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Medicaid as a tool for social justice and antiracism

This week, we are taking an opportunity to reflect on the 400 years of the genocide of the Native American people and our nation’s tragic history of theft and appropriation.

Native people continue to face striking health care disparities that threaten their survival and expose our collective failure to honor the lands and culture that we have and continue to benefit from. For more information on the struggle of Native people to protect the beauty and wisdom of their way of life and to promote and protect the social and emotional health of over 600 native tribes, please explore and support The One Sky Center. Additional information can be found at The Centers for Native American and Alaskan Health and this directory of Native American Mental Health Providers in California.

In this context, we offer a reflection on the origins of the California Children's Trust and our ongoing effort to reimagine Medicaid (MediCal in California) as a tool for anti-racism. We believe we can best support the social and emotional health of children not by responding to pathology, but by supporting healthy development grounded in social justice.

Origins and Acknowledgements:

The Trust formed over two years ago, grew through a planning process that included contributions from over 400 organizations, and is now a coalition-supported initiative that is leading a statewide conversation to reimagine children’s mental health services and delivery.

Judging by the growth of our partnerships or the number of our publications, our successes may seem easy and our journey rather linear.

But this work has actually been messy. And hard.

Reimagining how California’s child-serving systems finance and deliver supports to advance our children’s social, emotional, and developmental health and well-being brought our coalition together. But learning that we needed to confront the ways our existing child-serving systems pathologize children and youth, harm folks of color and marginalized communities within the safety net – at times, pulled us apart. And as a team, we frankly underestimated the challenge before us.

We knew that expanding and improving financing would not itself transform our child-serving systems or address the myriad ways that racism continues to determine access to services and shape children’s outcomes. So while our provider and systems partners were open to helping with restrictive financing structures, inaccessible specialty services, and critical workforce shortages, we knew from the start we also needed to address racism, white supremacy, and the inequality that shapes the lives of children and families. We needed to center families of color, and our success needed to be based not on budgets or services but on our ability to confront the forces—within our systems and outside—that render children vulnerable. And to be honest, we have struggled. And we have learned.

We gratefully acknowledge the leadership and counsel of Dr. Macheo Payne and Dr. Rhea Boyd and the members of our Equity, Accountability, and Outcomes (EAO) Design Team on this journey, and want to devote this newsletter to acknowledge their contributions to our work.

The EAO’s leadership resulted in two foundational pieces of work—our Framework for Solutions and our Belief Statement. This work helped us coalesce around specific policy objectives such as removing diagnosis as a prerequisite for care, dramatically expanding the behavioral health workforce to formally include young people and reimburse their work, and seeking and promoting models of accountability for child-serving systems to be beholden to beneficiaries. They helped us frame our policy agenda to reimagine Medi-Cal as a tool for anti-racism, to redefine mental health as a support for healthy development, and to reorient our child-serving systems towards social justice, not simply pathology.

There is a saying in the recovery community: “There is no way around, only through.” There is no way around 400 years of structural inequality, genocide, racist violence, and theft. And there is no series of conversations that will magically heal these harms. Instead we must name white supremacy and racism as threats to child health and well-being; identify the ways these powerful forces operate within and without our child-serving systems; and then work to eliminate them – institution by institution, policy by policy, norm by norm.

We are so grateful for the framework, call to action, and authenticity this team gifted us. We also deeply appreciate the wisdom and generosity many of these extraordinary leaders continue to offer not only the Trust but all of us—if we have the will and skill to listen.

We have also gratefully partnered and collaborated with youth leadership organizations and advocates across the state, including the California Coalition for Youth, the MHSA OAC Youth Commission, California Youth Connection, and Youth Forward to raise and center the voices of young people in our strategy and advocacy—including a recent survey of 300 homeless and system-involved youth and this first and only youth-led and authored letter commenting on the MediCal Managed Care Procurement RFI.

We offer this reflection on our own work to be transparent about how we are attempting anti-racist practice and as an invitation to our community to help us in this vital, ongoing process.

Thank you to the thousands of people who have taken an interest in our collective effort to reimagine and fundamentally transform our state’s approach to supporting the social and emotional health of children.

Alex Briscoe                      Rhea Boyd
Principal                            Director of Strategy & Equity

Read this post on the CCT website.

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