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AB 403

Medi-Cal: community health worker services.

2025-2026 Regular Session Introduced by Juan Carrillo and 3 co-sponsors

Requires DHCS to annually analyze and publish Medi-Cal CHW services, review plan outreach, with demographic disaggregation and no PII, first report due 7/1/2027.

In committee: Held under submission.
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Bill Summary · AB 403

AB 403 — Medi‑Cal: community health worker (CHW) services

Author: Ortega
Introduced: Feb 4, 2025 | Status: In committee — Held under submission (As of 05/23/2025)

Purpose / Intent

AB 403 requires the California Department of Health Care Services (DHCS) to perform and publish an annual, detailed analysis of the Medi‑Cal community health worker (CHW) services benefit and to review Medi‑Cal managed care plans’ outreach and education about that benefit. The goal is to improve transparency, inform policymaking and workforce planning, and assess equity and utilization of the CHW benefit under Medi‑Cal.

Key provisions

  • Adds Section 14132.37 to the Welfare and Institutions Code.
  • Requires DHCS to:
    • Annually review outreach and education efforts conducted by Medi‑Cal managed care plans under existing Section 14132.36.
    • Annually conduct an analysis of the CHW services benefit, submit each analysis to the Legislature per Government Code §9795, and publish it on DHCS’s website.
    • Complete and publish the first analysis by July 1, 2027.
  • Minimum contents of the annual analysis must include:
    • Assessment of CHW capacity and Medi‑Cal beneficiary needs (managed care and fee‑for‑service).
    • Disaggregated assessment by geographic region, race, ethnicity, language, age, and other sociodemographic factors, and by managed care plan as applicable.
    • Inventory and counts: types of services provided; number of eligible beneficiaries; referrals by provider type; number of contracted CHWs by employer type (CBOs, clinics, hospitals, licensed providers); CHW demographic diversity; total beneficiaries served and projected number of CHW entities needed.
    • Assessment of benefit utilization and the relative frequency of specific CHW services.
    • Demographic disaggregation of CHWs providing services and beneficiaries receiving services.
    • Data on Medi‑Cal reimbursements for CHW services billed to DHCS, including total dollars reimbursed to providers and supervising entities.
  • Data protections:
    • Only statistically significant demographic data are to be submitted/published.
    • No personally identifiable information (PII) may be collected, submitted, or published.

Who is affected

  • DHCS (reporting and analytical responsibilities).
  • Medi‑Cal managed care plans (their outreach/education will be reviewed).
  • CHWs, employers of CHWs (community‑based organizations, clinics, hospitals, licensed providers).
  • Medi‑Cal beneficiaries (data subjects and service recipients).
  • Legislature and stakeholders (receive submitted analyses to guide policy).

Fiscal/procedural notes

  • Bill contains no direct appropriation; referred to fiscal committee (fiscal committee: YES; appropriation: NO).
  • First report due July 1, 2027.
  • Adds statutory reporting and data‑collection obligations that may have administrative workload and potential fiscal implications for DHCS and plans.

Compiled from official sources — confirm details with the bill’s official record.

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