California’s Struggle to Close Health Disparities: Why Promising Solutions Were Left Behind

Fortina Hernández is known as “the one who knows it all.” She’s been a community health worker for over 20 years in southeast Los Angeles. Hernández helps families get food assistance, find affordable health coverage, and manage their chronic illnesses. Her guiding principle? “An ounce of prevention is worth a pound of cure.”

But despite her dedication, she earns only about $20 an hour from her job, needing a second job just to make ends meet. “They pay us very little and expect too much,” she tells us. “We build trust and offer support, but we don’t get fair wages.”

California aims to enhance the role of community health workers like Hernández to improve health among immigrant populations, especially Hispanic residents who often face higher rates of chronic diseases and barriers to care. Studies indicate that community health workers can help reduce hospitalizations and visits to emergency rooms.

In 2019, experts recommended training, certification, and fair pay for these workers, including reimbursement through Medi-Cal, California’s Medicaid program. However, six years later, many of these initiatives have been rolled back. The state has cut funding for training and eliminated a certification program, falling short of its goal to have 25,000 community health workers by now.

With recent federal funding cuts and increasing scrutiny on immigrant communities, advocates worry that California is neglecting health equity efforts. “We’re in a very dire situation right now,” says Cary Sanders from the California Pan-Ethnic Health Network.

Nationwide, there are over 60,000 community health workers, with about 9,200 in California. This workforce is growing, yet many are undercounted due to varying titles and roles. Community health workers often work outside traditional health systems, making them essential in their neighborhoods.

These workers don’t just assist with chronic illnesses; they promote reproductive health, children’s health, and connect families to housing and food resources. “Our office is on the street,” Hernández explains.

In 2022, California authorized $281 million for workforce development, focusing on training community health workers. However, the funding cuts last year hindered these efforts. Some fear that standardizing training may limit access for those with valuable lived experiences.

Total healthcare access and training options are still significantly limited across the state. Many community health workers, like Lourdes Bernis, started as volunteers and can find their way into full-time roles with proper training. Bernis now helps Spanish-speaking women deal with mental health issues but notes that many with years of experience still struggle in low-paying positions.

In July 2022, Medi-Cal began covering community health worker services, yet reimbursement processes remain complicated. “We have to jump through hoops,” says Maria Lemus, executive director at Visión y Compromiso, a nonprofit representing these workers. Many face inconsistent requirements from health plans, complicating payments.

Despite the potential for community health workers to alleviate health disparities, funding constraints make it hard to facilitate their growth. Advocates stress that active outreach is essential, especially as immigration policies challenge access to care.

As intricate as these dynamics are, community health workers remain crucial for building trust and bridging gaps in healthcare. Hernández emphasizes the need for recognition and fair pay as the work they do is vital and deeply connected to community well-being. “The community trusts me,” she says, reflecting on the ongoing struggle for better support and wages.

For more insights into healthcare access and community health initiatives, visit KFF Health News, a trusted resource in health policy issues.

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Health Disparities, Chronic, ELISA, Food, Health Care, Health Insurance, Medicaid, Mental Health, Public Health