Lawmakers advanced two bills aiming to improve access and equity in California’s Medicaid system (Medi-Cal) during an Assembly Health Committee meeting this month. Assembly Bill 2446 would expand access to medically-necessary diapers, while AB 2339 would increase access to telehealth services.
California has the most restrictive guidelines for establishing a need for medically-necessary diapers, according to the National Diaper Bank, which leaves children under five who are not eligible for medically-necessary diapers through Medi-Cal vulnerable to illnesses.
Asm. Elizabeth Ortega (D-San Leandro) noted a federal requirement that medically-necessary diapers must be supplied to all individuals under 21 through Medicaid under the Early and Periodic Screening and Diagnostic Treatment program (EPSDT).
“The bill will also expand the current restrictive medical necessity definition in California statute that only children over five can have access to prescription diapers if they suffer from incontinence. This bill intends to bring California into alignment with federal law under the EPSDT mandate,” Ortega said.
Expanding Medi-Cal beneficiary access to medically-necessary diapers will help alleviate the financial, physical, and mental costs of diaper needs for millions of Californians, Ortega added.
“As a young mother who had two little boys by the time she was 21 years old, I understand the need for diapers, and having to make that difficult choice of whether to buy formula or a diaper is one that our mothers or fathers should not have to make in the fifth-largest economy in the world,” Ortega said.
Becky Silva, director of government relations at the California Association of Food Banks, said about 25 percent of California households with children are food insecure, and disparities significantly impact Black and LatinX households.
“We know households that experience food insecurity also face barriers in affording other basic necessities,” Silva said. “Diapers are one of the most common non-food products requested by families who visit food banks, pantries, and other community organizations.”
Diapers are essential to keeping infants healthy and safe, and most child care facilities require parents to provide diapers for children left in their care, Silva said. This forces families deeper into poverty and affects parents’ ability to secure child care, he said. Many California families live paycheck to paycheck, and should not be forced to choose between paying rent, buying food, or purchasing diapers, Silva added.
“There are real and painful consequences for the baby when parents can’t afford diapers, but this issue impacts the entire family. The inability to adequately diaper an infant or toddler has been found to increase rates of family hunger overall. And diaper need is linked to maternal depression, stress, and anxiety, which can lead to health problems for parents, like high blood pressure and heart disease.”
— Silva
The Health Committee approved AB 2446, and sent it to the Appropriations Committee.
California is also exploring options to expand telehealth services for Medi-Cal beneficiaries. Currently, Medi-Cal beneficiaries can only use telehealth services under select circumstances, creating barriers to care. Asm. Cecilia Aguiar-Curry (D-Wine Country) sponsors AB 2339, which would expand the types of situations in which healthcare providers can be reimbursed by Medi-Cal for services rendered to patients through telehealth.
“Healthcare providers are prohibited from establishing a new patient relationship with Medi-Cal beneficiaries via asynchronous or other virtual communication modalities, unless a patient requests an audio-only modality, or attests that they do not have access to video,” Aguiar-Curry said.
This impacts the ability of Medi-Cal beneficiaries to access sexual and reproductive healthcare services that are available through asynchronous apps. AB 2339 would ensure that Medi-Cal beneficiaries have a choice in whether they want an in-person or virtual healthcare appointment.
“Allowing Medi-Cal beneficiaries to access this form of care will provide equal access to asynchronous telehealth services and give Medi-Cal beneficiaries the same convenient care as their peers with private insurance.”
— Aguiar-Curry
Dr. Jennifer Yager, assistant professor at the University of California at San Francisco’s Philip R. Lee Institute for Health Policy Studies, said AB 2339 would assist rural populations by removing their needs for transportation, child care, and the time it takes for in-person visits.
“In our research with young people, many also valued the privacy that telehealth visits offer, and feel more comfortable communicating with their provider and asking questions, compared to in-person visits,” Yager said.
The committee approved AB 2339 and sent it to the Appropriations Committee.