California’s Medi-Cal community health worker (CHW) benefit covers qualifying preventive services delivered through an eligible supervising provider. CHW qualification can follow a certificate or work-experience pathway. Program leaders must also distinguish Current Procedural Terminology (CPT) services from Healthcare Common Procedure Coding System (HCPCS) Community Health Integration requirements, maintain training evidence and document the actual service rather than assume certification alone establishes payment.
California CHW quick facts
| Topic | California guidance |
|---|---|
| Benefit start | July 1, 2022, for qualifying Medi-Cal CHW services. [1] |
| Workforce terms | CHWs may include promotores, CHRs, navigators and qualifying violence-prevention workers. [1] |
| Qualification pathways | Certificate or qualifying work experience, with community connection through lived experience. [2, 3] |
| State-approved certificate list | DHCS does not maintain one; the supervising provider evaluates the actual program against Medi-Cal requirements. [2] |
| Experience route | Confirm the required work evidence and certificate deadline with the supervising provider before using this pathway. [3] |
| Continuing training | At least six hours annually. [2] |
| Individual CPT code | 98960. [4] |
| Group CPT codes | 98961 for two to four members; 98962 for five to eight. [4] |
| Individual HCPCS pathway | G0019 and G0022, with initiating-visit and treatment-plan conditions. [5] |
| Required modifier | U2 for the identified CHW CPT and HCPCS codes. [4] |
| Who submits claims | The enrolled supervising provider. [4] |
| Last reviewed | November 6, 2026 |
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What do community health workers do in California?
The California Department of Health Care Services (DHCS) describes CHW services as preventive services addressing health needs and barriers. Its benefit covers qualifying education, navigation, screening or assessment that does not require a license, and individual support or advocacy. The current manual provides the actual service boundaries. [1, 3]
The workforce includes several community titles. Preserve the role used by a promotora, Community Health Representative or navigator rather than relabeling every person to fit a software field. The participant record should explain the support provided and the health-related need being addressed.
General outreach, another licensed service and a Medi-Cal-covered CHW service are different categories. Keep the organization’s broader community work visible while routing payment decisions through the actual benefit requirements.
Does California require a state-issued CHW certificate?
For this Medi-Cal benefit, DHCS says the certificate of completion does not need approval from DHCS, HCAI or another state agency. The supervising provider determines whether the program meets the benefit’s competency and field-experience requirements. DHCS does not maintain a list of approved certificate issuers. [2]
That differs from California’s peer-support certification framework. A peer credential is not a substitute for CHW qualification, and a CHW award does not establish peer-service eligibility. A person holding both must separately meet the applicable role requirements. [2]
For hiring, retain the actual training award and the supervising provider’s qualification determination. Avoid advertising a private course as a state-issued Medi-Cal CHW license when that is not what the award represents.
What are the qualification pathways?
The current manual describes certificate and qualifying work-experience pathways. Have the supervising provider review the actual training or work evidence and any required certificate deadline before assigning services under the selected pathway. [3]
Retain the provider’s reviewed qualification decision and supporting records. An estimated total or an unchecked experience field should not substitute for that review.
The certificate pathway needs the specified competencies and field experience. A useful review asks what was taught, what practical preparation occurred and what evidence supports the worker’s readiness. The award’s title alone is insufficient.
How should a worker choose CHW training?
Choose a program that can document the competencies and field experience the supervising provider needs to verify. Ask for the curriculum, practical-learning requirements, assessment and completion evidence before paying.
HCAI’s CHW/Promotores/Representatives initiative provides workforce and training resources. Read those resources alongside Medi-Cal qualification rules rather than assume a workforce-development initiative is the same as a payer-approved credentialing body. [6]
For a current employee, identify whether the experience pathway is being used and calendar the certificate deadline from the first qualifying member visit. Keep the worker’s learning records accessible outside a single supervisor’s inbox.
What ongoing training and evidence are required?
DHCS requires at least six hours of additional training annually, with supporting evidence retained by the supervising provider. It provides optional qualification and annual-training checklists to help organize that review. [2]
Maintain the actual subject, provider, completion date and hours. A total-hours field without supporting documents makes it difficult to explain what was accepted. Course completion, employer acceptance and the worker’s ongoing qualification status should remain distinguishable.
If the organization assigns specialty duties, identify the relevant preparation separately. Do not assume a violence-prevention-only award establishes qualification for the entire CHW benefit or that general CHW preparation automatically satisfies a separate asthma service’s requirements. [2]
Who can supervise and bill for CHW services?
The supervising provider is an enrolled Medi-Cal provider responsible for the CHW qualification and service oversight. The current manual distinguishes that organization-level role from particular licensed-provider functions, such as developing or approving a plan. CBOs and local health jurisdictions can have an enrollment pathway. [1, 3]
Do not apply one generic clinical-supervisor rule to every provider type. The manual contains specific clinic and education-provider conditions, including limitations for non-Tribal FQHC/RHC arrangements and the CYBHI context for eligible education providers. Review the applicable provider section before choosing a contract model. [3]
The practical record should identify the employing or contracting organization, supervising provider, relevant licensed provider and assigned CHW. Those relationships may overlap but should not be collapsed into one staff-manager field.
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What evidence should the supervising provider review before a CHW starts?
Review the worker’s connection to the population, the qualification pathway, the curriculum and field experience, and any applicable specialty limits. DHCS provides an optional minimum-qualification checklist. Its use is optional; satisfying the underlying Medi-Cal qualification requirements is not. DHCS provider-requirements FAQ.
A practical qualification file can contain the following:
- The actual certificate and the curriculum evidence used in the determination.
- A description of the field experience supplied by the training program.
- The supervising provider’s review and the role the worker will perform.
- Where the experience pathway is used, a reliable account of qualifying work and the first member-visit date.
- The certificate-completion deadline and a person responsible for following up.
- Evidence of annual additional training and preparation for assigned specialty work.
This is a suggested file structure, not a new state form requirement. Keep the determination and its supporting documents together so a new manager can understand why the worker was accepted. A provider should be able to explain the decision without relying on a course advertisement that may later change.
For a fictional applicant with a course certificate from outside California, the useful question is whether that program meets the Medi-Cal criteria. The location or title of the program does not answer that question by itself. Ask for the curriculum and field-experience evidence, then document the supervising provider’s assessment.
How should a community organization approach enrollment and plan contracting?
Treat organization readiness and worker qualification as separate projects. DHCS’s CHW page identifies enrollment resources for community-based organizations and local health jurisdictions, and its April 2026 CBO checklist explains the PAVE application materials for organizations using that pathway. DHCS also publishes guidance on enrollment and contracting with a managed care plan. CHW enrollment resources, CBO checklist and enrollment and managed-care guidance.
Before offering services under a new payment arrangement, establish which entity will supervise, employ or contract with the CHW, hold the payer agreement and submit the claim. Confirm the provider type and the current enrollment or screening route with DHCS and the plan. Do not assume that a contract for a different CalAIM service makes the organization ready for the CHW benefit.
Build a readiness file with the organization’s approval evidence, relevant agreements, responsible contacts and service-start decision. Keep pending applications separate from completed approvals. A participant-facing team should know who can answer a coverage or enrollment question before staff promise that a particular service will be paid.
For a fictional nonprofit, completing staff training is one milestone. Completing its organizational enrollment process and applicable plan arrangements is another. A platform demonstration should show how these facts can remain distinct without turning either into an automatic billing approval.
What is the difference between CPT and HCPCS CHW services?
Current Procedural Terminology (CPT) codes 98960, 98961 and 98962 cover the identified individual and group CHW services. Healthcare Common Procedure Coding System (HCPCS) codes G0019 and G0022 have additional individual-service requirements. U2 identifies CHW services with the relevant codes. [4]
For G0019/G0022, an eligible licensed-provider initiating visit must identify an unmet social determinant of health need affecting diagnosis or treatment, followed by the required treatment plan. The initiating visit must be within the preceding six months. A standing recommendation cannot replace those conditions. [5]
Use DHCS’s G-code decision tree as an aid to the review. It checks participant eligibility, the unmet need, initiating visit and plan evidence. A code choice should follow that review rather than determine which evidence staff later try to manufacture. [7]
When is a plan of care required?
For CPT services, the current manual requires a written plan for continued services after 12 units, equivalent to six hours, in a year from the initial service date, with the stated Emergency Department exception. The plan has a maximum one-year period and licensed-provider review at least every six months. [3]
The HCPCS pathway requires a treatment plan before the relevant services. A CHW may help develop or draft it, but a licensed provider must review and approve the applicable plan and share it as required. The initiating-visit provider and plan developer do not necessarily have to be the same person. [5]
Track the service pathway, utilization, plan dates and approval evidence separately. One “plan complete” checkbox cannot describe both a CPT case nearing its threshold and an HCPCS case needing a plan before services.
How should time and group attendance be recorded?
DHCS distinguishes uninterrupted CPT sessions from time that may accumulate under the monthly HCPCS pathway. Its billing FAQ specifies the relevant minimum thresholds and limits. Preserve each contact’s actual time and service facts before applying the approved calculation. [4]
Group records need the actual attendees and individual support evidence. The group event, attendance and unique people served are different report measures. A roster correction should not silently alter an earlier submitted report.
The current manual and payer instructions should govern configuration. Do not round every brief contact into a complete unit or combine unrelated small tasks just because a dashboard can sum them.
What are the most important time and billing distinctions?
Choose the service pathway before applying a time calculation. The current Medi-Cal manual distinguishes uninterrupted CPT sessions from cumulative HCPCS time in a calendar month. The table summarizes selected rules; the full manual and payer instructions still govern the actual claim. DHCS billing FAQ, questions 5 to 8 and current CHW manual linked by DHCS.
| Review point | CPT 98960, 98961 and 98962 | HCPCS G0019 and G0022 |
|---|---|---|
| Time record | Each billed unit must reflect a single uninterrupted session | Covered time may accumulate over the calendar month |
| Minimum time | At least 16 minutes to support one 30-minute unit | At least 31 minutes for one G0019 unit; at least 16 minutes for one G0022 unit |
| Combining brief contacts | Separate short sessions cannot simply be added to reach the CPT threshold | Multiple sessions may be combined under the HCPCS pathway’s conditions |
| Starting documentation | The applicable recommendation and service eligibility evidence | Initiating-visit and licensed-provider treatment-plan evidence are required |
| Group use | The identified group codes distinguish two to four and five to eight members | The identified HCPCS pathway is for individual services |
For a fictional CPT example, a single continuous session includes 11 minutes of one covered navigation activity followed immediately by nine minutes of another covered activity. That is different from two separate ten-minute contacts. Keep the real session boundaries and service facts; do not merge entries after the fact to create a billable unit.
For a fictional HCPCS example, several contacts during the same calendar month may contribute covered time, but only after the pathway’s initiating-visit and plan conditions are satisfied. Record each contact’s date, duration, topic and member engagement. Monthly accumulation does not turn every administrative task or message into a covered service.
The team should be able to review the underlying contacts before submitting a total. Do not replace the actual record with a single rounded monthly number. If a contact is corrected, preserve the original facts and explain how the correction affects any report or claim already prepared.
What happens when a group has more than eight Medi-Cal members?
DHCS allows CHWs to render covered group services to more than eight members, but its billing FAQ limits the number of members whose CHW services may be billed during one session to eight. A larger attendance list therefore does not establish an equal number of billable member entries. DHCS billing FAQ, question 8.
Keep the event, attendance and each member’s service evidence identifiable. Before a group, confirm who is expected, the purpose of the session and how individual participation will be documented. Afterward, reconcile the actual roster rather than copying the invitation list into the record.
If a participant leaves or an attendance error is found, record the correction and route the payment implications to the responsible reviewer. An operational report may need to describe all attendees even where the benefit’s billing limit is lower. Those two totals can serve different purposes and should not be forced to match by deleting real attendance or creating unsupported claims.
Which useful CHW activities are outside this Medi-Cal benefit?
The current manual identifies non-covered activities including transportation of members, childcare, shopping or cooking meals, companion services, personal care, respite, employment services and services requiring a license. It also excludes duplication of another covered Medi-Cal service. Medi-Cal CHW manual, non-covered services, linked from DHCS.
The distinction is between helping a member navigate a resource and delivering another service. Helping identify transportation options is not the same activity as driving the member. Helping the person understand a food-assistance application is not the same as doing their shopping or preparing meals.
An organization may undertake useful work funded through another arrangement. Record it accurately and identify that arrangement instead of treating everything a CHW does as a claim under this benefit. Where activities overlap, assign the decision to the supervising provider and payer reviewer while preserving the real support record.
How should a program verify the reimbursement amount?
Check the applicable fee schedule or managed-care agreement for the service date. The amount a system displays, a historical FAQ and the existence of a billing code are not interchangeable payment evidence.
CMS approved California SPA 25-0016 on July 17, 2026, effective April 1, 2025, establishing a reimbursement-rate methodology for the HCPCS CHW services. That approved amendment should not be described as still awaiting federal approval. CMS approval and approved state-plan pages.
For budgeting, retain the actual rate source, its effective period and the payer arrangement. If an older explanatory page conflicts with a later approval or current schedule, resolve the difference before quoting a number or configuring payment expectations. Do not promise that a submitted claim will be paid at a particular amount simply because a code is recognized.
Can services be provided by telehealth?
DHCS permits qualifying synchronous telehealth under Medi-Cal conditions, including consent and the applicable modality requirements. The provider FAQ excludes reimbursement for text, email, chat and the identified asynchronous modalities. [2]
A program may still use messaging for coordination. Record that activity accurately without automatically calling it a reimbursable visit. The presence of a video or messaging feature in software does not establish coverage.
For a remote encounter, retain the method, service facts and evidence required by the current telehealth policy. Confirm the actual workflow with the supervising provider, especially when audio-only conditions or a clinic arrangement affect the service.
How do CHW services relate to ECM and other programs?
Medi-Cal’s CHW benefit operates within a wider environment that includes Enhanced Care Management (ECM), Community Supports and other contracted services. The DHCS general FAQ and current manual explain overlap and nonduplication considerations. [1, 8]
Keep the actual program and service purpose visible. A shared participant can receive support from several teams, but that does not justify duplicate payment for the same covered service.
At intake, identify the relevant program relationships and who resolves an overlap question. Preserve the support record while holding an uncertain payment decision for review. Do not infer enrollment from an address or a worker’s job title.
What should a California CHW note show?
DHCS’s billing FAQ requires dates, time or duration, the nature of the support and documentation supporting the time billed. The supervising provider must have access to the supporting record. Diagnosis information belongs to the appropriate authorized provider process. [4]
A useful operational note also connects the participant’s stated need, the support delivered, response, referral result and next action. Record the actual service; do not copy the same paragraph across several participants to fill a group report.
Fictional example: A member asks for help maintaining health coverage and reaching a food resource. The CHW documents the support and actual time, the member’s response and the pending referral. The payment reviewer checks the applicable pathway and supporting evidence separately.
Which errors should program leads prevent?
Common risks include treating a course award as state approval, missing the experience-pathway certificate deadline, applying one plan rule to both code families and counting administrative messages as payable encounters.
Other errors occur when group attendance is mistaken for several separate sessions, an FQHC/RHC arrangement is treated like an ordinary supervising provider, or an ECM overlap question is never assigned to a reviewer.
Use a short operational review to find missing evidence, approaching deadlines and unresolved needs. Keep the approval owner clear rather than relying on the software to decide an uncertain coverage question.
How can software support the California workflow?
Explore community health workflows. Bring the qualification checklist, supervising-provider relationship and one required report to a demonstration.
Test a CPT case approaching the plan threshold, an HCPCS case requiring an initiating visit and plan, a corrected group roster and an unresolved referral. The program should be able to retrieve the supporting evidence without counting plan approvals or note versions as additional services.
See the Smores Health platform. Book a program walkthrough to evaluate the current product against your actual forms and reports. Request pricing for the staff, review, setup and reporting scope, with any additional interface or configuration work identified.
See it in your program
Build your program around a connected workflow.
Bring your forms and reporting needs. See how Smores Health connects service notes, supervisor review, and program reporting in a walkthrough focused on your team.
A 20-minute walkthrough for your program.
Frequently asked questions
Does DHCS publish an approved CHW certificate-provider list?
No. The supervising provider evaluates whether the actual certificate meets Medi-Cal requirements. [2]
Is a CHW required to obtain an NPI for this benefit?
The current DHCS billing FAQ says CHWs do not need their own National Provider Identifier at this time. The supervising provider submits the claim. [4]
Can a standing recommendation replace the G0019 initiating visit?
No. DHCS requires the HCPCS initiating-visit and treatment-plan conditions. [5]
Does a zero-dollar G-code listing necessarily mean noncoverage?
No. A zero-dollar listing alone does not establish the coverage or payment decision for a particular service. Check the current fee schedule, service date, applicable coverage conditions and the actual managed-care agreement where relevant. CMS approved California’s amended HCPCS payment methodology in July 2026. CMS approval of SPA 25-0016.
Can software guarantee a Medi-Cal claim will be paid?
No. Coverage, qualification, provider arrangement, documentation and current payer requirements still control. A software review status is not payer approval.
Does helping arrange transportation mean the CHW transportation service itself is covered?
No. The CHW benefit distinguishes navigation from transporting members, which the manual lists as non-covered under this benefit. Use the actual service facts and funding arrangement. DHCS CHW manual resources.
Can separate short CPT contacts be added together to reach a unit?
DHCS requires a single uninterrupted session for each CPT unit and does not allow separate brief sessions to be combined to meet that threshold. The HCPCS monthly-accumulation rules are different. DHCS billing FAQ.
Does DHCS’s optional qualification checklist replace the provider’s assessment?
No. The checklist helps document the underlying review; the supervising provider remains responsible for determining and documenting whether the CHW satisfies Medi-Cal qualifications. DHCS provider-requirements FAQ.
What should a California CHW program do next?
Verify qualification evidence, identify the supervising-provider arrangement and choose the actual service pathway. Map plan and training deadlines, referral responsibilities and the required report before configuring a platform.
Book a program walkthrough with Smores Health using one participant scenario and the current DHCS instructions.
Sources
[1] DHCS CHW benefit hub, including official manual and enrollment links. https://www.dhcs.ca.gov/providers-partners/community-health-workers/
[2] DHCS provider-requirements FAQ. https://www.dhcs.ca.gov/providers-partners/frequently-asked-questions-for-medi-cal-community-health-worker-services-provider-requirements/
[3] Medi-Cal Provider Manual, Community Health Worker Preventive Services, October 2026, pages 1 to 3 and 8 to 20. Open the current manual under Resources on the DHCS benefit hub. https://www.dhcs.ca.gov/providers-partners/community-health-workers/
[4] DHCS CHW billing FAQ. https://www.dhcs.ca.gov/providers-partners/faqs-for-medi-cal-community-health-worker-services-billing/
[5] DHCS G0019 and G0022 FAQ. https://www.dhcs.ca.gov/providers-partners/community-health-worker-faqs-for-hcpcs-codes-g0019-and-g0022/
[6] HCAI CHW/Promotores/Representatives initiative. https://hcai.ca.gov/workforce/initiatives/chwpr/
[7] DHCS G-code decision tree, August 2026. https://www.dhcs.ca.gov/file/dhcs-chw-g-code-billing-decision-tree-pdf/
[8] DHCS general CHW FAQ. https://www.dhcs.ca.gov/providers-partners/frequently-asked-questions-faqs-for-medi-cal-community-health-worker-chw-services-general-information/
[9] DHCS, Medi-Cal CBO Enrollment Requirements and Documentation Checklist, updated April 2026. Official checklist.
[10] DHCS, updated enrollment requirements and procedures for CBOs, LHJs and county children and families commissions. Official enrollment questions and answers.
[11] CMS, approval of California SPA 25-0016, July 17, 2026, effective April 1, 2025. Approved amendment.