Californians continue to experience accessibility barriers in health care settings.
Inaccessibility is pervasive in health care settings. For example:
- A California-based study conducted comprehensive in-person site inspections of 2,389 primary care offices found that only 53% of provider sites met all parking/exterior access criteria, 56% met all building entrance and interior public areas access criteria, and just 34.3% met all interior office and restroom access criteria.[38]This same study found that medical equipment was the most pervasive area of inaccessibility, with only 8.4% of offices having an adjustable height exam table and only 3.6% having an accessible weight scale.
- Medical diagnostic equipment such as mammography machines often lack the adjustability and spatial configuration needed to accommodate women in wheelchairs, making it difficult to position them properly for imaging. This results in many people not being able to receive mammograms in the seated position. The lack of accessible diagnostic equipment contributes to significant disparities in healthcare access for people with disabilities, leading to poor health outcomes.
- The increased reliance on online portals, forms, and virtual platforms for medical services creates disparities in access and delivery for people who rely on screen reading software. This underscores the need to enforce accessibility standards to ensure equitable healthcare for all.
- Deaf individuals still struggle to get ASL interpreters for healthcare appointments and procedures. Video Remote Interpreting, when not fraught with technical issues, is not effective for all Deaf individuals. Many medical settings attempt to shift the cost onto the patient or deny the patient outright to bring their own interpreter.
The recent updates to the Section 504 regulations strengthened protections against these types of discrimination.[39] We hope to see California enforce these regulations with rigor and uphold the critical rights of disabled people accessing health care.
Telehealth has significantly increased healthcare access for people with disabilities. During the COVID-19 pandemic, telehealth usage was higher among people with disabilities compared to those without, providing a vital alternative when in-person visits were limited. In particular, people with mobility disabilities had the highest rates of telehealth use, while those with hearing disabilities reported the lowest rates, underscoring the need for accessible telehealth platform designs that support various communication needs.[40]
Recent data from the UCLA Center for Health Policy Research shows that nearly 47% of California adults used telehealth in 2022, highlighting its critical role in expanding access to care. Usage was exceptionally high among older adults and those with both Medicare and Medicaid coverage. The flexibility of telehealth has been particularly beneficial for follow-up visits, managing chronic conditions, pain management, and accessing mental health services.[41]
California has taken significant steps to maintain telehealth accessibility beyond the COVID-19 emergency. The state has committed to continuing many telehealth policies established during the pandemic, including coverage of video and audio-only telehealth across Medi-Cal services. In the event the telehealth federal provisions are rescinded, California must continue to support telehealth access and services.
Children with disabilities need timely and affordable access to specialized health care.
Achieving disability equity begins with our youngest Californians. Nearly 16% of all California’s children under 18 have special health care needs and require more health care services than those of their peers.[42] Only 27.3%-34.6%[43] of children enrolled in Medi-Cal receive screening for developmental, behavioral, and social delays by age 3. This represents untold lost opportunities for early intervention and treatment. Challenges in Medi-Cal disproportionately impact children of color and children living in poverty (81% of non-elderly Medi-Cal enrollees are people of color).[44]
Children qualifying based on their condition or disability receiving care in the California Children’s Services program within the Medi-Cal program encounter significant ongoing challenges accessing services and coordinated care. Families continue to experience wait times for specialty care and difficulty securing DME and private-duty nursing care. Additionally, youth struggle with transition to adulthood in Medi-Cal.
Health insurance fails to meet the needs of wheelchair users.
Despite the requirements of the Affordable Care Act, disabled Californians who use customized wheelchairs continue to face insurance coverage denials and caps for their medically necessary wheelchairs and wheelchair repairs by qualified health plans throughout the state. Most cannot afford to pay out of pocket for these essential mobility devices. As a result, disabled Californians go without appropriate wheelchairs or decline employment or advancements in employment so that they can maintain income eligibility for Medi-Cal and its wheelchair coverage. This needs to stop. California must enact a coverage mandate for qualified health plans to cover medically necessary wheelchairs together with repairs and accessories.
Algorithmic bias threatens to embed discrimination into every aspect of our health care system.
As health care systems increasingly rely on artificial intelligence (AI) to make day-to-day decisions, we need to limit the potential for biased algorithms to make life-or-death decisions. AI models have already demonstrated ableist biases — biases that can prove deadly and injurious to people with disabilities.[45] For example, private insurers are already using AI to deny claims, overriding physicians’ determinations of what is necessary medical care.[46] With emerging legislation attempting to rein in the potential adverse effects of this technology, disability must be centered in the conversation.
[44] “Medicaid in California Fact Sheet” Kaiser Family Foundation, Aug. 2024.