Medi-Cal Community Health Worker Benefit: Child Access To-Date and a New Policy to Catalyze Enrollment

Key Takeaways:

• Department of Health Care Services (DHCS) data show less than 1% of children accessed the Community Health Worker Services (CHW) Medi-Cal benefit last year.
• In April, DHCS issued a statewide standing recommendation for the benefit. This means beneficiaries can access services without first receiving a recommendation from a licensed medical practitioner. This removes a significant access and implementation barrier.

Since July 2022, community health worker services have been a covered benefit under Medi-Cal. Despite being available for the past three years, utilization, especially for children, has fallen short. Eligibility for the CHW benefit is broad. With a focus on supporting social drivers of health, eligible individuals include Medi-Cal members who have experienced adverse childhood experiences, with unmet health-related social needs such as food, who would benefit from preventive services such as well-child visits, or who need support navigating the healthcare system.

Across the state, there are approximately 5.5 million children with Medi-Cal coverage, many of whom would also be eligible for CHW services under the benefit’s broad eligibility criteria. According to DHCS, just over 23,500 Medi-Cal members ages birth to 21 accessed CHW services last year, or less than 1% of all beneficiaries. As of April 2025, nearly 7,000 Medi-Cal members aged birth to 21 accessed CHW services this year.* Although the data represents a broader population than just birth to five, it is clear that only a fraction of young children who would benefit from CHW services have been able to access them.

Recognizing the slow utilization of the CHW benefit, the important role CHWs play as trusted members of the community and calls from advocates like First 5 Center to improve service delivery for the benefit, DHCS issued a statewide standing recommendation in April. Now, eligible Medi-Cal members are no longer required to receive a written recommendation from a physician or other licensed healing arts provider to receive CHW services for the first 6 hours of care.

In addition to streamlining access for children, removing the written recommendation requirement will enable more CHWs to bill Medi-Cal. Prior to the standing recommendation, CHWs that operate in community settings without licensed health care practitioners at their organization or on their team faced a significant implementation hurdle.

This marks a positive first step in supporting increased utilization of the CHW benefit. In conjunction with the standing recommendation, there are additional policy levers DHCS can toggle to ensure the successful implementation of the CHW benefit. These policy levers include:

• Raising the existing reimbursement rate for CHW services from $27.54 per 30 minutes of services to at least 87.5% of the Medicare rate, or $53.35 per 30 minutes.

• Investing in more technical assistance and capacity building supports for child-serving providers who are well positioned to deliver CHW services, but need support getting ready to bill, like First 5s.

• Developing a statewide CHW training certificate to reduce barriers for providers to become certified to deliver services.

The CHW benefit is a powerful tool for young children and their families across the state, supporting inclusive and equitable access to an array of critical services. While significant progress has been made, more can be done to scale the utilization of the CHW benefit for all eligible young children across the state.

*Data received from the Department of Health Care Services via email on 5/8/2025. Excludes FQHC and RHC providers.