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Medicaid Managed Care and Cultural Diversity in California


A Fund-sponsored study of California's cultural competence requirements for Medicaid managed care plans finds early promise in improving access to and understanding of health care services for low-income, non-English-speaking, minority enrollees. In their report, Medicaid Managed Care and Cultural Diversity in California, Molly Coye and Deborah Alvarez of the Lewin Group examine the effect of cultural competence contract provisions that were enacted in 1993 by Medi-Cal, California's Medicaid program.

Like many states, California has shifted a large proportion of its Medicaid-insured population into managed care in the past few years. According to Coye and Alvarez, by the end of 1998 more than 3 million Medi-Cal beneficiaries were enrolled in commercially or county-operated health plans. In 1997, about one-third of beneficiaries in the state's 12 counties with mandatory Medicaid managed care enrollment spoke a language other than English.

The state's contract provisions to promote culturally competent care include 24-hour access to interpreter services, translation of all written materials distributed to non-English-speaking members, assessment of the linguistic capability of plan employees and interpreters, and member needs assessments. Interviews with Medi-Cal staff, health plan officials, and physicians reveal that the provisions have had a substantial impact on health plans' services and operations.

As a result of the changes, plans have hired additional staff and established member services to improve access to care for enrollees who do not speak English. In addition, health plan networks have expanded to include minority physicians, community health centers, public clinics, and other traditional providers of care to those served by Medi-Cal.

Improvement is needed in some areas, report the authors. For instance, in order to raise the quality of language services, the translation approval process should be simplified and standards for interpreter services established. Complete data on patient satisfaction, health outcomes, and health status will be needed before the program's true effectiveness can be measured and its approach to achieving culturally appropriate care is adopted elsewhere.

Facts and Figures

  • Approximately 48 percent of all Medicaid beneficiaries in the United States are now enrolled in a managed care program.
  • One-quarter of Americans will be members of racial or ethnic minority groups by the year 2000, and more than two-thirds of California's population will be members of minority groups by 2025.
  • A 1997 survey of managed care plan members found that 42 percent of Medi-Cal beneficiaries experienced difficulties with their plans in seeking health care services, compared with only 27 percent of all managed care households.
  • Nearly two-thirds of California's Medicaid managed care contracts have some cultural competence requirements, but only limited research has been conducted to assess the impact of these provisions.

Publication Details



Medicaid Managed Care and Cultural Diversity in California, Molly Coye and Deborah Alarez, the Lewin Group, The Commonwealth Fund, January 1999