California screened three million Medi-Cal members for childhood adversity, and parents were mostly left out
- Between January 2020 and June 2025, Medi-Cal clinicians conducted 5,918,450 ACE screenings of 3,045,940 unique members; 70% of those screened were under 18.
- Of 2,128,639 members aged 0 to 17 who were screened, 8% had an ACE score of 4 or greater; of 917,296 members aged 18 to 64, 20% did.
- Among members with at least one primary care visit in managed-care plans, 33.2% of those aged 20 and under were screened, against 8.5% of those aged 21 to 64.
- American Indian/Alaska Native members had the highest share of scores of 4 or more (23%); certified clinicians receive a $29 Medi-Cal payment per qualifying screening.
California has paid for adverse childhood experience (ACE) screening in Medi-Cal since 2020, and the July 2026 progress report from the Department of Health Care Services and the Office of the California Surgeon General covers five and a half years of claims.
Who gets asked
Seven in ten people screened were children. The gap is sharper when the report sets screenings against everyone who actually came to primary care: a third of members aged 20 and under were screened, and fewer than one in eleven adults aged 21 to 64. A child can be screened once a year per clinician; an adult, once in a lifetime per clinician.
The adults who were screened carried more adversity than the children: 20% scored 4 or more, against 8%. Among AI/AN members the figure was 23%.
The parent in the room
For a child under 12, the screening form is filled in by a caregiver. The parent is in the room, answers questions about the child's adversity, and is rarely asked about their own. For a programme whose stated aim is to reduce toxic stress across generations, that is the person whose history the claims data mostly miss.
For a clinician working with a family, the practical step is small. When a child's screen comes back positive, ask the parent about their own childhood in a separate conversation, with a plan for what you will offer if the answer is yes.
The parent fills in the child's screening form and is seldom asked the same questions about their own childhood.
The report counts billed screenings, not what followed them, and does not link screening to any health outcome. Coverage rates apply only to members in a single managed-care plan with a primary care visit.
- adverse childhood experiences
- ACE screening
- Medi-Cal
- intergenerational trauma
- primary care