Community Health Worker Frequently Asked Questions (FAQ)

Community Health Workers (CHWs) are members of the community who guide, support and help members get the services they need. They work for agencies that partner with the health plan.

1. Call CalViva Health Member Services Department (toll-free) at 1-888-893-1569 (TTY: 711), 24 hours a day, 7 days a week.
2. Ask your doctor or clinic about the benefit.

No. CHW services are part of your health plan benefits at no extra cost.

CHW services are available to all CalViva Health Medi-Cal members. Your age does not matter.

You qualify for CHW services if you meet at least one of the following:

• > If you need guidance to find services in the healthcare system. Or if you need help to find resources.
• > Have been diagnosed with one or more chronic health conditions (includes behavioral health). Or, if you have a presumed mental disorder or substance use disorder that has not yet been diagnosed.
• > A raised risk of having a chronic condition but have not been diagnosed. Examples include:
  • o Higher than normal blood pressure
  • o Higher than normal blood glucose levels
  • o High lead levels in your blood or childhood lead exposure
• > Any stressful life event described via the Adverse Childhood Events screening.
• > Presence of known risk factors that include:
  • o A domestic or intimate partner violence
  • o Gang violence
  • o Tobacco use
  • o Too much alcohol use
  • o Drug misuse
• > Results of a Social Determinants of Health screening that show unmet social needs linked to health. This can include housing and the lack of access to healthy food.
• > One or more visits to a hospital ER within the past six months.
• > One or more hospital inpatient stays. This includes stays at a mental health facility (within the past six months). Or you being at risk of placement in a mental institution.
• > One or more stays at a detox center within the past year.
• > Two or more missed medical appointments within the past six months.
• If you have a chronic condition or health-related social need (as listed above) and believe you would benefit from a Community Health Worker:
  • o Talk to your doctor, or
    o Call Member Services toll-free at 1-888-893-1569 (TTY 711) to see if you qualify. Member Services is open 24 hours a day, 7 days a week.

CHWs can help guide you through the health system in many ways that include help to:

• • Connect you with:
  • o A doctor
  • o A mental health provider
  • o Same-day health services
• • Get referrals for Community Supports like:
  • o Housing
    o Meals
    o Other social services
• • Arrange transportation
  • Get extra support during pregnancy, such as doulas

CHWs can provide health information that can include:

• •Wellness programs and other resources
• •How to find information about any health condition you may have

CHWs can provide tailored support and guidance to help you:

• • Assess and define healthcare goals
• • Manage healthcare issues

Many CHWs offer home or local area visits to better know your needs and provide custom support. You can also receive services via phone or online visits.

• • Call CalViva Health Member Services Department (toll-free) at 1-888-893-1569 (TTY: 711), 24 hours a day, 7 days a week.
• • Member Wellness www.calvivahealth.org
• • Provider Directory email directoryrequest@calvivahealth.org
• • Ask your doctor or clinic about the benefit.

If you qualify, you can receive CHW services for up to six total hours. More services (beyond 6 hours) require the CHW to develop a plan of care.

Your CHW can help you find services like your health plan’s care management services or Enhanced Care Management (ECM). With ECM, you will have a care team and your own ECM lead care manager. Note: Even though you can’t receive both CHW and ECM at the same time, you can begin to receive services and then move to the other service. This depends on whether you qualify and your needs.

Non-covered services include::

• > Clinical case management/care management that requires a license
• > Childcare
• > Services that include shopping and cooking meals
• > Buddy services
• > Job training services
• > Help to enroll in government or other assistance programs that are not linked to helping you improve your health as part of your plan of care or treatment plan
• > Delivery of:
  • o Medication
  • o Medical equipment
  • o Medical supplies
• > Personal care services
• > Homemaker services
• > Respite care
• > Services that are the same as other covered Medi-Cal services being provided to a member
• > Socialization
• > Transportation
• > Services offered to people not enrolled in Medi-Cal, except as noted above
• > Services that require a license