Kim Nguyen weighed barely 80 pounds when she finally reached an eating disorder specialist through Medi-Cal last year.
Her periods were sporadic. Her electrolytes were dangerously skewed, a condition that could lead to coma, seizures or sudden cardiac death. The Orange County resident said she and her new psychiatrist quickly agreed she needed more care. But getting it through the country's largest public insurance program took almost a year.
The surge began early in the pandemic, amid a deluge of depression, anxiety and drug overdoses. But while those conditions have started to ebb, clinicians say anorexia, bulimia and binge eating disorder are still at their high water mark, an observation bolstered by recent data from the CDC showing ER visits for eating disorders remained up by more than 50% from 2019.
"Since I was 15, I haven't had my period for more than three months consecutively," said the Central Valley resident, who at 21 was just diagnosed with osteopenia, a precursor to osteoporosis."You can burst your esophagus from purging, or your electrolytes can go crazy and it's the end. I knew my heart could stop."
In part, that's because providers have long failed to recognize eating disorders in nonwhite teenagers—those most likely to use Medi-Cal—until they're gravely ill. Black and Latino teens are also more likely to struggle with bulimia and binge eating disorder, which can lead to serious cardiac complications and significantly increase suicide risk even in patients who aren't underweight. Decades of studies show those risks multiply with every hospitalization and each delay in care.
Even when providers are competent, Madera County, where Lopez-Avila lives, is hundreds of miles from most treatment centers. And there's no privacy for online programs in the cramped home she shares with her parents, 11-year-old brother and two adult siblings. Instead, once Medi-Cal patients are physically stable—meaning their heart rate is in the mid-50s instead of the high 30s, or their potassium level is 3.4 milliequivalents per liter instead of 2.5—their fate falls to one of 58 separate county behavioral health systems, where bureaucrats with little knowledge of eating disorders weigh who deserves care.
Rather than join the wait list for a residential or intensive outpatient program directly from the hospital, as many privately insured patients do, Medi-Cal patients often must first undergo rounds of new lab tests and fresh psychiatric evaluations through the county—a process each county does differently.
After her six-week hospitalization at the end of last summer, Lopez-Avila got a single-case agreement for residential care through Madera County Behavioral Health Services. It was her fourth such stay, and the first one the county had agreed should be followed by a step-down program, she said. "If they'd been quicker to get me into partial hospitalization, I could have avoided starting over," she said.
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