Community Health Workers, Promotores & Representatives

Frequently Asked Questions for Community Health Workers/Promotores/Representatives (CHW/P/R) Certificate and Training Programs August 29, 2023

State CHW/P/R Certificate 

What is the purpose of the state CHW/P/R certificate?  

  • The California Department of Health Care Access and Information (HCAI) is developing a CHW/P/R certificate process to comply with state law (Welfare and Institutions Code Section 18998.1) which requires HCAI to develop statewide requirements for CHW/P/R certificate programs in consultation with stakeholders. 
  • A state CHW/P/R certificate indicates that an individual has received training and education approved by the state for a CHW/P/R or the individual has the experience demonstrating they possess the core competencies to be a certified by the state as a CHW/P/R. HCAI is adopting the training and education standards established at the national level for CHWs. (Roles & Competencies | CHW Core Consensus Project (c3project.org) 
  • Possession of the state CHW/P/R certificate will enable billing for the CHW Medi-Cal benefit so long as all other Medi-Cal rules are followed. (Community Health Worker (CHW) Preventive Services (chw prev) (ca.gov) 
  • Under state law, HCAI must also review CHW/P/R training programs and approve those programs with curriculums that meet the statewide requirements for the training and education of CHW/P/Rs. Individuals that successfully complete these approved trainings will be able to secure a state CHW/P/R certificate.  

Who is the entity authorized to establish a process for the state CHW/P/R certificate?  

  • As described above, HCAI is authorized by state law to establish the process for the state CHW/P/R certificate and HCAI will be the certifying entity. 
  • HCAI will create two pathways to certify individuals as CHW/P/Rs, an Experience Pathway for active CHW/P/Rs and a Training Pathway. HCAI will also approve CHW/P/R training programs based on the statewide requirements developed through the stakeholder engagement process. 
  • The Experience Pathway will provide current CHW/P/Rs with an opportunity to become certified if they demonstrate they meet the core competencies, outlined in the state requirements and they can verify some of their worked/volunteered hours as a CHW/P/R. 

Do all CHW/P/Rs need to be certified by HCAI to continue working? 

  • A certificate is not required to continue working as a CHW/P/R. However, to bill Medi-Cal for the CHW Medi-Cal Benefit, CHW/P/Rs can be certified by the state as a pathway to do so.

What is the start date for the certificate?   

  • HCAI expects to begin issuing state CHW/P/R certificates in 2024.

How much will the certificate cost?  

  • HCAI has clearly heard from stakeholders that the state CHW/P/R certificate needs to be affordable. HCAI is committed to implementing this stakeholder feedback as we plan for sustainability of the state CHW/P/R certificate process. 
  • Initially, HCAI looks to bear the cost of the certificate and as discussed, HCAI will work to ensure the certificate will be low cost and/or free to lower the barriers to entry.  

Experience Pathway 

What is the state CHW/P/R certificate going to look like for existing CHW/P/Rs – the Experience Pathway?  

  • The Experience Pathway is one of two ways people can receive the state CHW/P/R certificate. HCAI has worked to make the Experience Pathway a low barrier pathway for currently practicing CHW/P/Rs. This pathway MUST demonstrate that a current CHW/P/R has the core competencies outlined in the (HCAI Guidance Letter) to be certified by the state as a CHW/P/R.  
  • In order to qualify for the Experience Pathway, experienced CHW/P/Rs applying for the state CHW/P/R certificate will be required to meet either option A or B. 
  • Option A: Submit 500 verified hours working as a volunteer CHW/P/R or as a paid CHW/P/R (approximately 3 months of full-time work) and attest to at least 2000 hours worked as a CHW/P/R (approximately 1 year of full-time work as an employee or a volunteer). 

-OR-

  • Option B: The CHW/P/R can provide proof they completed a training program that is currently approved for the Training Pathway. The program must be completed no later than January 1, 2019. In addition to the proof of a completed training program, the current CHW/P/R must also provide proof of completing 10 hours of field experience. (Refer to the following hyperlink for more information on the field experience requirement.) 
  • HCAI will consider other training program courses from HCAI-approved training organizations that were completed prior to the establishment of statewide standards in 2023.  
    • For example, if an approved training organization trained CHW/P/Rs using a 40-60 hour curriculum, these trainings will be accepted so long as the trainee provides proof of completing 10 hours of field experience. These CHW/P/Rs will also need to provide an attestation confirming that they have worked as a CHW/P/R over the last year. 
  • Forms for supervisors to fill out will be found on the certification portal. Example forms are located on the HCAI CHW/P/R webpage to show the information required. (Illustrative-DRAFT-Examples-of-Potential-Verification-Forms-for-website-.pdf) 
  •  The Experience Pathway will be available to the existing CHW/P/R community until June 30, 2029. As this date approaches, HCAI will consider the application volume and decide whether to close or maintain this pathway beyond this date.  Any decision made by HCAI regarding the Experience Pathway on or after this date will not impact the state CHW/P/R certificates already issued to existing CHW/P/Rs. 
  • The Experience Pathway also includes a Reciprocity process where HCAI will review for approval proof of CHW/P/R training from other states and other countries. Finally, the Experience Pathway includes a Discretionary process where an existing CHW/P/R can submit evidence of meeting the core competencies needed for certification as a CHW/P/R and HCAI will consider this information in deciding whether the individual should be certified. The Reciprocity and Discretionary processes will not end.  

Specialty Certificate 

What areas will the state Specialty CHW/P/R Certificate cover? 

  • HCAI has met with multiple organizations that either have already developed or are interested in developing a CHW/P/R specialty training. HCAI is not interested in limiting the type of specialized trainings available to CHW/P/Rs, but HCAI is required by state law to determine criteria for specialty certificate programs and specialized training requirements for CHW/P/Rs. Under the requirements developed by HCAI, specialty trainings must be at least 10 hours of training where trainees learn skills that are important for working on specific preventive health issues (e.g., preventive dental or mental health care), working with subgroups of underserved communities (e.g., immigrants with substance use disorders or Alzheimer) and/or working in important program areas (e.g., climate change or violence prevention). 
  • Under the requirements developed by HCAI, specialty trainings must be offered by or in partnership with an HCAI-approved training program. The specialty training curriculum must be approved by experts within the specialized field. Experts, include but are not limited to, state and local governmental entities that oversee the specialized area, health provider associations providing care in the specialty area, community-based organizations with a mission to promote or advance the specialized area. 

Is the Specialty Certificate required for billing for the CHW Medi-Cal Benefit? 

  • No, the Specialty Certificate is an optional add-on to support CHW/P/Rs in working with specific communities and/or to work with individuals with particular health conditions.  

What does the Specialty Certificate indicate? 

  • The Specialty Certificate indicates that a CHW/P/R has completed additional training that concentrates on specific program focus areas, with learning objectives and topics tailored to the skills required for distinct program and population needs. 

Training 

When will HCAI release the requirements for the state CHW/P/R certificate and for approving training programs that will train individuals to become certified CHW/P/Rs?

  • HCAI released a Guidance Letter outlining the requirements for certifying CHW/P/Rs and the requirements for approving training programs in July 2023. (HCAI Guidance Letter) 

How does this certificate process affect training programs? 

  • Any CHW/P/R wishing to receive the state CHW/P/R certificate, unless utilizing the Experience pathway to a certificate, will need to complete an HCAI-approved CHW/P/R training program.
  • CHW/P/R training programs in California are not required to be approved by HCAI unless they wish to support their trainees in receiving the state CHW/P/R certificate.    

Will all training materials be presented in multiple languages?  

  • HCAI recognizes the importance of ensuring training materials are in multiple languages. HCAI will approve training programs that provide state-approved CHW/P/R training in languages other than English.  

What will the requirements for continuing education look like? 

  • HCAI will set a requirement for a minimum of 6 hours of additional relevant training annually. Continuing education can cover the CHW/P/R core competencies, any new relevant updates in Medi-Cal policy or a CHW/P/R specialty training can be used to meet continuing education requirements.  
  • The state CHW/P/R certificate must be renewed every two years to remain valid. 
  • Continuing education training can be provided by HCAI-approved CHW/P/R training programs or by CHW/P/R employers. An employer can provide the continuing education themselves or verify that a seminar, conference, or outside training meets the state CHW/P/R continuing education requirements. CHW/P/R employers will need to sign a verification form for their employees confirming that the continuing education provided meets state requirements.

Stakeholder Input 

How are CHW/P/Rs involved in the development of the certificate process? 

  • HCAI’s stakeholder engagement process was meant to bring in the collective experience and voice to the process. HCAI has been delighted to see the high turnout of our stakeholders, including current CHW/P/Rs. Our stakeholders have helped HCAI develop the state CHW/P/R certificate process. 
  • HCAI is committed to continuing to engage stakeholders as this work continues.