As a core part of our Health Care Equity goal, RAMP advocates for policies and programs to integrate CHWs and promotoras into the health care system, focusing on Medi-Cal given the disproportionate impact of asthma on low-income communities. RAMP also works to build the capacity of CHWs and promotoras to improve asthma management.
Why CHWs and Promotoras?
Community Health Workers (CHWs) and promotoras serve an essential role in asthma management. Robust evidence shows that CHWs and promotoras provide effective asthma self-management and environmental education, bridge the gap between patients and their providers, offer social services such as interpretation and referrals, and perform care coordination.
CHWs/promotoras are recognized as uniquely effective in delivering culturally competent home-based asthma interventions because they often have shared cultural backgrounds with participants. Even in cases where there is not a shared cultural background, effective asthma educators practice cultural humility, which is the process of bringing into check the power imbalances between the provider and the individual or family. The CHW/promotora approach to a culturally humble process involves asking questions to gain knowledge, achieving mutual respect, and moving toward shared goal-setting and decision-making.
Innovations in state approaches to Medicaid, as well as the leadership of some private payers, are creating more opportunities for CHWs, promotoras and other non-licensed providers to be reimbursed for providing services in home and community settings.
Advocacy to integrate CHWs and promotoras into the health care system
Largely resulting from advocacy efforts of organizations and networks across the state, in 2022 the California Department of Health Care Services (DHCS) received approval from the Centers for Medicare and Medicaid Services to implement two State Plan Amendments (SPAs) to allow Medi-Cal reimbursement to non-licensed professionals, such as CHWs and promotoras.
The first SPA allows Medi-Cal reimbursement to CHWs and promotoras for a broad range of services, including health education, health navigation, individual support and advocacy, screening and assessment. RAMP’s Director, Anne Kelsey Lamb, served on a DHCS-convened group of stakeholders to guide the development of this benefit. The Community Health Workers, Promotoras, and Representatives (CHW/P/R) Coalition is now monitoring and shaping the implementation. Comprised of eleven lead entities—Asian Resources, Inc., California Consortium for Urban Indian Health, the California Pan-Ethnic Health Network, El Sol, Latino Coalition for a Healthy California, Mixteco/Indigena Community Organizing Project, Roots Community Health, The Children’s Partnership, Transitions Clinic Network, San Diego Refugee Communities Coalition, and Visión y Compromiso—you can learn more about the Coalition’s work here.
The second SPA allows Medi-Cal reimbursement to CHWs, promotoras, and other non-licensed professionals specifically for the Asthma Preventive Services benefit, which includes home-based asthma education and environmental asthma trigger assessments. DHCS worked directly with RAMP and our partners to develop this SPA. That included close collaboration with California Asthma Financing Workgroup. If you’re interested in learning more about the Workgroup, please contact joel@rampasthma.org. For more information about the Asthma Preventive Services benefit, click here.
Building the capacity of CHWs and promotoras to improve asthma management
RAMP hosts regular convenings for CHWs, promotoras, and others providing asthma education. Each year, the participants identify topics of interest and RAMP staff bring in expert speakers on those topics. Topics include: clinical issues related to asthma care, such as guidelines updates or medication reviews; topics relevant to home visiting, such as understanding tenants’ rights or how to identify and remediate mold; and other factors impacting asthma, like wildfire smoke or work-related environmental exposures.
The free convenings are held via Zoom every six to eight weeks and last 90 minutes to 2 hours.
If you are interested in hearing about upcoming convenings, please contact Anne Kelsey Lamb at anne@rampasthma.org/.
For a selection of recordings of past CHW meetings, click here.