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Community Health Worker Services

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Community Health Worker (CHW) services are preventive health services to prevent disease, disability, and other health conditions or their progression; to prolong life; and promote physical and mental health and wellbeing.

CHW services include:

  • Health education to promote the Medi-Cal member’s health or address barriers to health care, including providing information or instruction on health topics. to provide information, training, referrals, or support to help Medi-Cal members access health care, understand the health care system, and engage in their own care and to connect members to community resources necessary to promote their health.
  • Health navigation to provide information, training, to provide information, training, referrals, or support to help Medi-Cal members access health care, understand the health care system, and engage in their own care and to connect members to community resources necessary to promote their health.
  • Screening and assessment that help Medi-Cal members connect to appropriate services to improve their health.
  • Individual support or advocacy that assists Medi-Cal members in preventing the onset or exacerbation of a health condition or preventing injury or violence.

CHW services may assist with a variety of concerns impacting members, including but not limited to:

  • Control and prevention of chronic conditions or infectious diseases.
  • Behavioral health conditions.
  • Perinatal care, preventive care, sexual and reproductive health.
  • Environmental and climate-sensitive health issues.
  • Oral health, aging and injury.
  • Domestic violence and other violence prevention services.

CHWs may include individuals known by a variety of job titles, such as community health representatives, navigators, and non-licensed public health workers, including violence prevention professionals.

Eligibility requirements

CHW services must be recommended by a physician or other licensed practitioner. The recommending physician or other licensed practitioner must ensure that a member meets the eligibility criteria below before recommending CHW services:

  • The member must be active and enrolled in Medi-Cal.
  • Diagnosis of one or more chronic health (including behavioral health) conditions, or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
  • Presence of medical indicators of rising risk of chronic disease (for example, elevated blood pressure, elevated blood glucose levels, etc., that indicate risk but do not yet warrant diagnosis of a chronic condition).
  • Positive Adverse Childhood Events (ACEs) screening.
  • Presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
  • Results of a social drivers of health screening indicating unmet health-related social needs, such as housing or food insecurity.
  • One or more visits to a hospital emergency department within the previous six months.
  • One or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six months, or being at risk of institutionalization.
  • One or more stays at a detox facility within the previous year.
  • Two or more missed medical appointments within the previous six months.
  • Beneficiary expressed need for support in health system navigation or resource coordination services.
  • Need for recommended preventive services.

How to Recommend Medi-Cal Members for CHW Services

CHW services require a written recommendation by a physician or other licensed practitioner of the healing arts within their scope of practice under state law before services can be provided. Once completed, the provider should give the form to the member.

Download the Medi-Cal Member Recommendation form:

Referrals to CHW Services

Use one of the ways below to make a CHW referral.

1. Member Services (Anyone can make a referral)

2. Provider Directory (Anyone can make a referral)

Go to the CalAIM Resources for Providers page to learn more about CHW and its in-depth workflow.

Resources

Member Flyer:

Reference:

Community Health Worker (CHW) Preventive Services Provider Manual (PDF)

Last Updated: 04/15/2025