The state hewed closely to a series of expert recommendations<\/a> put out in 2019 to standardize training and certification, integrate these workers into the health care workforce, and provide fair wages, including reimbursements through Medi-Cal, the state\u2019s Medicaid health insurance program, to compensate for work that traditionally has been done on a volunteer basis or for low pay. But six years in, California has backed out of many of those initiatives.<\/p>\n The state has eliminated a certification program and rolled back nearly all funding to train and expand this workforce even though it set a goal of 25,000 workers<\/a> by this year. Although Medi-Cal began covering their services, participating health plans set uneven billing requirements, making it difficult for workers to get reimbursed. And the state didn\u2019t follow through on a planned pay raise.<\/p>\n With federal funding cuts<\/a> just passed and President Donald Trump targeting immigrants for deportation \u2014 even sharing personal Medicaid data<\/a> with the Department of Homeland Security \u2014 advocates fear California is abandoning its health equity initiative for immigrants, people of color, and people with low incomes when they say that effort is needed most.<\/p>\n \u201cWe\u2019re in a very dire situation right now,\u201d said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network, a statewide health equity advocacy group.<\/p>\n A spokesperson for Gov. Gavin Newsom, Elana Ross, said \u201cthe state has taken difficult but necessary steps to ensure fiscal stability\u201d and that the administration continues to have a dialogue with community health workers. Ross added that the Democratic governor, a potential presidential candidate<\/a>, remains committed to defending immigrants being targeted by the Trump administration.<\/p>\n \u2018Our Office Is on the Street\u2019<\/strong><\/p>\n There are more than 60,000 community health workers nationwide, including roughly 9,200 in California, and this workforce is projected to grow 13% over the next decade, three times as fast as for all occupations, according to 2024 data<\/a> from the U.S Bureau of Labor Statistics. But experts say these numbers are an undercount given the various titles community health workers hold and that many work outside of health care and governmental institutions.<\/p>\n Community health worker is an umbrella term that includes peer supporters and community health representatives. These workers, often known as promotores, tend to be women<\/a> who work in clinics, hospitals, public health departments, and local nonprofits, places where they are trusted and have a grasp of their community\u2019s most pressing health needs.<\/p>\n Besides helping people manage chronic illnesses such as heart disease and diabetes, they promote reproductive health, children\u2019s health, and oral hygiene, and they help seniors with dementia<\/a> prevent injuries and review medications. They can make people feel safe when reporting domestic violence and other abuses. They also connect people to housing and food assistance. \u201cThe community health worker is not sitting at a desk,\u201d Hern\u00e1ndez said. \u201cOur office is on the street.\u201d<\/p>\n Back in 2019, the California Future Health Workforce Commission recommended integrating community health workers into the health care system, and in 2022, the state authorized $281 million<\/a> over three years for the California Department of Health Care Access and Information, which oversees health care workforce development, to recruit, train, and certify them.<\/p>\n The agency sought to standardize training and certification, but some community groups feared that would create barriers to entry by not giving enough credit for lived experiences and cultural competency. But just as the agency offered more flexibility and allowed community-based training, the state slashed $250 million in funding last year due to budget constraints. This year, the certification program was officially eliminated.<\/p>\n Spokesperson Andrew DiLuccia said the agency is now considering a program to accredit community organizations rather than individual workers and plans to spend its remaining $12 million on technical assistance, workforce development, and salaries for those working with immigrant communities.<\/p>\n According to the National Academy for State Health Policy, 32 other states<\/a> offer a voluntary or mandatory community health worker certification program.<\/p>\n Some community health advocates say California\u2019s missing an opportunity to carve a career path for this workforce. Currently, some courses offered by nonprofits, counties, and colleges require a fee<\/a>, a degree, English fluency, or prior experience. Most are concentrated in the San Francisco or Los Angeles area, leaving training deserts<\/a> in much of the state.<\/p>\n Lourdes Bernis, a dentist from Ecuador, is a model for how community health workers could be integrated into the health care system. She began as a volunteer promotora more than a decade ago and in 2019 received free training from Los Angeles County, allowing her to move into a full-time job with benefits for the county\u2019s Department of Mental Health to help Spanish-speaking women manage depression and anxiety as they recover from drug use.<\/p>\n Bernis now plans to become a peer-to-peer support specialist inside hospitals and clinics. Meanwhile, many of her colleagues with decades of experience remain stuck in low-paying roles and can\u2019t afford training to advance. \u201cThere are promotoras who have 20 to 25 years of experience, but they are still volunteering,\u201d Bernis said in Spanish.<\/p>\n Medi-Cal\u2019s Role<\/strong><\/p>\n To pay community health workers, Medi-Cal began covering their services in July 2022, but California suspended a planned pay increase<\/a> for them after voters approved Proposition 35, which hiked the pay of physicians, hospitals, community clinics, and other providers instead. Since then, the state has yet to establish a uniform system for how health plans should contract with organizations that employ community health workers.<\/p>\n \u201cWe have to jump through hoops,\u201d said Maria Lemus, executive director at Visi\u00f3n y Compromiso, a Los Angeles-based nonprofit representing community health workers. \u201cIt just causes havoc, because each plan could have different requirements.\u201d<\/p>\n Lemus said it took the organization nearly six months to establish payment with one health plan.<\/p>\n And though Medi-Cal reimbursements are tied to individual tasks, ranging from $9.46 to $27.54 for 30 minutes of work, advocates say they aren\u2019t fully compensated for the time they spend building trust and following up with patients. Advocates say these workers should earn at least $30 a visit, with benefits, but many earn about $21 an hour<\/a>, often without benefits.<\/p>\n Advocates say they\u2019re surprised by how infrequently these services are used in a program with 15 million Californians. More than 16,000 Medi-Cal enrollees used these services in the first year, rising to 68,000 last year, according to state data. \u201cI don\u2019t think it\u2019s reached the potential that the governor talked about, and that we all imagined that it could possibly achieve,\u201d Sanders said.<\/p>\n Griselda Melgoza, a spokesperson for the California Department of Health Care Services, said the agency, which administers Medi-Cal, has seen \u201ca steady, upward trend\u201d and believes the data underestimates utilization because the benefit is sometimes bundled with other services.<\/p>\n A proposal<\/a> to assess whether Medi-Cal managed care plans are doing enough outreach and education to enrollees about community health services died this year.<\/p>\n More Crucial Than Ever<\/strong><\/p>\n With health funding cuts from the Trump administration and passage of the GOP\u2019s tax and spending legislation, advocates fear there will be even less funding and support for community health worker positions, shrinking a workforce tackling health disparities. Already, Fresno County\u2019s Department of Public Health said it has cut its community health workers by more than half, from 49 positions to 20<\/a>.<\/p>\n Yet, outreach is more crucial than ever. As the Trump administration continues immigration raids, which appear to have targeted at least one health clinic<\/a> in the state, advocates and policy researchers say community health workers could act as intermediaries for immigrant patients afraid to seek medical care in hospitals and clinics.<\/p>\n Without a state certification program, no raises, and dwindling training funds, the path to professionalizing community health workers is unclear, leaving workers feeling left behind.<\/p>\n \u201cThe community trusts me,\u201d said Hern\u00e1ndez, the veteran community health worker, \u201cbut at the government level, there\u2019s still a long way to go before this work is valued and fairly compensated.\u201d<\/p>\n This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. 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