Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under federal law, covered services include “preventive services,” which are defined as, services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under state law to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health and efficiency. On July 26, 2022, the federal Centers for Medicare and Medicaid Services approved the department’s Medicaid State Plan Amendment to add community health workers as a preventive service.

This bill would codify the requirement that community health worker services be a covered Medi-Cal benefit. The bill would require a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees, as determined by the department, but that would include, at a minimum, specified information to enrollees, including, among other things, a description of the community health worker services benefit and a list of providers that are authorized to refer an enrollee to community health worker services. The bill would require the department, through existing and regular stakeholder processes, to inform stakeholders about, and accept input from stakeholders on, implementation of the community health worker services benefit. The bill would be implemented only to the extent that federal financial participation is available and not otherwise jeopardized. The bill would authorize the department to implement, interpret, or make specific this bill by means of policy letters, provider bulletins, or other similar instructions, without taking any further regulatory action.