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Community Health Workers Resources

Frequently Asked Questions

 

  1. What is a Community Health Worker?
    Community Health Workers (CHWs) are members of the community who guide, support, and help members get the services they need. They work for agencies that partner with the health plan.
  2. How can a CHW help me?
    CHWs can help guide you through the health system in many ways that include help to:
    • Connect you with:
      • A doctor
      • A mental health provider
      • Same-day health services
    • Get referrals for Community Supports like:
      • Housing
      • Meals
      • Other social services
    • Get transportation to medical services
    • Get connected to extra support during pregnancy, such as doulas
  3. How can a CHW help me learn more about my health?
    CHWs can provide health information that can include:
    • Wellness programs and other resources
    • How to find information about any health condition you may have
  4. How can a CHW help me with my health goals?
    CHWs can provide tailored support and guidance to help you:
    • Assess and define healthcare goals
    • Manage healthcare issues
  5. Do I have to pay for CHW services?
    No. CHW services are part of your health plan benefits at no extra cost.
  6. Where do CHW services take place?
    Many CHWs offer home or local area visits to better know your needs and provide custom support. You can also receive services via telephone or virtual visits.
  7. How do I know if I am able to get CHW services?
    CHW services are for Medi-Cal Managed Care Health Plan Members of all ages who are enrolled in the Medi-Cal health plan.

    You qualify for CHW services based on one or more of the following:
    • If you need guidance with getting services in the healthcare system. Or if you need help to find resources.
    • Have been diagnosed with one or more chronic health conditions (includes behavioral health). Or, if you have a presumed mental disorder or substance use disorder that has not yet been diagnosed.
    • A raised risk of having a chronic condition but have not been diagnosed. Examples include:
      • Higher than normal blood pressure
      • Higher than normal blood glucose levels
      • High lead levels in your blood or childhood lead exposure
    • Any stressful life event described via the Adverse Childhood Events screening.
    • Presence of known risk factors, that include:
      • A domestic or intimate partner violence
      • Tobacco use
      • Too much alcohol use
      • Drug misuse
    • Results of a Social Determinants of Health screening that show unmet social needs linked to health. This can include housing and the lack of access to healthy food.
    • One or more visits to a hospital ER within the past six months.
    • One or more hospital inpatient stays. This includes stays at a mental health facility (within the past six months) or being at risk of being placed in a mental institution.
    • One or more stays at a detox center within the past year.
    • Two or more missed medical appointments within the past six months.
  8. How many hours of service can I receive?
    If you qualify, you can receive CHW services for up to six total hours. More services (beyond 6 hours) require the CHW to develop a plan of care.
  9. What if I need more support to manage my care?
    Your CHW can help you find services like your health plan’s care management services or Enhanced Care Management (ECM). With ECM, you will have a care team and your own ECM lead care manager.

    Note: Even though you can’t receive both CHW and ECM at the same time, you can begin to receive services and then move to the other service. This depends on whether you qualify and your needs.
  10. What type of services are not covered in CHW services?
    Non-covered services include:
    • Clinical case management/care management that requires a license
    • Childcare
    • Services that include shopping and cooking meals
    • Buddy services
    • Job training services
    • Helping you enroll in government or other assistance programs that are not linked to helping you improve your health as part of your plan of care or treatment plan
    • Delivery of:
      • Medication
      • Medical equipment
      • Medical supplies
    • Personal care services
    • Homemaker services
    • Respite care
    • Services that are the same as other covered Medi-Cal services being provided to a member
    • Socialization
    • Transportation
    • Services offered to people not enrolled in Medi-Cal, except as noted above
    • Services that require a license
  11. How do I learn more about who is contracted to provide Community Health Worker services?
Last Updated: 03/03/2026