The Community Health Worker (CHW) program

Community Health Worker services
Community Health Workers (also known as CHWs, promotores, community health representatives, navigators, and violence prevention professionals) are non-licensed public health workers. CHWs have personal, lived experience that helps them connect with the population they serve.

CHWs are employed and overseen by organizations such as hospitals, outpatient clinics, and community-based organizations. These supervising providers ensure that CHWs meet necessary qualifications, document their services appropriately, and submit proper claims, as outlined in our provider manual.

CHWs can support Blue Shield of California Promise Health Plan members with a variety of health challenges. Some of the services offered by CHWs are:

  • Support with chronic health challenges
  • Asthma preventive services (APS)
  • Support with mental health challenges
  • Substance use recovery
  • Domestic abuse recovery and prevention
  • Support with stressful life events


Member eligibility for community health worker services
Licensed care providers must refer members to CHW services. Members who qualify typically meet one or more of the following criteria:

  • Chronic health conditions
  • Mental health disorders
  • Substance use disorder
  • Domestic or intimate partner violence
  • Unmet health-related social needs, such as insecure housing
  • Need for help in navigating the healthcare system

Note: Enhanced Care Management (ECM) services include CHW services. Members who are currently enrolled in ECM cannot simultaneously receive CHW services.


Referring a member to CHW services
A written recommendation by a licensed care practitioner is required for members to receive CHW services.

To recommend Blue Shield Promise members for CHW services:


CHW services
Members can receive a maximum of 12 units (6 hours) per year, and four units (2 hours) per day of CHW services.

For members who need more than 12 units per year of CHW care, a written plan must be submitted to Blue Shield Promise by the provider. This plan must be reviewed and updated every 6 months.


Covered Asthma Preventive Services (APS)
Members can receive a maximum of four units (2 hours) per day, up to two visits per year of asthma preventive services. In-home environmental trigger assessment visits for eligible beneficiaries are limited to two visits per year, subject to an override by a CHW Benefit Extension Request Form demonstrating medical necessity for additional visits and/or when there has been a change of primary residence.


Additional resources:

Health Care Options: (844) 580-7272  {TTY: {800) 430-7077}, Monday through Friday from 8 a.m. — 6 p.m. 

For information on Blue Shield Promise plans for your health care, call the Department of Health Care Services at (800) 430-4263 {TTY: (800) 735-2922}, or visit

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal Plans.

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California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, 
Long Beach, CA  90806

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