New Medi-Cal benefit will address longstanding reimbursement inconsistency for community health workers, expert says

The addition of community health workers (CHW) and promotore services as a Medi-Cal benefit is just one part of California’s larger efforts to make these services more accessible across the state, according to Carlina Hansen, Senior Program Officer of Improving Access at the California Health Care Foundation.

 

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Gov. Gavin Newsom allocated $16.3 million ($6.2 million General Fund) for this benefit in the 2021-2022 budget, increasing to $201 million ($76 million General Fund) by 2026-2027. The new benefit took effect July 1st. Providers who work with CHWs and meet the requirements outlined in the recently published Medi-Cal Provider Manual for the CHW benefit will be able to bill Medi-Cal for those services. According to Hansen, this benefit will address the long-lasting problem of funding consistency in the CHW field.

“In many cases, CHWs [have been] working with Medi-Cal beneficiaries prior to this benefit being realized,” she said. “They just haven’t been getting reimbursement for it.”

Hansen said CHWs provide accessible information on chronic illnesses like asthma and diabetes, as well as help people understand the benefits available to them and navigate instructions from health care providers in a culturally competent manner.

“One of the most important roles that community health workers play [is acting as] a cultural bridge between diverse communities and the complex health and social service systems that serve them,” she said. “They take time to develop trust with people and that’s really what enables them to be effective. That trust is often built on a foundation of shared life experience, so that means some community health workers share cultural backgrounds with the folks they’re serving. They may have formerly been homeless or have come out of incarceration, and it’s really that shared life experience that enables them to connect with the beneficiary in a really unique and special way.”

Hansen emphasized the importance of the state establishing a mechanism for ongoing input and feedback from stakeholders so state leaders can understand how the benefit can be improved. She said it’s especially important to gain feedback from the CHWs themselves and the organizations that work with them, as well as the managed care plans that have to deploy the benefit.

“I think there’s a few things that are deserving of attention as the benefit takes hold,” Hansen said. “One of the first is that it is amplifying the [CHW] role and doesn’t over-medicalize it. [CHWs] are ultimately a community connected workforce, and if [the managed care plans] don’t have the time and resources available to support the role, then the impact on Medi-Cal beneficiaries really can’t be realized. 

I think it’s important to understand if [the reimbursement rates] are sufficient and if they’re going to be enough to encourage new types of entities to become CHW Medi-Cal providers or encourage existing providers to add CHWs … I think it’s also important to realize that the benefit has a downstream impact on the workforce. The CHW workforce are largely people of color and themselves have low incomes, and many are or have been Medi-Cal beneficiaries. So it’s important that consideration is given to economic mobility when we’re thinking about rates in addition to the impact on Medi-Cal beneficiaries.”

Hansen said one of the biggest challenges with the benefit’s implementation will be the time and resources necessary to engage with this benefit for providers who haven’t historically interacted with Medi-Cal and haven’t employed CHWs. 

“[This benefit] really represents a pretty revolutionary change and how Medi-Cal is approaching health care delivery. It represents a focus on health equity and understanding that we need to bring health care systems closer to the community.”