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:
- Complete the CHW Referral form and fax it to (844) 742-1152.
- For members requiring CHW services beyond 12 units in a single year, complete the CHW Benefits Extension Request Form and fax it to (844) 742-1152.
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.