Medi-Cal: community health worker services.

Plain English Breakdown

The official source does not provide specific details about what happens if Medi-Cal managed care plans do not follow the new rules.

Medi-Cal: Community Health Worker Services

This law requires the State Department of Health Care Services to review and analyze how Medi-Cal managed care plans inform patients about community health worker services, and share this information with lawmakers and on their website.

What This Bill Does

• Requires the department to annually review outreach and education efforts conducted by Medi-Cal managed care plans regarding CHW services.
• Needs the department to conduct an annual analysis of the CHW services benefit, including assessments of CHW capacity and needs of Medi-Cal beneficiaries, disaggregated by geographic region, race, ethnicity, language, age, and other sociodemographic factors.
• Requires the department to submit each analysis to the Legislature and publish it on their website starting July 1, 2027.

Who It Names or Affects

• The State Department of Health Care Services
• Medi-Cal managed care plans

Terms To Know

community health worker (CHW)

A person who helps connect community members with healthcare and social services, making sure they understand how to get the help they need.

Medi-Cal

A government program that provides free or low-cost health care for people in California who have a low income.

Limits and Unknowns

• The bill does not specify how much money will be spent on these reviews and reports.
• It is unclear if the federal government needs to approve this change before it can happen.

Official Summary Text

AB 403, as amended, Ortega.
Medi-Cal: community health worker services.
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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, community health worker (CHW) services are a covered Medi-Cal benefit subject to any necessary federal approvals. CHW is defined as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery. Existing law requires a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees with regard to the CHW services benefit, as specified. Existing law requires the department to inform stakeholders
about implementation of the benefit.
This bill would require the department to annually
review the above-described outreach and education efforts conducted by Medi-Cal managed care plans. The bill would require the department to annually
conduct an analysis of the CHW services benefit, submit
each
the
analysis to the Legislature, and publish
each
the
analysis on the department’s internet website, with the first analysis due July 1, 2027.
The bill would require the
analysis to include, at a minimum, an assessment of
CHW capacity and the needs of Medi-Cal beneficiaries, a disaggregation of the assessment by geographic region, race, ethnicity, language, age, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable,
the above-described outreach and education efforts conducted by each Medi-Cal managed care plan, an assessment of the CHW benefit utilization and services, a demographic disaggregation of CHWs providing the CHW benefit and the Medi-Cal beneficiaries receiving services,
and data on Medi-Cal reimbursements for CHW services billed to the department, as specified.

Current Bill Text

Download Bill PDF