Community Health Worker (CHW) Benefit Services

The Alliance provides Community Health Worker (CHW) services to eligible members.

Services currently available to Alliance members include:

  • Health Education: Promote member health or address barriers to physical and mental health care by providing information or instruction on health topics. Health education content must be consistent with established or recognized health care standards and may include coaching and goal setting to improve a member’s health or ability to self-manage their health conditions.
  • Health Navigation: Provide information, training, referrals, or support to assist members in accessing health care, understanding the health care delivery system, or engaging in their own care. This includes connecting members to community resources necessary to promote health; addressing barriers to care, including connecting to medical translation/interpretation or transportation services; or addressing health-related social needs.
  • Under health navigation, CHWs can also:
    • Serve as a cultural liaison or assist a licensed health care provider to participate in the development of a plan of care, as part of a health care team.
    • Perform outreach and resource coordination to encourage and facilitate the use of appropriate preventive services; or
    • Help members enroll or maintain enrollment in government or other assistance programs that are related to improving their health if such navigation services are provided under a plan of care.
  • Screening and Assessment: Provide screening and assessment services that do not require a license and assist members with connecting to appropriate services to improve their health.
  • Individual Support or Advocacy: Assist members in preventing the onset or exacerbation of a health condition or preventing injury or violence. This includes peer support as well if not duplicative of other covered benefits.

What are CHW services?

CHW services are defined as preventive health services delivered by a CHW to prevent disease, disability, and other health conditions or their progression to help prolong life, and to promote physical and mental health.

CHWs provide services at no cost to qualifying Medi-Cal members.

Who is eligible for CHW services?

Alliance members with Medi-Cal coverage and a CHW recommendation form completed by their primary care provider, and meet at least one (1) of the following conditions:

  • Diagnosis of one (1) or more chronic health (including behavioral health) conditions or a suspected mental disorder or substance use disorder that has not yet been diagnosed.
  • The member expressed a need for support in health system navigation or resource coordination services.
  • Need for recommended preventive services, including updated immunizations, annual dental visits, and well-child visits for children.
  • One (1) or more hospital inpatient stays, including stays at a psychiatric facility, within the previous six (6) months, or at risk of institutionalization.
  • One (1) or more stays at a detox facility within the previous year.
  • One (1) or more visits to a hospital emergency department (ED) within the previous six (6) months.
  • The presence of known risk factors, including domestic or intimate partner violence, tobacco use, excessive alcohol use, and/or drug misuse.
  • Presence of medical indicators of rising risk of chronic disease (e.g., elevated blood pressure, elevated blood glucose levels, elevated blood lead levels, or childhood lead exposure, etc.) that indicate risk but do not yet warrant diagnosis of a chronic condition.
  • Results of a Social Determinants of Health (SDOH) screening indicate unmet health-related social needs, such as housing or food insecurity.
  • Stressful life event(s) presented via the Adverse Childhood Events screening.
  • Two (2) or more missed medical appointments within the previous six (6) months.

Who is considered a licensed provider to write a recommendation for CHW Services?

Who is considered a licensed provider to write a recommendation for CHW Services?

  • Clinical Nurse Specialist
  • Dentists
  • Licensed Clinical Social Workers (LCSW)
  • Licensed Educational Psychologists
  • Licensed Marriage & Family Therapists (LMFT)
  • Licensed Midwife
  • Licensed Professional Clinical Counselor (LPCC)
  • Licensed Vocational Nurse (LVN)
  • Nurse Midwife
  • Nurse Practitioner
  • Obstetrician/Gynecologist (OB/GYN)
  • Pharmacists
  • Physician Assistant
  • Podiatrists
  • Practicing Physician Group (PPG)
  • Primary Care Physician (PCP)
  • Psychologist
  • Public Health Nurse
  • Registered Dental Hygienists
  • Registered Nurse (RN)

If you are a licensed provider who would like to write a recommendation but do not fall under one of the licensed provider types listed above, please email the Alliance CHW team at chw@alamedaalliance.org. We can help confirm if your licensed provider type is permitted to write a recommendation.

CHW supervising providers in the Alliance network

  • Journey Health – https://journeyhealth.io

The Alliance is working to add CHW supervising providers and their organizations to the provider directory.

If you have any questions, please email the Alliance CHW team at chw@alamedaalliance.org.

Provider Resources