Prioritizing Children and Families in California’s New Community Health Worker Benefit

By Alexandra Parma

Director of Policy Research & Development

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:

  1. Providing health system navigation, resource coordination, and linkage. Health system navigation support from a CHW can help families receive more timely preventive care including prenatal visits, well-child visits, and immunizations. In a pediatric clinical setting, CHWs can be part of a care team that supports plans and providers in meeting the existing Medi-Cal managed care plan case management/care coordination requirement for children. Integrating CHWs directly into health centers with the ability to also conduct their work from outside the clinical setting can help make existing benefits more accessible.
  2. Addressing social determinants of health and supporting whole-family wellness. CHWs should be able to connect beneficiaries to non-medical community resources, including services to support social determinants of health. By providing navigation support outside of medical needs, CHWs can promote overall family wellness. When CHWs are in the pediatric setting they should also be able to provide care to caregivers/parents of beneficiaries. This acknowledges that caregiver and family wellness is essential to supporting children’s health and development.
  3. Conducting health promotion and education activities. In order to meet the most salient health needs of families and children, CHW topics for health promotion and education should include prenatal care, perinatal mood and anxiety disorders, developmental milestones and screening, preventive care, peditatric special health care needs, and childhood mental health. Where appropriate, CHWs can be part of a care team that supports plans and providers in meeting existing Medi-Cal preventive care requirements, like developmental screenings. Furthermore, CHWs can play an important role in educating California families about Medi-Cal and getting them connected to eligibility services for Medi-Cal.
  4. Providing administrative support services to clinicians. In a health care setting, CHWs should be able to conduct administrative roles such as identifying and coordinating existing social, developmental, and behavioral health resources, requesting educational and medical records from schools and other providers, and assisting families with completion of eligibility forms.
  5. Providing services in flexible locations and modalities. CHW services should be allowed via telehealth, home visits, and in other community-based settings to meet families where they are and best support their needs.

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.

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