This information was collected through a combination of state surveys and NASHP staff research. It offers a snapshot of how the state is defining, training, certifying, and paying for the CHW workforce — as well as how the state is developing cross-agency and state-to-local strategies to improve community health in partnership with CHWs.
This is a dynamic policy space, and states are continuing to develop new approaches. We will continue to make periodic updates to this page. Learn more about state CHW policies across the U.S.
State CHW Definition
California statute defines a “community health worker” (CHW) 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. A community health worker is a frontline health worker either trusted by, or who has a close understanding of, the community served. [CHWs] include Promotores, Promotores de Salud, Community Health Representatives, navigators, and other non-licensed health workers … including violence prevention professionals. A community health worker’s lived experience shall align with and provide a connection to the community being served.”
State CHW Governance
California does not have a dedicated state office of CHWs.
CHW benefits policy for California’s Medicaid program — known as Medi-Cal — is overseen by the Department of Health Care Services. CHW certificate requirements and workforce development is overseen by the Department of Health Care Access and Information.
Certification and Training
The Department of Health Care Access and Information (HCAI) was given authority to develop statewide requirements for CHW certificate programs. To be reimbursed through Medi-Cal, CHWs must demonstrate their qualifications through either a certificate or work experience pathway. A CHW certificate attests to demonstrated skills across core competencies after completion of a training program. A CHW may provide services without a certificate for up to 18 months if they have at least 2,000 hours of paid or unpaid experience as a CHW and demonstrate the same core competencies outlined via the certificate pathway.
Medicaid Reimbursement
The Department of Health Care Services (DHCS) added CHW services as a covered state plan benefit under Medi-Cal on July 1, 2022. A CHW must have lived experience and fulfill either the training pathway or experience pathway to bill for CHW services provided to a Medi-Cal member in either fee-for-service or managed care.
As part of a 2024 State Plan Amendment, reimbursement is now allowed for certain CHW services in dental settings.
As part of California’s CalAIM Section 1115 Demonstration waiver, CHW services provided by individuals with lived experience are eligible for reimbursement for services to qualified incarcerated individuals within 90 days prior to release.
In addition, California’s BH Connect 1115 Demonstration waiver includes a number of CHW-related services, pilots, and workforce development programs. Counties that opt in to the BH-CONNECT demonstration (to implement coverage for services provided within institutions for mental disease) will be required to offer CHW and peer support services with a forensic specialization. It also created workforce initiatives, including for CHWs, alcohol and other drug counselors, and peer support specialists; student loan repayment up to $120,000; funding to attend training to provide evidence-based practices, including CHW services; and up to $10,000 per practitioner for training and education.
California WIC section 14132.36 requires Medi-Cal managed care plans (MCPs) to educate Medi-Cal members and providers about Medi-Cal’s CHW benefit. In 2024, this section of WIC was amended by Senate Bill 1385, which codified requirements for Medi-Cal MCPs to create billing pathways for providers to claim CHW benefits during emergency department (ED) visits and outpatient follow-ups to ED visits.
Other Funding or Financing Mechanisms
The 2023 California state budget included $280 million appropriation to the HCAI to recruit, train, and certify 15,000 new CHWs by 2028, with specialized training to work with varying populations.
Key Partnerships
The California Health Care Foundation and Visión y Compromiso (including La Alianza, a network of community-based organizations working with CHW/P/Rs managed by Visión y Compromiso) have been important partners for the Department of Health Care Services, Department of Health Care Access and Information, and California Department of Public Health. The Community Health Workers, Promotoras, and Representatives (CHW/P/R) Coalition includes a number of state partners. The coalition is comprised of seven lead entities: California Consortium for Urban Indian Health, California Pan-Ethnic Health Network, Latino Coalition for a Healthy California, The Children’s Partnership, Transitions Clinic Network, Roots Community Health, and Visión y Compromiso. The California Association of Community Health Workers is another state partner.
DHCS and HCAI collaborate to advance CHW policy through outreach to Medi-Cal members and providers.
State CHW Legislation
Senate Bill 184 enacted California WIC section 18998–18998.4, which outlines CHW core competencies. It requires CHW training and scope of work to focus on “lived experience,” which is defined as “personal knowledge of a specific health condition or circumstance, which may include, but not be limited to, Alzheimer’s and other related dementia, climate impact on health, disability, foster system placement, homelessness, justice involved, LGBTQ+ status, mental health conditions, substance use, military service, pregnancy, and birth.”
California WIC section 14132.36 requires Medi-Cal MCPs to educate Medi-Cal members and providers about Medi-Cal’s CHW benefit. In 2024, this section of the WIC was amended by Senate Bill 1385, which codified requirements for Medi-Cal MCPs to create billing pathways for providers to claim CHW benefits during ED visits and outpatient follow-ups to ED visits.
State Resources
ACO – Accountable care organization
AHEC – Area Health Education Centers
APHA – American Public Health Association
APM – Alternative payment model
CBO – Community-based organization
CDC – Centers for Disease Control and Prevention
CDC CCR Funding – Community Health Workers for COVID Response and Resilient Communities Funding
CHR – Community health representative
CHW – Community health worker
CPT Codes – Current Procedural Terminology Codes
C3 Project – CHW Core Competency Project
FFS – Fee for services
HCSPCS Codes – Healthcare Common Procedure Coding System Codes
HRSA – Health Resources & Services Administration
MCO – Managed care organization
NACHW – National Association of Community Health Workers
SDOH – Social determinants of health
VBP – Value-based payment
State CHW Definition: This category indicates where states have a formal definition of a CHW. In some cases, where there is not a definition in statute, this category may draw information from provider manuals and state websites or reports.
Certification and Training: This category includes information about how CHWs are trained in the state, which entities provide training, whether or not the state runs or recognizes a CHW certification program, and information about the entities that administer existing certification programs.
Medicaid Reimbursement: This category includes information about state Medicaid strategies that provide enrollees access to CHW services. Entries indicate whether state Medicaid programs currently reimburse for CHW services or incorporate CHWs into alternative payment models under the authority of a state plan amendment (SPA), or where states have earmarked funds to support CHW services under the authority of an 1115 demonstration waiver. It also indicates where CHW services might be supported through managed care approaches (e.g., where MCOs are paying for CHW services using administrative dollars or where states are using managed care contracts to incentivize or require MCOs to cover CHW services).
Other Funding or Financing Mechanisms: This category includes information about other state funding or financing approaches that cover CHW services or CHW positions. It includes information about federal grant dollars for which the state is the grantee.
Key Partnerships: This category offers information about key partners outside state government, including state CHW associations and CHW training entities, and highlights formal cross-agency partnerships within the state that support alignment of funding and resources for the CHW workforce.
State CHW Legislation: This category highlights any state legislation relevant to the CHW workforce. This might include statutory language directing agencies to develop a Medicaid reimbursement approach, laws that established state CHW certification, or other relevant statutes.
State Resources: This category offers links to any key reports or resources that states elected to highlight as critical to CHW policy and partnership.
