Community health workers have been on mind quite a bit lately.  Not totally surprising, as the core of Health Outreach Partners’ work is strengthening, supporting, and integrating outreach programs in communities and health centers.  No other profession has more influence and impact on outreach programs than community health workers (CHWs).  As the COVID-19 public health crisis moves towards its third anniversary, I can’t help but reflect on how different the outcomes would be right now without the contributions of CHWs.  I firmly believe that without the hard work and dedication of CHWs many more people would have died and/or been hospitalized with much more serious illness from COVID-19 without their collective mobilization.

Community health workers are one of the most trusted professions in health care.  They typically work in the communities they live in and share lived experience with the people they work with.  They have first-hand knowledge and experience working with the resources available in their communities. During the pandemic their contributions (to name a few) included delivering health education to their communities, distributing PPE, assuring their communities had access to healthy food, promoting telehealth, dispelling fear and anxiety about the COVID-19 vaccine, and, in the case of farmworkers, addressing employer inequities.   The support that CHWs give to the clinical team in support of the social needs of their patients is also invaluable to the health of their communities. If their work in care coordination wasn’t considered essential prior to the pandemic, it certainly is now.  Sadly, in lean economic times, community health workers and outreach programs are usually the first to be cut from organizational budgets.

Earlier this year, California rolled out The California Advancing and Innovating Medi-Cal (CalAIM) initiative. This program seeks to take California’s very complicated and fragmented Medicaid system and transform it to improve health outcomes for all Californians, especially those from the most marginalized populations. This initiative seeks to address the needs of the whole person from a more holistic standpoint. It has three main objectives:

1. Identify and manage comprehensive needs through whole person care approaches and social drivers of health.
2. Improve quality outcomes, reduce health disparities, and transform the delivery system through value-based initiatives, modernization, and payment reform; and
3. Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility.​

As part of CalAIM there are many different programs to help achieve the overall objectives.  One I am extremely excited about (along with my HOP colleagues) is the community health worker benefit.  On July 1, 2022 CalAIM and Medi-Cal launched the Community Health Worker Preventive Services Benefit and began reimbursing providers and other CBOs for CHW services.  This is a huge advancement towards recognizing the essential nature of CHWs’ work and their contribution to the wellness of Californians as well as demonstrating a commitment to equitable care.

Medi-Cal is now covering Community Health Worker Preventive Services.  Covered services include preventive health services that aim to prevent chronic and infectious disease and promote physical and mental health.  CHW services must be ordered by a licensed medical provider and a care plan must be created by the licensed provider that outlines the services and support the community health worker will provide the patient.  Services that are reimbursable include health education, navigation, screenings and assessment (that do not require a license), advocacy, and individual support.  Of course, there are nuances that fall under each of these services types that can be found in the Medi-Cal manual.

However, my purpose here is not to be yet another resource for the CHW Prevention Services.  I want to give California kudos on recognizing the role of CHWs as well as acknowledge the importance of this profession in moving the needle towards equity. CalAIM is a large step in recognizing that traditional structures in medicine have failed to improve the health of under-resourced Californians and have often been part of the complex societal causes of poor health, such as lack of coverage, poverty, limited providers, and no access to care.  This new CHW service improves access, invests dollars in non-traditional care, and brings CHWs onto the care coordination team.  Under this initiative many different roles, job titles, and types of lived experience are also included in the job category of “community health worker,” recognizing the diversity of the field and the important place they hold in serving their community.   Lastly, Medi-Cal also recognizes lived and work experience in lieu of certification programs as the main training for CHWs.  While there are more and more training and certification programs in California to meet the need to train and hire upwards of 10,000 new CHWs in the coming years, those programs require time, money, and other resources that folks living in under-resourced communities often can’t afford. This recognition and the provision of alternatives for training is another step for equity.

As I write this, I am at a national conference attending many great sessions and conversations on health center workforce, Value Based Care, and payment reform.  Every state, is experiencing huge workforce shortages and is looking for innovative ways to staff health centers, while also preparing for transformation in care delivery and payment practice.  While every state and region are different and have different laws, policies, populations, and needs, there are some creative and inspiring programs around our country addressing these complex issues.  I also feel SO PROUD to be a Californian.  We are a diverse complex state with close to 40 million people and, while not perfect, CalAIM is a step in recognizing that quality health care is a right that should be afforded to all and that equal access to care and non-traditional providers can collectively improve our well-being.

With gratitude – Cindy