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 Bill Text - AB-403 Medi-Cal: community health worker services.

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 |Add To My Favorites |Track Bill | Version: 03/17/25 - Amended Assembly
 02/04/25 - Introduced

 AB-403 Medi-Cal: community health worker services.(2025-2026)

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 Date Published: 03/17/2025 09:00 PM

AB403:v98#DOCUMENTBill Start

 Amended
 IN 
 Assembly
 March 17, 2025

 CALIFORNIA LEGISLATURE—
 2025–2026 REGULAR SESSION

 Assembly Bill

No. 403

Introduced by Assembly Member Ortega
(Coauthor: Assembly Member Carrillo)(Coauthors: Assembly Members Carrillo, Mark González, and Schiavo)

February 04, 2025

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

LEGISLATIVE COUNSEL'S DIGEST

AB 403, as amended, Ortega.
 Medi-Cal: community health worker services.

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 review the above-described outreach and education efforts conducted by Medi-Cal managed care plans. The bill would require the department to annually conduct an analysis of the CHW services benefit, submit each the analysis to the Legislature, and publish each 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 CHW capacity and the needs of Medi-Cal beneficiaries, a disaggregation of the assessment by geographic region, race, ethnicity, language, age, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, 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.

Digest Key

 Vote:
 MAJORITY 
 Appropriation:
 NO 
 Fiscal Committee:
 YES 
 Local Program:
 NO 

Bill Text

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)The department shall annually review the outreach and education efforts that are conducted by Medi-Cal managed care plans pursuant to Section 14132.36.

(c)

(b) On an annual basis, the department shall conduct an analysis of the CHW services benefit covered under Section 14132.36, submit each the analysis to the Legislature in accordance with Section 9795 of the Government Code, and publish each the analysis on the department’s internet website. The department shall complete, submit, and publish the first analysis by July 1, 2027.

(d)

(c) The analysis described in subdivision (c) (b) shall include, at a minimum, all of the following:

(1)An assessment of CHW capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.

(2)A disaggregation of the assessment described in paragraph (1) by geographic region, race, ethnicity, language, age, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:

(A)The types of services provided by CHWs to M