Brief

Executive Summary

THE OPPORTUNITY: NEW MEDI-CAL BENEFITS FOR EARLY CHILDHOOD

California has created a historic opportunity to transform care for young children through two new Medi-Cal benefits that leverage trusted community organizations. The community health worker (CHW) services benefit (June 2022) provides Medi-Cal reimbursement for community health workers to deliver health education, navigation, advocacy support, and screening - preventative services addressing social determinants of health with broad eligibility criteria. The enhanced care management (ECM) benefit offers community-based, high-touch care coordination for populations with complex needs, including certain children (July 2023) and pregnant/postpartum individuals (January 2024).

Yet without addressing critical implementation barriers, California risks squandering this opportunity. Data from 2025 indicate only 1 percent of children under 21 have received CHW services. Meanwhile, children birth to five account for just 6 percent of ECM recipients even though they make up 26 percent of the under 21 Medi-Cal population.

If the state fails to remove barriers preventing trusted community providers from participating, hundreds of thousands of young children will miss out on preventative health support and care navigation. California will forgo millions in Medi-Cal revenue that could flow to community organizations and sustain critical early childhood services. And the state will undermine its own transformation goals of equitable, community-integrated care.

FIRST 5 ENGAGEMENT AND PROGRESS

California has a unique asset to close this gap: First 5 county commissions, voter-mandated public agencies established by Proposition 10 (1998) to support early childhood development. This network of 58 commissions has deep early childhood expertise, community connections, and established trust with families. The CHW and ECM benefits align directly with First 5 core investments, including home visiting, parenting education, and care coordination, and offer a pathway to braid Medi-Cal funds with First 5 Proposition 10 funds to expand reach and sustain services.

To date, eight First 5s have contracted with Medi-Cal managed care plans (MCPs) to deliver CHW and/or ECM services, with six more actively engaged in the contracting process. In this work, First 5s have identified four models for engagement:

Direct Service Providers: First 5 contracts with MCP and First 5 staff deliver services directly to families.

Hubs: First 5 contracts with MCP on behalf of community partners working directly with families.

Administrative Partners: First 5 supports partner organizations with administrative aspects of the partner’s contract with the MCP.

Champions: First 5 provides strategic leadership to ensure early childhood providers participate in new benefits.

CRITICAL BARRIERS REMAIN

Despite this progress, contracting with MCPs and beginning Medi-Cal billing has taken years for most First 5s. Several key barriers persist:

Policy guidance and requirements designed for clinical providers, not community organizations like First 5s.

Limited technical assistance available for capacity building, with existing resources via the Department of Health Care Services’ (DHCS) Providing Access and Transforming Health (PATH) initiative sunsetting after 2026.

Inconsistent MCP implementation approaches and readiness to support community partners with contracting.

Reimbursement rates inadequate to cover true cost of service delivery.

Substantial organizational change requirements to become a Medi-Cal provider including HIPAA compliance and new privacy/security infrastructure.

Federal policy uncertainty making organizations hesitant to invest without guaranteed sustainability.

POLICY RECOMMENDATIONS

The experience of First 5s that have successfully become Medi-Cal providers reveals a clear path forward. Their multi-year journey, from initial conversations with MCPs to billing for services, demonstrates both the feasibility of community provider participation and the specific policy changes needed to enable it at scale. The following recommendations are grounded in First 5 implementation experience and address the barriers that prevent broader community provider engagement:

1. Standardize implementation across MCPs: Create consistency in contracts, requirements, and expectations across MCPs statewide. Current flexibility has created confusion at the community level. Standardization will improve equitable access and reduce administrative burdens.
2. Sustain technical assistance: Create ongoing TA infrastructure beyond PATH’s 2026 sunset, including group-based learning cohorts modeled on the First 5 Medi-Cal Learning Community, accessible materials documenting field successes and challenges, and support that moves beyond time-limited 1:1 grants.
3. Clarify hub roles: DHCS recently published a Hub Toolkit to define hub roles, but it is written for healthcare and managed care audiences. Translate this guidance into accessible language for non-healthcare organizations that could serve as critical cross-sector hub partners.
4. Increase CHW rates: Raise base reimbursement to at least 87.5 percent of Medicare rates ($53.35 per 30 minutes). Current rates are inadequate to cover true service costs, forcing organizations to blend and braid funding from other sources to sustain CHW services.
5. Ensure dedicated community provider support staff: Establish liaisons specific to community providers at DHCS and MCPs to triage questions and provide clear points of contact. Community providers face roadblocks navigating complex systems like enrolling as a Medi-Cal provider with the state.

First 5s and their community partners are not peripheral to Medi-Cal transformation - they are foundational to reaching California’s most vulnerable families. They bring cultural relevance, trust, community embeddedness, and the ability to bridge clinical systems to populations that have historically experienced barriers to healthcare access. Without their intentional involvement, there is a risk of rebuilding systems outside the trusted networks First 5s have cultivated for over two decades. DHCS must stay committed to supporting community organizations through this journey to fully realize Medi-Cal transformation goals for young children and families.