Commentary: In Orange County, children wait years for care available in weeks elsewhere

My daughter has documented hearing loss and needs hearing aids. Like any parent, I did what I was supposed to do: I tried to schedule her fitting.

We have private insurance, and she is also covered by CalOptima through California’s Whole Child Model. She is enrolled in California Children’s Services and protected by the federal Early and Periodic Screening, Diagnostic and Treatment mandate — protections meant to ensure timely, medically necessary services for the most medically complex and vulnerable children.

On paper, she is fully covered. In reality, she is still waiting.

Appointments that should have occurred within days have stretched into months — far beyond what California law allows. We were told the wait for a critical pediatric audiology test requiring sedation or anesthesia is one to two years at the only Medi-Cal provider in Orange County offering this level of care, Rady Children’s Health Orange County (formerly CHOC). At Children’s Hospital Los Angeles, similar services, called “step down” procedures, carry wait times of up to a year.

To put that in perspective: I called pediatric hospitals across the country to ask about wait times for this same procedure. Instead of being given a wait time, I was connected directly to schedulers who were able to book appointments within one to 12 weeks. At Children’s Hospital Colorado, appointments were available within one to two weeks.

Because of these delays, my daughter is on track to go an entire school year without even securing an appointment for a service essential to diagnosing and treating her hearing loss — care that directly affects her development, language acquisition and education.

These delays are not unique to audiology. While children who require sedation or anesthesia face the greatest barriers, the problem extends far beyond those services. According to Children Now’s California Children’s 2026 Report Card, three-quarters of Medi-Cal families report wait times that exceed the state’s own Network Adequacy Standards for specialty care.

Medi-Cal managed care plans are required to meet appointment wait-time standards, including 15 business days for specialty care. These are contractual obligations between the plans and the Department of Health Care Services. But they are not being enforced.

Plans like CalOptima — the largest county-organized Medi-Cal managed care plan in California — know how long patients are waiting. They track provider availability and network capacity. They know where shortages exist. And yet, the shortages persist.

A 2023 audit by the state controller raised concerns about California’s oversight of Medi-Cal managed care plans, pointing to gaps in monitoring and accountability. Those warnings should have triggered urgent reform. Instead, little has changed.

Gov. Gavin Newsom has built a national reputation on expanding Medi-Cal and positioning California as a model for healthcare. But it is not a model. It is smoke and mirrors, because if a child with hearing loss cannot obtain a timely diagnostic appointment, the system is not delivering healthcare — it is delaying it to the point that it no longer functions as care at all.

I worked at Orange County United Way on the “Insuring America’s Children: Getting to the Finish Line” initiative following the passage of the Affordable Care Act. At the time, our focus was on expanding coverage by enrolling eligible children into Medi-Cal to improve access to care. Before that, I worked on a dental program for children with special needs requiring sedation and anesthesia at Healthy Smiles for Kids of Orange County. That program is gone now. And today, children who need that same level of dental specialty care are at risk of falling through the cracks.

Since then, things have not improved. They have worsened.

Expanded coverage alone has not ensured access. Gaps in care persist because the system does not enforce its own standards. When children wait months or years for care that should be delivered in weeks, coverage becomes meaningless.

Delayed care is not a minor inconvenience. For children like my daughter, it means missed developmental windows, delayed treatment, and lasting harm.

At some point, delay becomes indistinguishable from denial.

More than five million children in California rely on Medi-Cal, and tens of thousands with serious health conditions depend on CCS to access specialized care. I never imagined that we would be at this point where Orange County and California would fail children when they need care most.

Until California closes the gap between coverage and actual access — by enforcing the laws that already exist, Medi-Cal will continue to fail the very children it was designed to protect and continue to result in the denial of care for millions of children still left waiting.

Yvette Lavery, MPA, MBE, is an outgoing commissioner at First 5 Orange County and serves on the Medical Ethics Committee at UCI Health.