MedicaidCoverageMedium impact
23-265 Help Improve Patient Health Outcomes Through Community Health Worker (CHW) Services
Health Net·CA · Family Medicine, Internal Medicine, General Practice +3 more·Prior Authorization
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Community Health Worker (CHW) services are now covered benefits under Medi-Cal as preventive care services, requiring physician recommendations and written submissions to Health Net/CalViva Health. CHW services include health education, navigation, screening, and individual support for members with chronic conditions or those facing health barriers.
Action Required
Immediately: Billing team must establish workflow to process CHW service recommendations from physicians. Update referral system to capture written recommendations for CHW services for Medi-Cal patients with chronic conditions or health barriers. Contact CalViva Health at 888-893-1569 for specific billing procedures and CPT codes. Ensure documentation includes dates, time/duration, and nature of services provided.