New Medi-Cal benefit will resolve longstanding reimbursement inconsistencies for community health workers, expert says – State of Reform

The addition of community health workers (CHWs) and outreach services as Medi-Cal Advantage is just part of California’s larger efforts to make these services more accessible across the state, according to Carlina Hansen, senior program manager for improving access at the California Health Care Foundation.

Governor Gavin Newsom assigned $16.3 million ($6.2 million from the general fund) for this benefit in the 2021-22 budget, increasing to $201 million ($76 million from the general fund) by 2026-27. The new benefit came into effect on July 1. Providers who work with CHWs and meet the requirements outlined in the recently released report Medi-Cal Provider Manual for the benefit CHW may bill Medi-Cal for such services. According to Hansen, this advantage will solve the long-standing problem of funding consistency in the field of CHWs.

“In many cases, CHWs [have been] work with Medi-Cal recipients before this benefit is realized,” she said. “They just weren’t reimbursed for it.”

Hansen said CHWs provide accessible information about chronic conditions like asthma and diabetes, as well as help people understand the benefits available to them and follow instructions from health care providers on a given day. culturally competent way.

“One of the most important roles community health workers play [is acting as] a cultural bridge between diverse communities and the complex health and social service systems that serve them,” she said. “They take time to build trust with people and that’s really what allows them to be effective. This trust is often based on shared life experience, which means that some community health workers share cultural backgrounds with the people they serve. They may have been homeless before or have been released from incarceration, and it’s really this shared life experience that allows them to connect with the recipient in a truly unique and special way.

Hansen stressed the importance for the state to establish a mechanism for ongoing stakeholder input and feedback so that state leaders can understand how benefits can be improved. She said it was especially important to get input from the CHWs themselves and the organizations that work with them, as well as the managed care plans that need to roll out the benefits.

“I think there are a few things that are worth looking at as the benefits take hold,” Hansen said. “One of the first is that it amplifies the [CHW] role and does not medicalize it excessively. [CHWs] are ultimately a community-connected workforce, and if [the managed care plans] don’t have the time and resources available to support the role, then the impact on Medi-Cal recipients really can’t be realized.

I think it is important to understand if [the reimbursement rates] are enough and whether they will be enough to encourage new types of entities to become CHW Medi-Cal providers or encourage existing providers to add CHWs… I think it’s also important to realize that the benefit has a downstream impact on the workforce. The CHW workforce is largely made up of people of color and low-income themselves, and many are or have been Medi-Cal recipients. It is therefore important to consider economic mobility when we think about rates in addition to the impact on Medi-Cal recipients.

Hansen said one of the biggest challenges in implementing the benefit will be the time and resources required to engage with this benefit for providers who have not historically interacted with Medi-Cal and did not employ CHWs.

“[This benefit] really represents quite a revolutionary change in how Medi-Cal approaches the delivery of health care. It’s about emphasizing health equity and understanding that we need to bring health care systems closer to the community.