The 2021-2022 State budget included Community Health Workers (CHWs) as a class of Medi-Cal providers effective January 2022. CHWs are frontline public health workers who have a deep understanding and/or are trusted members of the communities they serve. CHWs create a link between health/social services and the community to improve service access and quality.
The First 5 Center, First 5 Association, and our partners listed below recently submitted stakeholder comments to inform California’s definition of this new CHW benefit. Our feedback urged the Department of Health Care Services to consider children, especially infants and toddlers, and pregnant people among the priority populations for CHW services. The following is a summary of our comments.
Dr. Anda Kuo, MD; Professor, Pediatrics; Director, Child Health Equity and Community Engagement; UCSF
Dr. J. Raul Gutierrez, MD; Associate Clinical Professor, Pediatrics, ZSFG; Director, Pediatric Leaders Advancing Health Equity (PLUS); Co-Director, CoE Immigrant Child Health and Wellbeing, Bridges Clinic; UCSF
Dr. Kate Margolis, PhD; Licensed Clinical Psychologist; Director, ZSFG Division of Integrated Behavioral Health; Associate Professor of Psychiatry and Pediatrics, UCSF; Zuckerberg SF General Hospital and Trauma Center
Dr. Melanie Thomas, MD, MS; Perinatal Psychiatrist; Director, Solid Start Initiative at ZSFG; Associate Clinical Professor of Psychiatry and OB/GYN, UCSF
First 5 Association of California
First 5 Center for Children’s Policy
The California Children's Trust
The Children’s Partnership
ZERO TO THREE, California
Although CHWs are more frequently deployed to work with adults, evidence suggests community health workers help manage childhood chronic health conditions, reduce child morbidity and mortality, improve maternal and newborn health, support breastfeeding, bolster immunization uptake, and help families enroll in health insurance. Additional health navigation and education support is especially important during the prenatal to three period when individuals may be experiencing new health concerns, and accessing services and systems for the first time.
CHW services focused on young children and pregnant people are also necessary due to California’s persistent poor health care access for children and disparities in birth outcomes. Research suggests CHWs are likely to reduce health disparities due to their unique ability to serve as change agents in their communities. Their effectiveness is rooted in CHWs’ lived experience with the communities they serve, the trust they build in relationships, and the holistic and multifaceted work they do.
In particular we would like to see these specific activities included as Medi-Cal billable for CHWs:
We recommend that CHWs have as broad of a scope of practice as possible and appropriate. As historically true, CHWs should come from and have a deep understanding of the communities they serve through shared ethnicity, culture, language, or life experiences. CHW should be trained on local providers and health resources, ensuring knowledge of children’s services and systems. Importantly, the State must consider the expertise and background of CHWs already working in the State, making sure qualifications do not create barriers to entry or exclude communities of color and immigrants who have led CHW work throughout history.
Sarah Crow • Jul 19, 2021
Among the many important investments in this year’s state budget, California’s new dyadic care benefit in the Medi-Cal program is particularly significant.
Alexandra Parma • Mar 25, 2021
California’s children covered by Medi-Cal Managed Care received alarmingly low levels of recommended preventive care in 2019, according to data newly released by the California Department of Health Care Services (DHCS).
Sarah Crow • Christina Altmayer • Mar 30, 2021
Revamping Medicaid policies to improve young children’s social and emotional health and address health care inequities is particularly critical in California, where over half of children ages 0 to 5 have Medicaid coverage (known as Medi-Cal, in California), and two-thirds are children of color.