ACEs Aware Progress Report: 2019-2023

ACEs Aware has demonstrated significant progress in the effort to prevent, identify, and respond to ACEs and toxic stress since its launch in 2019.

Graphic showing that $14.3 trillion is the cost of ACEs per year in the US
By Paula Murphy
1 min read

As one of his first acts in office, Governor Gavin Newsom established the Office of the California Surgeon General (CA-OSG) and appointed Dr. Nadine Burke Harris as California’s first Surgeon General. She was charged with addressing the root causes of persistent health inequities among Californians and set as her top priorities ACEs and toxic stress, early childhood, and health equity. As the foundation for this work, the newly established CA-OSG and the DHCS launched ACEs Aware in 2019, a first-in-the-nation initiative to promote early detection and intervention for ACEs and toxic stress.

A consensus of scientific evidence points to cumulative adversity, especially when experienced during critical and sensitive periods of development, as a root cause of some of the most harmful, persistent, and expensive health challenges facing our state and nation, from heart disease to homelessness. Research confirms that exposure to ACEs, along with other adversities, may lead to prolonged activation of the biologic stress response, which can lead to long-term disruption of neurologic, immune, metabolic, and endocrine systems, as well as changes to genetic regulatory mechanisms. Together these changes constitute the toxic stress response.

The good news is that ACEs are not predetermined. Research indicates that early detection and evidence-based interventions can significantly reduce negative outcomes.

— Diana Ramos, MD, California Surgeon General

Between January 1, 2020 and March 31, 2023 (the most recent data available at the time this report was published), providers conducted more than 2.3 million ACE screenings of approximately 1.5 million unique Medi-Cal members. These screenings, which are reimbursed at $29 per screen, have generated more than $66 million in revenue to clinics serving predominantly low-income communities.

After completing our flagship training, qualified clinicians are certified to receive $29 for each eligible ACE screening they conduct. Since the launch of the ACEs Aware initiative, more than 35,360 individuals have completed the training, including approximately 17,100 Medi-Cal providers.