The Community Health Worker/Promotora/Representative (CHW/P/R) Policy Coalition was formed in 2022 for CHW/P/Rs to play an active role in policy campaigns and conversations that impact their profession and advocate to transform health care to support all peoples. CHW/P/Rs reflect the communities they serve, and their unique connection with the community has not only proven effective in supporting the COVID-19 response, improving outcomes for chronic diseases and mental health, and expanding access to health care services but also positions them as pivotal leaders in the transformation of a costly, disjointed, and inefficient health care system. California has the opportunity to address care fragmentation, diversify the healthcare workforce, and forge a stronger link between health care and public health as the state conscientiously expands the CHW/P/R workforce, centering CHW/P/R values and voices in decision making.
Read The People’s Agenda: Planting the Seeds for a Healthy Tomorrow here.
Centering the Voices of CHW/P/Rs
Through their participation in coalition meetings, focus groups, interviews, and surveys, CHW/P/Rs shared the challenges they face in their work today and what they need to ensure sustainable jobs. Several key themes emerged:
- Lack of ongoing professional development and advancement. Seven in ten CHW/P/Rs say they do not know how to advance their career. Many CHW/P/Rs lack access to accessible, afforable training and face many barriers to workforce participation, including costly certification and training programs, language and immigration requirements, and background checks.
- Healers need healing, too. CHW/P/Rs discussed the mental toll their work can take on them and the lack of mental health and wellness supports to help them.
- Inadequate compensation and benefits. Many CHW/P/Rs are currently experiencing economic and income insecurity. Only 10% of CHW/P/Rs felt that their current salary covers their basic expenses. And many CHW/P/Rs do not receive standard employment benefits or reimbursement for work-related expenses.
- Insufficient respect for their role and contribution to care delivery. Sixty percent of CHW/P/Rs feel that the general public does not know what they do. Even worse, many health care providers, employers, and plans do not fully understand the CHW/P/R role and how best to incorporate CHW/R/Rs into care delivery.
- Insufficient education and access for community members to CHW/P/R services. Many community members are not aware that they can access covered CHW/P/R services through their health plans. Additional barriers, such as immigration status, language, transportation, and technology, limit access to CHW/P/R services.
Calls to Action
This report presents the policy agenda developed by CHW/P/Rs for the State of California to implement to grow the CHW/P/R workforce in a way that ensures equity and sustainability for CHW/P/Rs and improves care for marginalized communities. The development of these recommendations was led by the CHW/P/R members of the CHW/P/R Policy Coalition to ensure their perspectives guide state policies impacting their workforce. This policy agenda consists of fifteen priority recommendations, each linked to one of the four policy priority areas: workforce development, economic equity, effective integration into care teams, and equitable access for Medi-Cal enrollees.
2023-2024 CHW/P/R Policy Recommendations
Workforce Development
1. Provide No Cost, Accessible, Culturally Responsive CHW/P/R-Led Training in All Languages
2. Prioritize Hiring and Developing Individuals with Lived Experience
3. Establish a Career Pathway for CHW/P/Rs that Provides Opportunities for Growth and Specialization
4. Establish a Standing CHW/P/R Majority (51%) Governing Board
5. Establish a Targeted Recruitment and Technical Support Program to Broaden Representation in the CHW/P/R Workforce
6. Ensure CHW/P/Rs Can Access Mental Health and Wellness Support, Resources, and Supervision
Economic Equity
7. Secure Thriving Wages for CHW/P/Rs
8. Ensure Full Workplace Benefits for CHW/P/Rs
9. Financially Support CHW/P/R Work in the Community
10. Increase Transparency Around CHW/P/R Pay and Billing Practices
Effective Integration of CHW/P/Rs into Care Teams
11. Require Trainings for Providers and Health Plans on the Role of CHW/P/Rs
Equitable Access to CHW/P/R Services for Medi-Cal Enrollees
12. Ensure Community Members are Aware of and Able to Access the New Medi-Cal Benefit
13. Utilize State and Federal Dollars to Build CBO Infrastructure
14. Establish a Learning Collaborative to Facilitate Uptake of the Medi-Cal CHW/P/R Benefit
15. Measure and Publicly Report Utilization of CHW/P/Rs in Medi-Cal
Many recommendations can be implemented in the short term while others may require a longer, iterative approach. While the primary audience for this policy agenda are California policymakers, agency leaders, and other decision makers, we encourage community members, CHW/P/Rs, and advocates to take individual action on the policy recommendations to prioritize the economic, emotional, and physical wellbeing of this workforce as a commitment to advancing health equity for all Californians.