, numbers remain low and processing times are lengthy. The pandemic has forced dentists to suspend all non-emergency work, and it may further decimate Denti-Cal as state funding declines and dentists seek higher reimbursement rates from private insurers, leaving some of the most vulnerable Californians without access to essential dental care. In our Denti-Cal reports, the Commission recommended consistent and sustainable Denti-Cal funding to ensure that access to dental care is easy and seamless for low-income Californians, and this will be an important consideration for policymakers as they struggle with a post-COVID state budget.

Now more than ever, it is vital that California’s most vulnerable populations receive the health care they need. Lawmakers must bear these needs in mind as they struggle to mitigate the spread of COVID-19 and save the lives of the state’s most vulnerable residents.

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