The Department of Health Care Services (DHCS) has announced that, effective April 1, 2025, all eligible Medi-Cal members can access Community Health Worker (CHW) services without a provider referral. To facilitate access and minimize barriers, Medi-Cal members who meet specified eligibility criteria may receive up to six hours per year of CHW services, covered by Medi-Cal, under the supervision of an enrolled provider. This standing recommendation will remain in effect until it is modified or rescinded.
Background to CHW Services
CHWs include promotores, navigators, community health representatives, and other non-licensed public health workers, including violence prevention professionals. CHW services include preventive health services such as health education, health navigation, screening and assessment, individual support, and advocacy. CHW services are also able to address needs such as chronic/infectious disease management, behavioral health, perinatal, reproductive, oral, and preventive care, climate-sensitive health issues, injury and violence prevention.
Eligibility Criteria for CHW Services
A Medi-Cal member qualifies if they meet any of the following:
- One or more chronic conditions or suspected mental/substance use disorder.
- Rising risk indicators (e.g., high blood pressure/glucose).
- Risk factors like domestic violence, substance use, smoking.
- Unmet social needs (e.g., food or housing insecurity).
- Recent hospital/ED visits, psychiatric stays, or detox visits.
- Frequently missed medical appointments.
- Expressed need for health system navigation.
- Need for preventive services.
- Released from incarceration in the past 6 months.
For More Information
Information about service limitations, supervision, billing, and other details are available at: https://www.dhcs.ca.gov/services/medi-cal/Documents/Standing-Recommendation-for-CHW-Services.pdf
If you have any questions, please contact psrgroup@cencalhealth.org.