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On June 29, the Department of Health Care Services (DHCS) announced that, effective July 1, Medi-Cal will cover community health worker (CHW) services, including violence prevention and asthma prevention.
Medi-Cal will cover CHW services as preventive services and on the written recommendation of a physician or other licensed practitioner within their scope of practice. CHWs may include individuals known by a variety of job titles such as promoters, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals.
CHW services may address issues that include — but are not limited to — the control and prevention of chronic conditions or infectious diseases; mental health conditions and substance use disorders; preventive services; perinatal health conditions; sexual and reproductive health; environmental and climate-sensitive health issues; child health and development; oral health; aging; injury; domestic violence; and violence prevention. Covered CHW services include health education, health navigation, screening and assessment, and individual support or advocacy.
The DHCS announcement contains details on:
- CHW service definitions
- Non-covered CHW benefits and services
- CHW staffing minimum qualifications
- Beneficiary eligibility criteria to receive CHW services
- CHW services procedure codes and fee-for-service reimbursement rates
- CHW services documentation and plan of care requirements
- CHW services supervisory requirements for CHW services
- Specific requirements for asthma prevention and violence prevention CHW services
