Community Health Worker (CHW) Covered Benefit
This is an advisory notification to Molina Healthcare of California (MHC) network providers with information on the Medi-Cal Community Health Worker (CHW) program. MHC’s goal is to have access to a broad network of CHWs to support the wellness and health of all our members.
What you need to know:
CHWs are trusted members of their community who help address issues that affect the physical and mental health of their community members. CHWs are not licensed clinicians; they may include individuals such as promotores, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals.
CHWs can provide and charge for the following services in virtual, in-person, individual, or group settings:
• Health education
• Health navigation
• Individual support or advocacy
• Complete screenings and assessments
A CHW may:
• Assist a member with finding an appointment to treat a behavioral health condition.
• Provide a member with health education to control a chronic condition.
• Provide a member with resources to prevent infections.
• Assist a member with accessing services for their sexual or reproductive health.
• Educate a member on the importance of prenatal and postpartum health care.
• Encourage a member to attend preventive appointments, including cancer screenings and immunizations.
• Refer a member to domestic or intimate partner violence support services.
• Help a member get necessary resources following an injury.
• Assist a member with accessing dental services for prevention or treatment.
When this is happening:
On January 1, 2023, CHW services became a benefit for all Medi-Cal members. Studies of CHWs have shown a positive impact on improving health outcomes for individuals who experience systemic barriers to care caused by geographic location, language and literacy, and other Social Determinants of Health (SDOH).
Member Referrals
Most Medi-Cal Members qualify for CHW services. Refer to the MHC CHW Medi-Cal Benefit Frequently Asked Questions (FAQs) to learn about the member eligibility criteria for CHW services: https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/ca/Medicaid/Resources-and-Training/CHW-Supervising-Provider-FAQ.pdf.
Eligible members need a written recommendation from a physician or other licensed practitioner of the healing arts:
• The provider must complete the CHW Referral Form at: https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/ca/Medicaid/forms/Community-Health-Worker-Referral-Form.pdf.
• The form must then be emailed, faxed, or phoned to the designated staff at MHC. MHC staff will link the member with the CHW the member selected or assign a CHW that is available for them based on their specific needs.
For more information about the CHW Benefit, refer to the Department of Health Care Services (DHCS) All Plan Letter (APL) 22-016 at: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-016.pdf.
