The Department of Health Care Services (DHCS) plans to add a new Community Health Worker/Promotores (CHW/P) benefit in Medi-Cal starting July 2022. The budget includes costs of $16.3 million total funds ($6.2 million General Fund) in FY 2021-22 for CHWs growing to $201 million by 2026.
This is an important extension as CHW/Ps will be an effective short-term solution to the growing health disparities for the state’s communities of color who are often marginalized and for whom healthcare systems may be challenging to access due to socio-economic, cultural, or linguistic barriers and the current shortage of healthcare workers. CHW/Ps unique connection to the community have made them effective in supporting the COVID-19 response, improving chronic disease and mental health outcomes, and increasing access to health care services.
CPEHN’s Key Principles
CPEHN aims to ensure the state’s implementation of this new benefit values and encourages the participation of culturally and linguistically diverse, community-based CHW/Ps who carry with them a wealth of social, cultural and community knowledge and expertise. To that end, below are some principles we feel are important to ensure equitable implementation of the new CHW/P benefit in California:
- Ensure financial sustainability: Financing mechanisms should be designed to ensure the new CHW/P benefit is widely adopted by multiple payers including health plans, health systems and providers and attracts and sustains a diverse workforce. CHW/P programs should be able to start, grow, and maintain its programming and benefits over time to effectively develop economic and community empowerment and eliminate health disparities.
- Prioritize workforce diversity: Ensure CHW/P opportunities and roles are accessible to racially/ethnically diverse individuals and those with intersecting identities in particular, non-English speaking, low income, and undocumented. To achieve a positive impact in historically marginalized communities requires centering the lived experiences of CHW/Ps and avoiding exclusionary barriers to participation like costly certifications and trainings, language requirements, immigration status, or educational level.
- Strengthen health care quality: Ensure services and supports from CHW/Ps are trusted and patients are activated in their own decision-making and health choices. The benefit should improve patient agency in their health by holistically addressing their mental, emotional, spiritual and physical needs. CHW/Ps should be supported in leading a community transformation model that does not rigidly and medically define their role to just outreach and education, time-limit their activities, and restrict their funding. CHW/Ps should also be supported to have an active role throughout healthcare delivery with the resources and networks to achieve upstream structural policy changes to advance health care quality and eliminate disparities.
- Value community cultural wealth: Community health workers/Promotoras should come from the community they serve. Ensure implementation of the new benefit values and takes into account the importance of social, cultural and community wealth including the unique contributions, services and community trust engendered by diverse community-based organizations. The benefit should center historically marginalized communities, their aspirations, their languages and communication skills, their social resources and networks, and their wisdom, values, and stories. The benefit should partner directly with community-based organizations and ensure CHW/Ps have decision making powers and leadership roles.
- Community Health Workers Advancing Child Health Equity | The Children’s Partnership
- Community Health Workers and Promotores: Investing in Change Agents for a Healthy California | Latino Coalition for a Healthy California
- Community Health Workers and Promotores Career Pathway Initiative | El Sol CHW/P Training Center
- Department of Health Care Services (DHCS) website
- Joint Recommendation Letters From CPEHN and CHW/P Partners
- CPEHN November All Network Meeting Presentation
- CPEHN February All Network Meeting Presentation
- CPEHN Crosswalk of CHW/P Final SPA and 2.18 Joint Recommendation Letter
Glossary of Terms
As defined by the Community Health Worker Section of the American Public Health Association:
- A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.
- A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.
- For more information, click here.
- Characterized by servicio de corazon (service from the heart), promotores are natural leaders and the “go to” people in their neighborhoods. They share the ethnicity, language, cultural traditions, practices, socioeconomic status and life experiences of the communities they serve”
- For more information, visit Visión y Compromiso’s website
§ 440.130 Diagnostic, screening, preventive, and rehabilitative services.
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(c) Preventive services are services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law to—
(1) Prevent disease, disability, and other health conditions or their progression;
(2) Prolong life; and
(3) Promote physical and mental health and efficiency.
42 CFR 440.130(c)