Opinion: Community Health Workers and Promotoras Are California’s Key to Reaching Vulnerable Communities. So Why Are They Underpaid?

Community health worker Leticia Olvera, right, and an unnamed volunteer distribute COVID test kits and information on how to stay safe during an event in Indio in 2021. Photo courtesy of El Sol Neighborhood Educational Center.

Last year, a youth advocacy organization in San Diego called Social Advocates for Youth began a pilot program that placed community health workers in a handful of pediatric offices that serve families with limited English proficiency. The doctors in these clinics had been having trouble connecting high-needs families to necessary social services, and sometimes even just getting them something as simple as access to a food pantry or adequate transportation.

The community health workers, who are mostly Latinx or Middle Eastern, come from the same communities these offices serve, speak the same languages and are familiar with their cultures. When the pilot program began, these workers were able to immediately connect with families, and the clinics saw a big bump in engagement.

“A lot of the patients that we interacted with, sometimes it was their first interaction with any social services, and we were just seeing how much help they needed that they weren’t connected to,” said Mackenzie Brooks, a director of community health workers for the organization.

The health workers were able to integrate into the offices seamlessly, with doctors referring families to them frequently for help. Families were more likely to trust the workers with their care because they understood their culture and language.

“We were able to determine other contributing factors to why families were behaving the way they were in the office,” Brooks said. “Maybe the doctor was frustrated because the family wasn’t getting connected to services or referrals, but we’d go in and find out it was because they’re experiencing domestic violence or housing insecurity.”

The program was a success. But less than a year later, in early April, because of the low rate at which these workers are reimbursed by Medi-Cal, the pilot project was deemed financially unsustainable and shut down. Brooks said the loss of the program has been tragic both for the families and the pediatricians who were able to get families connected to services through these health workers.

“Everyone we’re calling is saying ‘Who’s going to help me now, what are we going to do?’ We’re trying to get them connected to different services, but they’ve already made this connection with the community health workers,” she said.

The lack of reimbursement money to make a necessary program like this sustainable is an extremely common problem and a large reason these workers aren’t being utilized to their fullest potential. Last year when other Medi-Cal providers (like OBGYNs and doulas) were given a rate increase for their services, community health workers were left out.

The average rate that an organization can bill Medi-Cal for a community health worker is a little over $26 per half hour of services, an amount that quickly gets eaten up by things like organizational costs, transportation and other fees. We at the California Pan-Ethnic Health Network (CPEHN) crunched the numbers and found that at the end of the day, when accounting for things like overhead costs and other fees, the current reimbursement rate leaves very little — if any — money for community health worker take-home pay. By generous estimates, a health worker could be taking home about $10 an hour, an amount less than California’s minimum wage.

We believe that there is a dire need to at least double the rate these services are reimbursed at. With about a $53 per half hour rate, these workers who are interfacing most directly with California’s highest needs and most vulnerable communities could finally make a living wage.

Community health workers are a powerful workforce that can help us all achieve greater health equity and access to care in a state where nearly half the population speaks a language other than English. But without a sustainable reimbursement rate on these services, organizations like Social Advocates for Youth in San Diego cannot afford to run them.

As the California legislature begins discussions about how to streamline the state’s budget, we hope they will consider allocating money for this essential service. Paying community health workers a sustainable rate is the simplest and most direct way we can hope to address health disparities across our vast and diverse state.

Kiran Savage-Sangwan is the Executive Director of the California Pan-Ethnic Health Network (CPEHN).

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