MedicaidCoverageHigh impact
Reminder: Policy Clarifications for Covered Medi-Cal CHW Services
Medi-Cal·CA·Specialty Services
We identified it
Sep 1, 2026
Summary
DHCS has published clarifications on Medi-Cal coverage for Community Health Worker (CHW) services, specifically addressing billing requirements for individual services (CPT 98960, HCPCS G0019/G0022) and group services (CPT 98961/98962), telehealth modality use, and health navigation services. The policy emphasizes that CHWs may now assist members with maintaining Medi-Cal enrollment and enrollment in related assistance programs (CalWORKs, CalFRESH) as part of covered health navigation services.
Action Required
Immediately: Billing team must review the Medi-Cal Provider Manual's Community Health Worker Preventive Services section to ensure accurate coding and billing practices. Verify that: (1) Individual CHW services use correct codes (CPT 98960 for individual sessions or HCPCS G0019/G0022 where applicable), (2) Group CHW services use CPT 98961/98962, (3) Telehealth modalities are billed appropriately per policy. Update billing guidelines and staff training documentation. Ensure that claims for health navigation services now include support for Medi-Cal enrollment maintenance and related assistance program enrollment (CalWORKs, CalFRESH). Review existing CHW billing practices to identify and correct any non-compliant claims. Communicate changes to providers and CHW staff to prevent future claim denials.