Title
a. Approve and authorize the Director of Health Services or designee to execute a non-standard Allied Health Care Community Health Worker (CHW) Services Agreement with the Central California Alliance for Health (Alliance), as part of the credentialing application process for the County of Monterey to provide non-licensed CHW services and submit claims for those services, effective upon the credentialing commencement date through December 31, 2026 with automatic one-year renewals each January 1 unless terminated by either party, with services to be reimbursed to the County by the Alliance;
b. Accept all non-standard provisions in Agreement, as recommended by the Director of Health Services; and
c. Authorize the Director of Health Services or designee to approve up to three additional Amendments that do not significantly alter the scope of services.
Report
RECOMMENDATION:
It is recommended that the County of Monterey Board of Supervisors:
a. Approve and authorize the Director of Health Services or designee to execute a non-standard Allied Health Care Community Health Worker (CHW) Services Agreement with the Central California Alliance for Health (“Alliance”), as part of the credentialing application process for the County of Monterey to provide non-licensed CHW services and submit claims for those services, effective upon the credentialing commencement date through December 31, 2026 with automatic one-year renewals each January 1 unless terminated by either party, with services to be reimbursed to the County by the Alliance;
b. Accept all non-standard provisions in Agreement, as recommended by the Director of Health Services; and
c. Authorize the Director of Health Services or designee to approve up to three additional Amendments that do not significantly alter the scope of services.
SUMMARY:
Monterey County Health Department (MCHD) has provided Community Health Worker (CHW) services over the past decade through a combination of grant and county funding. Effective July 1, 2022, the California Department of Health Care Services (DHCS) established CHW services as a covered Medi-Cal benefit under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, where they are a key component of Enhanced Care Management and Community Supports offered by managed care plans (MCPs). In Monterey County, Central California Alliance for Health (CCAH) is the Medi-Cal managed care plan.
MCHD intends to contract with CCAH to establish a braided funding model that leverages Medi-Cal reimbursement for CHW services, supporting program sustainability and expansion. CHW services are preventive in nature and support disease prevention, health promotion, access to care and social services, and improved well-being.
The Plan will pay MCHD on a fee-for-service basis for Covered Services that are CHW Services provided by CHW Provider to Medi-Cal Members as specified by Program.
DISCUSSION:
MCHD has provided CHW services through a combination of county and grant funding and is now advancing efforts to leverage Medi-Cal reimbursement through CCAH to support a more sustainable, braided funding model.
In accordance with the terms and conditions set forth within the CCAH Community Health Worker Services Agreement, the CHW Provider Manual, the Plan’s QI and UM Programs, the applicable Program Requirements, applicable Accreditation Organization standards and the Law. MCHD shall ensure that CHW Services provided under the CCAH CHW Services Agreement are readily available, accessible, appropriate, and provided in a prompt and efficient manner. Health shall also comply with the specific requirements set forth in the CHW Services Schedule.
MCHD seeks to become a CHW provider to serve Medi-Cal members enrolled in CCAH. This approach will support a braided funding model that leverages Medi-Cal reimbursement to expand existing CHW services currently supported by grant funding. CHW services are preventive health services that help prevent disease and disability, improve health outcomes, increase access to care and social services and promote overall physical and mental well-being.
As a Medi-Cal benefit, CHW services will be provided to eligible CCAH members in accordance with DHCS requirements, including standing orders, referrals from licensed providers, or other plan-authorized pathways. MCHD will submit complete fee-for-service claims for covered services, which will be reimbursed in accordance with applicable legal and program timelines. Reimbursement for CHW services is based on established Medi-Cal rates, with CCAH reimbursing at approximately 150% of the Medi-Cal fee schedule.
This work supports the Monterey County Health Department 2025-2028 Strategic Plan Strategic Plan Initiative: Goal 2. Provide Exceptional Person-Centered Care through Accessible, Community-Focused Health Services. It also supports 4 of the ten essential public health services, specifically: 3. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it; 4. Strengthen, support, and mobilize communities and partnerships to improve health; 5. Create, champion, and implement policies, plans, and laws that impact health; 7. Assure an effective system that enables equitable access to the individual services and care needed to be healthy.
OTHER AGENCY INVOLVEMENT:
The Offices of County Counsel and the Auditor-Controller have reviewed and approved this Agreement as to form and fiscal provisions, respectively.
FINANCING:
There is no impact on the General Fund with this action. Reimbursements for services will be made after MCHD submits complete fee-for-service claims for covered services, which CCAH will process and pay according to relevant legal and program deadlines.
BOARD OF SUPERVISORS STRATEGIC PLAN GOALS:
This initiative advances the County of Monterey’s strategic goals and key objectives by supporting sustainable community health worker programs and expanding funding opportunities to ensure long-term program stability and the continued delivery of services that improve community members’ quality of life.
Mark a check next to the related Board of Supervisors Strategic Plan Goals:
X Well-Being and Quality of Life
____ Sustainable Infrastructure for the Present and Future
____ Safe and Resilient Communities
____ Diverse and Thriving Economy
Prepared by: Jennifer L. Rivas, Management Analyst II, 755-4312
Approved by: Elsa Mendoza Jimenez, Director of Health Services, 755-4526
Attachments:
Board Report
Agreement