New Medi-Cal benefit will address longstanding inconsistency in reimbursement for community health workers, expert says – State of Reform

The addition of community health workers (CHW) and promotional services such as a Medi-Cal benefit is just one part of California’s larger effort to make these services more accessible across the state, according to Carlina Hansen, senior program officer for improving access at the California Health Care Foundation.

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Governor Gavin Newsom distributed $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 came into effect on July 1. Providers who work with CHW and meet the requirements outlined in the recently published Medi-Cal Provider Guide for the CHW benefit, you will be able to bill Medi-Cal for these services. According to Hansen, this benefit will address the long-standing problem of consistency of funding in the CHW field.

“In many cases CHWs [have been] working with Medi-Cal beneficiaries prior to the realization of this benefit,” she said. “They just haven’t been compensated for it.”

Hansen said CHWs provide accessible information about chronic conditions such as 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 perform [is acting as] a cultural bridge between different communities and the complex health and social service systems that serve them,” she said. “They take time to build trust with people and that really allows them to be effective. This trust is often built on shared life experiences, so this means that some community health workers share a cultural background with the people they serve. They may have previously been homeless or come out of prison, and it’s really that shared life experience that allows them to connect with the beneficiary in a really unique and special way.”

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

“I think there are a couple of things that are worth noting as the benefit lingers,” Hansen said. “One of the first is that it amplifies [CHW] role and does not overdo it with medicine. [CHWs] are ultimately a community-related workforce and if [the managed care plans] do not have the time and resources available to support the role, then the impact on Medi-Cal beneficiaries cannot really be realized.

I think it’s important to find out if [the reimbursement rates] are sufficient, and if they are going to be sufficient to encourage new types of entities to become CHW Medi-Cal providers or to encourage existing providers to add CHWs… I think it’s also important to realize that the benefit has a downstream impact chain on the workforce. CHW workers are predominantly people of color and low income themselves, and many are or have been Medi-Cal beneficiaries. So it’s important to look at economic mobility when thinking about rates in addition to the impact on Medi-Cal beneficiaries.”

Hansen said one of the biggest challenges in implementing the benefit will be the time and resources required to commit to this benefit for providers who have not previously interacted with Medi-Cal and have not employed CHWs.

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

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