25-995 Expanded Access to Community Health Worker Services

Date: 09/29/25

New DHCS guidance removes barriers for Medi-Cal members

The Department of Health Care Services (DHCS) has issued a statewide standing recommendation that streamlines access to Community Health Worker (CHW) services for eligible Medi-Cal patients. This update:

• Eliminates the need for a written recommendation – allows licensed practitioners to verbally inform patients about CHW services.
• Meets federal requirements under Title 42, Section 440.130(c) of the Code of Federal Regulations.

What this means for members

Eligible Medi-Cal patients can now directly access CHW services by:

• Calling the Member Services number on the back of their ID card to find in-network CHWs.
• Using the online provider directory at Find a Provider to locate CHWs.

Who is eligible?

Patients currently enrolled in Medi-Cal may qualify for CHW services if they meet any of the following criteria:

• Diagnosed with one or more chronic physical or behavioral health conditions or suspected of having a mental health or substance use disorder.
  
• Rising risk of chronic disease, as shown by medical indicators (e.g., elevated blood pressure or glucose levels), but do not yet warrant diagnosis of a chronic condition.
• Have experienced a stressful life event identified through Adverse Childhood Experiences (ACEs) screening.
• Exhibit known risk factors such as domestic violence, intimate partner violence, tobacco use, excessive alcohol consumption or drug misuse.
• Screened positive for unmet health-related social needs (e.g., housing or food insecurity).
• Had one or more emergency department visits in the past six months.
• Had one or more inpatient hospital stays (including psychiatric facilities) within the past six months or are at risk of institutionalization.
• Had a stay at a detoxification facility within the past year.
• Missed two or more medical appointments in the past six months.
• Expressed a need for help navigating the health system or coordinating resources.
• Require preventive services, such as immunizations, dental visits or well-childcare visits.

Additional information

Relevant sections of the Plan’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the provider portal.

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Imperial County.