DHCS says CHW visits may be billed to Medi-Cal plans, not PPS
Issue
DHCS says FQHCs and RHCs serving Medi-Cal managed-care members may bill CHW encounters to their managed care plans (MCPs). CHW services are not a PPS encounter and get no wrap payment, and under capitation they may already be covered.
Check your plan contract, supervision, coding and documentation before changing workflows.
Key points
- This DHCS pathway applies to Medi-Cal managed care only. It is not a PPS encounter or wrap payment.
- Capitated contracts may already include CHW services, so review the contract before counting new revenue.
- Confirm the plan contract, supervision, coding, documentation and reconciliation rules before you start.
Sources for this story
California Department of Health Care Services (DHCS)Part of
- Medicaid financing and eligibility operations
Managed-care plan exits and transitions
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FQHC Talent. (2026, January 15). DHCS says CHW visits may be billed to Medi-Cal plans, not PPS. Source: California Department of Health Care Services (DHCS). Retrieved November 13, 2026, from https://www.fqhctalent.com/intel/chw-medi-cal-billing