Medi-Cal: community health worker services., the official text

An act to add Section 14132.37 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, community health worker (CHW) services are a covered Medi-Cal benefit subject to any necessary federal approvals. CHW is defined as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery. Existing law requires a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees with regard to the CHW services benefit, as specified. Existing law requires the department to inform stakeholders about implementation of the benefit.
This bill would require the department to annually conduct an analysis of the CHW services benefit, submit the analysis to the Legislature, and publish the analysis on the department’s internet website, with the first analysis due July 1, 2027.
The bill would require the analysis to include, at a minimum, an assessment of the above-described outreach and education efforts conducted by each Medi-Cal managed care plan, an assessment of the CHW benefit utilization and services, a demographic disaggregation of CHWs providing the CHW benefit and the Medi-Cal beneficiaries receiving services, and data on Medi-Cal reimbursements for CHW services billed to the department, as specified.

The people of the State of California do enact as follows:

SECTION 1.
Section 14132.37 is added to the Welfare and Institutions Code, immediately following Section 14132.36, to read:
14132.37.
(a) For purposes of this section, “community health worker” or “CHW” has the same meaning as set forth in subdivision (b) of Section 18998. The term includes, among other persons listed in that subdivision, promotores and community health representatives.
(b) On an annual basis, the department shall conduct an analysis of the CHW services benefit covered under Section 14132.36, submit the analysis to the Legislature in accordance with Section 9795 of the Government Code, and publish the analysis on the department’s internet website. The department shall complete, submit, and publish the first analysis by July 1, 2027.
(c) The analysis described in subdivision (b) shall include, at a minimum, all of the following:
(1) An assessment of the outreach and education efforts that are conducted by each Medi-Cal managed care plan pursuant to Section 14132.36.
(2) An assessment of the CHW benefit utilization and services provided to Medi-Cal beneficiaries eligible for the CHW Medi-Cal benefit, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, including the following:
(A) Of the specific services described in the CHW benefit, the relative frequency of each service being provided by CHWs to Medi-Cal beneficiaries.
(B) An estimate of the number of eligible Medi-Cal beneficiaries.
(C) The number of referrals by provider type.
(D) The number of CHWs providing the CHW benefit, by employer type, including, but not limited to, community-based organizations, licensed providers, clinics, or hospitals.
(E) The number of CHWs needed to meet the expected demand for CHW services.
(3) A demographic disaggregation of the CHWs providing the CHW benefit and of the Medi-Cal beneficiaries receiving services through the benefit by geographic region, race, ethnicity, language, age, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable.
(4) Data on Medi-Cal reimbursements for CHW services billed to the department. The data shall include the total amount, in dollars, reimbursed to providers and supervising entities in the provision of CHW services.
(d) The demographic data that are submitted and published as part of the department’s analysis under this section shall include only data that are statistically significant.
(e) For purposes of protecting the privacy of Medi-Cal beneficiaries, the collection, submission, publication, and other reporting of data under this section shall exclude any personally identifiable information.