FREQUENTLY ASKED QUESTIONS (FAQS) FOR MEDI-CAL COMMUNITY HEALTH WORKER (CHW) SERVICES- Provider Requirements
The following FAQs provide additional guidance and clarification to Medi-Cal members and providers regarding CHW services.
CHW Qualifications and Supervising Provider Requirements
1. What are the qualifications to become a CHW?
In order to bill for CHW services provided to a Medi-Cal member, a CHW must have lived experience that aligns with and provides a connection between the CHW and the community or population being served and fulfill either the training pathway or experience pathway, as outlined in the Medi-Cal Provider Manual: Community Health Worker Preventive Services. CHWs who enter through the experience pathway must earn a CHW certificate within 18 months of rendering CHW services to a Medi-Cal member.
2. Does the Department of Health Care Services (DHCS) have a list of approved organizations that issue CHW certificates?
No. Under current Medi-Cal policy, the supervising provider is solely responsible for determining if the certificate of completion fulfills all Medi-Cal CHW policy requirements, including that the curricula for the CHW certificate of completion attests to demonstrated skills and/or practical training in certain core competencies, as well as field experience, as outlined in the Medi-Cal Provider Manual: Community Health Worker Preventive Services. The certificate of completion can be any certificate issued by the State of California or a State designee and may also be a certificate issued outside of California or United States.
3. Is there any additional required training for CHWs?
Yes. CHWs are required to complete a minimum of 6 hours of additional training annually. Training may be in the core competencies or an area of special focus. The supervising provider is responsible for maintaining appropriate supporting documentation evidencing each CHW they supervise has satisfied all annual training requirements and shall make that information available to DHCS upon request and/or in the event of an audit.
4. Who can supervise CHWs?
The supervising provider is an enrolled Medi-Cal provider who submits claims for services provided by CHWs. The supervising provider ensures each CHW that they supervise meets the qualifications listed in the Medi-Cal Provider Manual: Community Health Worker Preventive Services, and directly or indirectly oversees each CHW and all services delivered to Medi-Cal members. At this time, the supervising provider can be a licensed provider, a hospital, an outpatient clinic, a local health jurisdiction (LHJ), or a non-profit community-based organization (CBO). CHWs may be supervised by a CBO or LHJ that does not have a licensed provider on staff. Starting October 1, 2024, pharmacies may also supervise CHWs and bill for their services. Additionally, DHCS is planning to expand the list to also include other county-based entities, and more information will be released soon.
If you are not currently an enrolled Medi-Cal provider, you can enroll to become one and supervise CHWs by submitting an application through DHCS’ Provider Application and Validation for Enrollment portal.
5. Can a CHW with a violence prevention certificate provide CHW services?
No. A Violence Prevention Professional Certificate issued by Health Alliance for Violence Intervention or a certificate of completion in gang intervention training from the Urban Peace Institute allows a CHW to provide violence prevention services only.
6. Can a CHW provide services for domestic violence prevention?
Yes, if the supervising provider determines that a CHW is qualified to render those services. Please note that domestic violence counselors, as defined in section 1037.1 of the Evidence Code, are not considered CHWs for purposes of Medi-Cal coverage and reimbursement policy.
7. Can a CHW provide asthma preventive services?
CHWs may provide CHW services to individuals with asthma, but evidence-based asthma self-management education and asthma trigger assessments may only be provided by asthma preventive service providers who have completed either a certificate from the California Department of Public Health Asthma Management Academy, or a certificate demonstrating completion of a training program consistent with the guidelines of the National Institutes of Health’s Guidelines for the Diagnosis and Management of Asthma. (Note: These services may also be rendered by a licensed provider within their scope of practice.)
8. Can Peer Support Specialists (PSS) provide CHW services?
PSS are a separate provider type and their services cannot be billed as CHW services, or vice versa. However, an individual can be certified as a PSS and as a CHW and separately provide either PSS or CHW services. Their supervisor is responsible for ensuring there is no duplication of services.
9. Can CHWs provide services via telehealth?
Yes, CHWs may provide services via synchronous audio-visual or audio-only that are appropriate for telehealth. CHWs must follow all existing Medi-Cal policies regarding delivery of covered services via telehealth modalities, including consent requirements, as outlined in the Medicine: Telehealth Provider Manual. Services rendered by text, email, or chat are not eligible for reimbursement.
10. Can CHWs provide public health services?
Medi-Cal coverage and reimbursement policy for CHW services does not include broader public health services and are limited to those services listed in the Medi-Cal Provider Manual: Community Health Worker Preventive Services. Additionally, it is important to remember that CHW services must be specific to an individual Medi-Cal member’s health needs and not broader public health concerns.
11. What is a written plan of care? Is it required?
The plan of care is a written document that is developed by one or more licensed providers that describe services a CHW will provide to address a Medi-Cal member’s ongoing needs for CHW services. A CHW may assist in developing a plan of care with the licensed provider(s).
Under current Medi-Cal policy, a written plan of care is required for continued CHW services after 12 units (equivalent to six hours) of care per recommendation. Similar to a written plan of care for physical therapy, it must contain goals and services intended to help the Medi-Cal member meet those goals through ongoing CHW services. This requirement does not apply to CHW services provided in the Emergency Department (ED). The written plan of care may not exceed a period of one year.
12. Can CHWs help Medi-Cal members enroll and/or maintain enrollment in housing or health care plan?
CHWs services are limited to those services outlined in the Medi-Cal Provider Manual: Community Health Worker Preventive Services. To that end, CHWs may help a Medi-Cal member to enroll and/or maintain enrollment in government or other assistance programs that are related to improving their health if such navigation services are provided pursuant to a written plan of care. CHW services that are not related to improving the Medi-Cal member’s health are not covered services.
