MedicaidCoverageMedium impact
Clarification to Existing Community Health Worker (CHW) Preventive Services Policy
Medi-Cal·CA·Specialty Services
Effective date
Jun 26, 2026
We identified it
Jun 27, 2026
Summary
The California Department of Health Care Services clarified that Community Health Workers (CHWs) may now bill Medi-Cal for assisting members with maintaining or obtaining enrollment in Medi-Cal and other government assistance programs (CalWORKS, CalFRESH, etc.). This expands the scope of reimbursable CHW preventive services. All existing Medi-Cal Presumptive Eligibility policies apply to CHW services in the same manner as other covered services.
Action Required
By July 31, 2026: Billing team must review current CHW billing practices and confirm that enrollment assistance services are being captured and billed appropriately under existing Medi-Cal CHW preventive service codes. Providers should document CHW activities related to Medi-Cal enrollment maintenance, initial enrollment support, and assistance with other government programs (CalWORKS, CalFRESH) in patient records. Monitor for updated provider manual sections from Medi-Cal Update. Ensure staff understand that Presumptive Eligibility pathways continue to apply to CHW services. Contact Medi-Cal if clarification is needed on applicable billing codes for these expanded services.