Community Health Worker (CHW) Services

L.A. Care Health Plan is now offering no cost Community Health Worker (CHW) services to Medi-Cal members and DSNP members who have their Medi-Cal benefits under MCLA. CHW services are defined as preventive health services delivered by a CHW to prevent disease, disability, and other health conditions or their progression; to prolong life; and to promote physical and mental health. CHWs are trusted members of their community who help address chronic conditions, preventive health care needs, and health-related social needs within their communities. CHWs may include individuals known by a variety of job titles, such as promotoras, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals.

What services are offered under CHW Services?
  • Health Education
  • Health Navigation
  • Screening and Assessment
  • Individual Support or Advocacy
  • Resource Connection
  • Violence Prevention Services (Only offered through L.A. Care contracted providers.)
What is the eligibility criteria for Basic CHW Services?

The recommending provider must determine whether a member meets eligibility criteria for CHW services based on the presence of one or more of the following before recommending CHW services:

  • Diagnosis of one or more chronic health (including behavioral health) conditions, or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
  • Presence of medical indicators of rising risk of chronic disease that indicate risk but do not yet warrant diagnosis of a chronic condition.
  • Any stressful life event presented via the Adverse Childhood Events screening.
  • Presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
  • Results of a SDOH screening indicating unmet health-related social needs, such as housing or food insecurity.
  • One or more visits to a hospital emergency department (ED) within the previous six months.
  • One or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six months, or being at risk of institutionalization.
  • One or more stays at a detox facility within the previous year.
  • Two or more missed medical appointments within the previous six months.
  • Member expressed need for support in health system navigation or resource coordination services
  • Need for recommended preventive services, including updated immunizations, annual dental visit, and well childcare visits for children.
What is the eligibility criteria for CHW Violence Prevention Services?

Members experiencing interpersonal and/or domestic violence can access CHW services through contracted providers and other CHW pathways with training and experience specific to those needs.

The recommending provider must determine whether a member meets eligibility criteria for CHW Violence Prevention services based on the presence of one or more of the following:

  • The Member has been violently injured as a result of community violence.
  • The Member is at significant risk of experiencing violent injury as a result of community violence.
  • The Member has experienced chronic exposure to community violence.
Who is excluded from the CHW Benefit Program?

If a member is connected to any case management program that provides support by a CHW, the member DOES NOT qualify to receive similar services through this benefit. Members who are connected to the following programs are excluded from this service as it is considered duplicative, with the exception of violence prevention services which are carved out from basic CHW services:

  • Enhanced Care Management
  • Complex or High-Risk Care Management
  • Hospice
Where can a member receive services?

 

Members can visit an L.A. Care Community Resource Center (CRC) at one of these six locations for in-person or telephonic CHW services:

Members can also receive CHW services from L.A. Care contracted network of providers who can be found using our online provider directory. Who can submit a Recommendation Form? Written recommendation of a physician or other licensed practitioner of the healing arts within their scope of practice, including:

  • Clinical Nurse Specialist
  • Dentist
  • LCSW
  • Licensed Educational Psychologist
  • Licensed Midwives
  • Licensed Professional Clinical Counselor
  • Licensed Vocational Nurse
  • LMFT
  • MD/DO
  • Nurse Midwives
  • Nurse Practitioner
  • Pharmacist
  • Physician Assistant
  • Podiatrist
  • Psychologist
  • Public Health Nurse
  • Registered Dental Hygienists
  • Registered Nurse
Where can I find the Recommendation Form?

The recommending provider must complete a CHW Benefit Recommendation Form which can be found under the Social Services tab.