AB 403: California's CHW Medi-Cal Benefit Serves Fewer Than 6,000 of 15 Million — Here's the Bill That Would Finally Show Us Why

The Benefit Almost Nobody Is Using

California's CHW Medi-Cal benefit launched on July 1, 2022, built into the CalAIM transformation. It pays providers for outreach, health promotion, navigation, and SDOH screening delivered by trusted community workers — many of them promotoras and community health representatives with decades of trust in their neighborhoods. A 2024 State Plan Amendment expanded the benefit, letting dental and pharmacy practices supervise CHWs and bill for their services.

On paper, this should be a transformative benefit. In practice, the numbers tell a different story. DHCS reports that the share of managed-care members statewide using any Community Support reached just 0.9% in 2024, up from 0.1% in 2022. For CHW services specifically, the figures are starker still: fewer than 6,000 beneficiaries, less than $1 million in reimbursement, three full years after launch.

The benefit hasn't failed because CHWs aren't doing the work. They are — they always have. It has failed because the plumbing connecting the work to the billing code is leaky, and because nobody has been required to publish the data that would let us pinpoint the leaks.

What AB 403 Actually Does

AB 403 does one focused thing. Starting **July 1, 2027**, it would require DHCS to publish an annual analysis to the Legislature and the public on CHW Medi-Cal benefit utilization. The analysis must include an assessment of CHW capacity and beneficiary need, disaggregated by geographic region, race, ethnicity, language, age and other sociodemographic factors, and by Medi-Cal managed care plan.

In plain English: the state would finally have to show its work. Where is the benefit actually reaching people? Which counties are leaving CHW dollars on the table? Which managed care plans are dragging? Which beneficiaries — by language and ethnicity — are still being missed? Today, advocates, providers, and even the Legislature itself are flying blind on every one of those questions.

The bill is co-sponsored by the founding organizations of the California CHW/P/R Policy Coalition: the Latino Coalition for a Healthy California, the California Pan-Ethnic Health Network, Visión y Compromiso, and The Children's Partnership. It is not the same bill as SB 803.

Why FQHCs Are at the Center of This

FQHCs are where most CHW billing already lives. As the largest cohort of safety-net providers eligible to bill the benefit — with established ECM contracts, integrated care teams, and the cultural-linguistic match the work demands — health centers are both the biggest beneficiaries of the program and the most exposed to public reporting if AB 403 becomes law.

For FQHC executives, three implications are worth thinking about now, not in 2027:

• **Site-level visibility is coming.** Annual reporting disaggregated by managed care plan and demographics will, indirectly, surface which providers are billing — and which are not. If your FQHC runs a robust ECM workflow but isn't billing CHW services as a distinct line, that's a quiet revenue gap. Audit it now, while the spotlight is still hypothetical.
• **Rate advocacy gets a real foundation.** The state cannot credibly argue that CHW rates are adequate if benefit utilization is functionally zero. The California Budget Center's Trusted, But Undervalued report calls explicitly for higher rates and better data — AB 403 builds the data half. FQHC and primary care association advocacy can now pair both halves.
• **Distinct from SB 803.** AB 403 is about utilization of the benefit. SB 803 is about the CHW certification credential — a separate workstream that has been stalled since November 2023 without DHCS guidance. Do not conflate them in board memos, union conversations, or advocacy. They move on different tracks.

Trusted, But Undervalued — The Workforce Underneath the Bill

The benefit's underuse isn't an indictment of CHWs. It's an indictment of the system around them. A 2026 JAMA Network Open analysis on strengthening Community Health Worker and Promotora workforce capacity reinforces what frontline organizations have said for a decade: this is essential workforce, it is overwhelmingly women of color, and it is chronically underpaid.

The California Budget Center frames it sharply: CHWs, promotoras, and representatives are the connectors California's safety-net depends on, yet a major challenge in evaluating and expanding the workforce is the lack of reliable, centralized data on who is delivering services, who they are reaching, and what outcomes they are producing. AB 403 doesn't fix the rate. It doesn't fix the credential. What it does is fix the data — and without that data, neither of the other fixes is politically possible.

There is a quiet through-line here that FQHC leaders should name out loud: a benefit reaching fewer than 6,000 of 15 million beneficiaries is not the workforce's failure. It is a policy failure that the workforce has been asked to carry. AB 403 is the smallest plausible step toward changing that.

What to Watch This Week (and This Year)

If you lead an FQHC, sit on a board, or represent the CHW workforce, here is the calendar that matters:

• **May 29, 2026** — House-of-origin passage deadline. If AB 403 doesn't clear the Assembly floor by Friday, it dies in this session. Track via the California Legislature bill page.
• **July 1, 2027** — The earliest date for DHCS's first annual report if AB 403 is signed into law this year.
• **SB 803 (CHW certification)** — Separate bill, paused since late 2023. Don't expect movement in this session; don't tie your AB 403 advocacy to it.
• **CHW Medi-Cal rate** — Watch the May Revision and any fall budget proposals for an actual rate increase. AB 403 makes the case but is not itself a rate change.
• **Site-level prep** — Audit your current CHW/ECM billing this quarter. Is your ECM team billing CHW services as a distinct code where appropriate? Are pharmacy and dental sites taking advantage of the 2024 expansion? Are you tracking patient language and ethnicity in a way that will hold up when DHCS publishes its first disaggregated dataset?

A benefit that reaches fewer than 6,000 of 15 million people is not a benefit. It's a promise California made and then quietly stopped checking on. AB 403 forces the check.