In California, the demand for community health workers is growing, and the need for those service is expected to continue to outstrip availability. Since 2022, California has included community health worker services as a Medi-Cal benefit. DHCS in May 2024 updated its policies on employing community health workers serving Medicaid members and the community health worker (CHW) services benefit, which will be of interest not just to Medicaid managed care plans, but to community health workers and organizations that employ CHWs and seek Medicaid payments for CHW services.
Among the topics covered in the guidance are the minimum qualifications for community health workers; eligibility requirements for CHW services; whether CHWs need to be enrolled as Medi-Cal providers; services that qualify as CHW services; and the responsibilities of the organizations that employ CHWs and contract with managed care plans to provide CHW services. CHW services must be reimbursed through a CHW supervising provider. Tribal clinics may bill managed care plans for CHW services at fee-for-service rates using the CPT codes in the CHW Preventive Services Medi-Cal Provider Manual.