Key Takeaways
- Trusted community relationships are essential to expand access. Organizations reached community members who face the greatest barriers to care by embedding services in schools, food and housing programs, and faith communities, and by employing CHW/P/Rs who share their community’s language and lived experience.
- Regional collaboratives and workforce investment are the infrastructure that makes scale possible. Collaboratives helped smaller organizations set up billing and navigate Medi-Cal, while investments in training, certification, and career pathways built a workforce that reflects the communities it serves.
- “Financial sustainability remains the biggest challenge. Medi-Cal reimbursement alone rarely covers the relationship-based, community-centered work these programs depend on, so braided funding and shared infrastructure are essential to keep them going.”
Summary
The California Health Care Foundation’s (CHCF) Amplifying Impact Initiative helped 28 California organizations expand community health worker services under Medi-Cal. The evaluation shows what it takes to sustain them.
What Was Evaluated
In 2024, CHCF launched the Amplifying Impact Initiative, with support from the Cedars-Sinai Foundation, to scale CHW/P/R services across California. The initiative funded 28 organizations through two tracks: Regional Accelerators (collaboratives that strengthen networks of providers) and Community of Spread (individual organizations testing new approaches on the ground). Building on CHCF’s earlier Capacity Building Collaborative, the initiative provided flexible funding, technical assistance, and implementation support with four goals: expand access to CHW/P/R services, strengthen the capacity to provide culturally responsive care, develop financially sustainable models, and create quality jobs and career pathways.
CHCF commissioned Bright Research Group to evaluate the initiative’s progress and impact. The evaluation examined how funded organizations expanded access to CHW/P/R services through Medi-Cal, strengthened organizational and regional capacity, and advanced workforce development and sustainability. The evaluation also sought to identify lessons learned, implementation challenges, and promising practices that can inform future policy and program design.
Between July 2025 and May 2026, the team interviewed and held small-group discussions with funded organizations, community health workers, managed care plans, and partners; analyzed grantee progress reports; and reviewed existing research on CalAIM and the CHW benefit.
What We Learned
Across the initiative, funded organizations established Medi-Cal billing capacity at over 100 organizations or service sites, trained or hired 350 CHW/P/Rs, offered services in 10+ languages, supported more than 8,880 Medi-Cal members through CalAIM services, and served over 3,400 members through the new CHW benefit. Four lessons stood out:
1. CHW/P/R Provider Organizations Expanded Access to Care Through Trusted Community Relationships
Funded provider organizations successfully integrated CHW/P/Rs into care delivery models serving populations with complex health and social needs. Organizations strengthened partnerships with community-based organizations, schools, food access programs, housing providers, and other trusted community settings to identify eligible members and improve care coordination.
Rather than relying primarily on traditional health care referral pathways, organizations leveraged trusted community relationships to reach populations that often experience barriers to care, including people experiencing homelessness, justice-involved individuals, rural residents, and culturally and linguistically diverse communities.
2. Regional Collaboratives Accelerated Implementation at Scale
Regional collaboratives played a critical role in building the infrastructure necessary to expand CHW/P/R services across California.
Collaboratives helped partner organizations navigate Medi-Cal requirements, establish billing infrastructure, develop workforce training programs, and strengthen relationships with managed care plans. They reduced barriers for smaller organizations that lacked the resources or administrative capacity to independently implement Medi-Cal-funded CHW/P/R services.
The evaluation found that collaborative models created efficiencies, accelerated learning, and enabled organizations to share solutions to common implementation challenges.
3. Workforce Development Investments Expanded Capacity and Strengthened Career Pathways
Organizations used initiative funding to recruit, train, certify, and support a diverse CHW/P/R workforce that reflects the communities being served.
Funded organizations developed culturally and linguistically responsive training programs, expanded certification opportunities, strengthened partnerships with community colleges, and created career advancement pathways for CHW/P/Rs. Several organizations promoted CHW/P/Rs into leadership and supervisory roles, helping to strengthen long-term workforce sustainability.
4. Sustainability Remains the Most Significant Challenge
Despite substantial progress, organizations consistently identified financial sustainability as the primary barrier to long-term expansion of CHW/P/R services.
Many providers reported that Medi-Cal reimbursement rates do not fully support the costs of community-based CHW/P/R programs. Organizations also described challenges associated with billing infrastructure, administrative requirements, workforce retention, and the mismatch between highly relational CHW/P/R service models and encounter-based reimbursement systems.
As a result, many organizations continue to rely on braided funding approaches that combine Medi-Cal reimbursement with philanthropic and public funding sources.
Why It Matters
The Amplifying Impact Initiative demonstrates that expanding access to CHW/P/R services requires more than reimbursement alone. Successful implementation depends on investments in organizational capacity, workforce development, technical assistance, regional infrastructure, and trusted community partnerships.
The findings suggest that California’s continued efforts to strengthen the CHW/P/R workforce should prioritize sustainable financing models, support for intermediary and collaborative infrastructure, workforce development pathways, and policies that preserve the community-centered nature of CHW/P/R services while enabling long-term integration into the Medi-Cal delivery system.
The Amplifying Impact Initiative helped organizations across California expand access to culturally responsive, community-based care for Medi-Cal members. While significant challenges remain, the initiative provides evidence that targeted investments in providers, collaboratives, and workforce development can accelerate the integration of CHW/P/Rs into California’s health care system and improve access to care for communities that have historically faced barriers to services.
