Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law requires that Medi-Cal provider payments and payments for specified non-Medi-Cal programs be reduced by 10% for dates of service on and after June 1, 2011, and conditions implementation of those payment reductions on receipt of any necessary federal approvals. Existing law, for dates of service on and after July 1, 2022, authorizes the maintenance of the reimbursement rates or payments for specified services, including, among others, Adverse Childhood Experiences (ACEs) trauma screenings and specified providers, using General Fund or other state funds appropriated to the State Department of Health Care Services as the state share, at the payment levels in effect on December 31, 2021, as specified, under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 that were implemented with funds from the Healthcare Treatment Fund, as specified. Existing law requires the department to develop the eligibility criteria, methodologies, and parameters for the payments and rate increases maintained, and would authorize revisions, as specified.

This bill would require the department, as part of its above-described duties, to include (1)community-based organizations and local health jurisdictions that provide health services through community health workers and (2)doulas, that are enrolled Medi-Cal providers, as providers qualified to provide, and eligible to receive payments for, ACEs trauma screenings pursuant to the provisions described above. The bill would require the department to require these providers to make clinical or other appropriate referrals, as specified, as a condition of payment for conducting ACEs trauma screenings. The bill would require the department to file a state plan amendment and seek any federal approvals it deems necessary to implement these provisions and condition implementation on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would also require the department to update its internet website and the ACEs Aware internet website to reflect the addition of the Medi-Cal providers described above as authorized to provide ACEs screenings. The bill would authorize the department to implement, interpret, or make specific these provisions by means of a provider manual, provider bulletins or notices, policy letters, or other similar instructions, without taking regulatory action.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law requires that Medi-Cal provider payments and payments for specified non-Medi-Cal programs be reduced by 10% for dates of service on and after June 1, 2011, and conditions implementation of those payment reductions on receipt of any necessary federal approvals. Existing law, for dates of service on and after July 1, 2022, authorizes the maintenance of the reimbursement rates or payments for specified services, including, among others, Adverse Childhood Experiences (ACEs) trauma screenings and specified providers, using General Fund or other state funds appropriated to the State Department of Health Care Services as the state share, at the payment levels in effect on December 31, 2021, as specified, under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 that were implemented with funds from the Healthcare Treatment Fund, as specified. Existing law requires the department to develop the eligibility criteria, methodologies, and parameters for the payments and rate increases maintained, and would authorize revisions, as specified.

This bill would require the department, as part of its above-described duties, to include (1)community-based organizations and local health jurisdictions that provide health services through community health workers and (2)doulas, that are enrolled Medi-Cal providers, as providers qualified to provide, and eligible to receive payments for, ACEs trauma screenings pursuant to the provisions described above. The bill would require the department to file a state plan amendment and seek any federal approvals it deems necessary to implement these provisions and condition implementation on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would also require the department to update its internet website and the ACEs Aware internet website to reflect the addition of the Medi-Cal providers described above as authorized to provide ACEs screenings.

Date of Hearing: April 23, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 29

Author:(Arambula) – As Amended Ver:March 19, 2025

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill makes both of the following eligible to provide, and eligible for reimbursement by Medi-Cal for, Adverse Childhood Experiences (ACEs) trauma screenings: (1) community-based organizations (CBOs) and local health jurisdictions (LHJs) that provide health services through community health workers (CHWs) and (2) doulas.

Specifically, this bill:

1. Requires the Department of Health Care Services (DHCS) to include CBOs and LHJs with CHWs as providers of ACEs screenings.
2. Requires DHCS to include doulas as providers of ACEs screenings.
3. Requires DHCS to require the above providers to make clinical or other appropriate referrals based on the results of the screenings as a condition of payment for conducting ACEs trauma screenings.
   
4. Requires DHCS to file a state plan amendment and seek any federal approvals it deems necessary to implement the bill, and conditions implementation on the availability of federal financial participation and receipt of any necessary federal approvals.
   
5. Authorizes DHCS to implement the bill by means of a provider manual, provider bulletins or notices, policy letters, or other similar instructions, without taking regulatory action.
   
6. Requires DHCS to update its website and the ACEs Aware website to reflect the addition of the Medi-Cal providers in items 1 and 2, above, as qualified to provide ACEs trauma screenings.
   

FISCAL EFFECT:

Costs of an unknown amount to DHCS, likely in the high hundreds of thousands to low millions of dollars per year to pay for additional providers to conduct ACEs screenings, file a state plan amendment and seek federal approvals if needed, notify stakeholders, and update the website (General Fund, federal funds).

COMMENTS:

1. Purpose. This bill is sponsored by Black Wellness and Prosperity Center (BWPC) and the Fresno Community Health Improvement Partnership (FCHIP). According to the author:
   

All Californians should have access to trauma-informed Adverse Childhood Experiences screenings by health care providers they trust. Adverse Childhood Experiences, also known as ACEs, can have life-long negative impact on physical and behavioral health. ACEs screenings enable providers to identify patients who are at higher risk for toxic stress and develop a trauma-informed care plan. Because community health workers and doulas are trusted messengers in the communities they serve, this bill will authorize them to receive Medi-Cal reimbursement for ACEs screenings.

1. Background. Addressing ACEs has been a signature state initiative of the California Office of the Surgeon General (CA-OSG). ACEs are potentially traumatic events that occur in childhood. According to the CA-OSG, ACEs can include abuse, neglect, and “household dysfunction” (parental incarceration, mental illness, substance dependence, parental separation or divorce, and intimate partner violence). An ACE score is a tally of the ACEs a person has experienced.

On January 1, 2020, California became the first state to screen for ACEs through the state’s Medi-Cal program. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age. Between January 1, 2020, and March 31, 2024, Medi-Cal clinicians conducted more than 3.6 million ACEs screenings of over 2.1 million unique Medi-Cal members. More than 43,800 individuals completed the “Becoming ACEs Aware in California” training, including approximately 20,700 Medi-Cal clinicians who are ACEs Aware-certified and eligible to receive Medi-Cal payment for conducting ACE screenings.

1. Prior Legislation.
   
   AB 2110 (Arambula), of the 2023-24 Legislative Session, was similar to this bill and was held on suspense in this committee.
   
   AB 1110 (Arambula), of the 2023-24 Legislative Session, would have required, subject to an appropriation, DHCS and CA-OSG to develop guidance for culturally and linguistically competent ACEs screenings through improved data collection methods, as specified. AB 1110 was held on the suspense file of the Senate Appropriations Committee.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 1, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 29

Author:(Arambula) – As Amended Ver:March 19, 2025

SUBJECT: Medi-Cal: Adverse Childhood Experiences trauma screenings: providers.

SUMMARY: Allows doulas, as well as community-based organizations (CBOs) and local health jurisdictions (LHJs) that provide health services through community health workers (CHWs), to provide Adverse Childhood Experiences trauma screenings (ACEs screening) and makes them eligible for Medi-Cal reimbursement for the screening. Specifically, this bill requires the Department of Health Care Services (DHCS) to:

1. Include CBOs/LHJs and doulas as providers of ACE screenings.
2. Require the providers listed in (1), above, to make clinical or other appropriate referrals based on the results of the screenings as a condition of payment for conducting ACEs trauma screenings.
3. File a state plan amendment and seek any federal approvals it deems necessary to implement the bill, and conditions implementation on the availability of federal financial participation and receipt of any necessary federal approvals.
4. Update its internet website and the ACEs Aware website to reflect the addition of the Medi-Cal providers described in 1), above, as qualified to provide ACEs trauma screenings.

EXISTING LAW:

1. Establishes the Medi-Cal Program, administered by DHCS, to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) § 14000 et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program. [WIC § 14132]
3. Establishes CHW services as a Medi-Cal benefit. [WIC § 14132.36]
4. Requires DHCS to convene a workgroup to examine the implementation of the Medi-Cal doula benefit and to, by July 1, 2025, publish a report on utilization of the benefit that identifies any barriers that impede access to doula services and make recommendations to reduce any identified barriers. [WIC § 14132.24]
5. For services provided on or after July 1, 2022, allows General Fund or other state funds to be used to maintain payment levels for ACEs screenings under Medi-Cal at the payment levels in effect on December 31, 2021, inclusive of supplemental payments established under Proposition 56, an initiative measure approved in 2016. [WIC § 14105.197]
6. Requires DHCS, in consultation with the State Department of Social Services (DSS) and stakeholders, to convene an advisory working group to update, amend, or develop, if appropriate, tools and protocols for the screening of children for trauma, within the Early and Periodic Screening, Diagnostic and Treatment benefit, consistent with existing law. [WIC § 14132.19]
7. Defines trauma as the result of an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being. [Ibid.]
8. Requires a health care service plan contract issued, amended, or renewed on or after January 1, 2022, that provides coverage for pediatric services and preventive care, to include coverage for ACEs screenings. [Health & Safety Code § 1367.34]
9. Permits the Department of Managed Health Care (DMHC) to adopt guidance to health care service plans to implement 8) above. Requires DMHC’s guidance to apply the rules and regulations for screening for trauma as set forth in the Medi-Cal program as the minimum ACEs coverage requirements for health care service plans. Specifies that this provision does not prohibit a health care service plan from exceeding the Medi-Cal program’s rules and regulations for trauma screening. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, all Californians should have access to trauma-informed ACEs screenings by health care providers they trust. ACEs can have life-long negative impacts on physical and behavioral health. The author indicates ACEs screenings enable providers to identify patients who are at higher risk for toxic stress and develop a trauma-informed care plan. Accordingly, because CHWs and doulas are trusted messengers in the communities they serve, this bill will authorize them to receive Medi-Cal reimbursement for ACEs screenings. This bill is sponsored by the Black Wellness & Prosperity Center (BWPC) and the Fresno Community Health Improvement Partnership (FCHIP).
2. BACKGROUND.
   1. ACES. Addressing ACEs has been a signature state initiative of the California Office of the Surgeon General (CA-OSG). ACEs are potentially traumatic events that occur in childhood. According to the CA-OSG, ACEs can include abuse (physical, emotional, or sexual abuse), neglect (physical or emotional), and “household dysfunction” (parental incarceration, mental illness, substance dependence, parental separation or divorce, and intimate partner violence). Someone’s ACE score is a tally of the ACEs they have experienced.

According to the California ACEs Aware initiative, ACEs screening has been successfully integrated into a wide range of clinical settings. Prominent health care and public health organizations, such as the National Academies of Science, Engineering, and Medicine, the federal Centers for Disease Control and Prevention (CDC), and American Academy of Pediatrics now recommend screening for ACEs.

• 1. Why are ACEs Important to Health Care? CA-OSG indicates understanding the science of ACEs and toxic stress, and how it can manifest in the body, is critical to effective treatment planning for patients. High levels of adversity, without the buffering protections of trusted caregivers and safe, stable environments, lead to changes in brain structure and function, how genes are read, functioning of the immune and inflammatory systems, and growth and development. These changes comprise the “toxic stress response.”

According to the Harvard Center for the Developing Child (Center), toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity. The Center indicates the more ACEs, the greater the likelihood of developmental delays and later health problems, including heart disease, diabetes, substance abuse, and depression.

While the mechanism of exactly how toxic stress impacts the brain and body are still somewhat unclear, ACEs have been described as having a dose-response effect where higher ACE scores are more strongly associated with poor health outcomes at a population level. In adults, experiencing four or more ACEs is associated with significantly increased risk for 9 out of 10 leading causes of death in adulthood, such as heart disease, stroke, cancer, chronic obstructive pulmonary disease, diabetes, Alzheimer’s, and suicide.

Although ACEs are associated with a high number of negative health outcomes at a population level, screening for ACEs has not yet shown an ability to predict specific risks for negative health outcomes on an individual basis. Rather, the cumulative effect of an elevated stress response over an extended period of time can put individuals at higher risk for a variety of poor outcomes.

• 1. ACEs Aware Initiative. The ACEs Aware Initiative offers Medi-Cal providers training and clinical protocols for screening children and adults for ACEs. According to the ACEs Aware training materials, non-licensed providers like CHWs often play important roles in facilitating the screenings, which are often provided in a team-based care environment. For example, non-licensed staff can review records to determine if the ACEs screen is indicated, provide the questionnaire to the patient or caregiver, and transcribe the ACEs score into the medical record. Staff then transmit this information to a licensed clinician (the billing provider) who documents that the completed screen was reviewed, interprets the results (including assessing whether the patient has any ACE-Associated Health Conditions), discusses the results with the patient, and integrates this ACE screening information into the treatment plan for the patient.
  2. ACEs Aware also provides an “ACEs and Toxic Stress Risk Assessment Algorithm” that helps a provider assess whether a patient is at low, intermediate, or high risk of a toxic stress physiology, based on the ACE score and the presence or absence of ACE-associated health conditions. According to the algorithm, a patient with an ACEs score of one to three without associated health conditions is at intermediate risk, while a patient with an ACEs score of one to three with associated health conditions is at high risk, of toxic stress. A patient's status as intermediate risk or high risk, and the presence or absence of ACE-associated health conditions, has implications for the education and guidance that is offered by the provider after the assessment, and it also informs treatment planning and follow-up care. In other words, the algorithm indicates that conducting the assessment is just a portion of the ACEs screening—the other portions include the clinical assessment of the interplay between ACEs, risk of toxic stress, and ACE-associated health conditions, incorporation of the results into the patient’s care plan, and documentation of the results in the patient’s medical record along with the provider’s notes.
  3. ACEs Medi-Cal Screening Data. On January 1, 2020, California became the first state to screen for ACEs through the state’s Medi-Cal program. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age.

According to the February 2025 ACE Screening and Clinician Training Data Quarterly Progress Report, between the launch of ACEs Aware Initiative Between January 1, 2020, and March 31, 2024, Medi-Cal clinicians conducted more than 3.6 million ACE screenings of over 2.1 million unique Medi-Cal members. More than 43,800 individuals completed the Becoming ACEs Aware in California training, including approximately 20,700 Medi-Cal clinicians who are ACEs Aware-certified and eligible to receive Medi-Cal payment for conducting ACE screenings.

Of the 1.7 million unique Medi-Cal members ages 0 to 20 screened for ACEs, 7% had an ACE score of four or more. Of the nearly 490,000 unique Medi-Cal members ages 21 to 64 screened for ACEs, 17% had an ACE score of four or more.

• 1. Current Medi-Cal Reimbursement Policy for ACEs. Providers must meet the requirements of the billing code in order to be reimbursed for Medi-Cal covered services. DHCS defines these requirements as follows:
     1. Billing Codes and Required Components. To be reimbursed for ACEs screening, providers bill one of the following Healthcare Common Procedure Coding System (HCPCS) codes:
        1. G9919: ACEs score of four or greater, high risk. Screening performed – result indicates patient at high risk for toxic stress; education and interventions (as necessary) provided; or,
        2. G9920: ACEs score of zero to three, lower risk. Screening performed – result indicates patient at lower risk for toxic stress; education and interventions (as necessary) provided.

Providers must document the following: completed screen was reviewed, appropriate tool was used, ACEs screening results, interpretation of results, discussion with the beneficiary and/or family, and any appropriate actions taken. This documentation should remain in the beneficiary’s medical record and be available upon request. Clinical risk assessment and management should be pursued according to the ACEs Aware Screening Clinical Workflows, ACEs and Toxic Stress Risk Assessment Algorithm, and ACE-Associated Health Conditions guidelines.

DHCS notes, in a training presentation on ACEs screening, that the clinical response to identification of ACEs and increased risk of toxic stress should include the following:

• • • 1. Applying principles of trauma-informed care;
      2. Identification and treatment of ACE-associated health conditions;
      3. Patient education about toxic stress and buffering interventions, including supportive relationships, mental health treatment, exercise, sleep hygiene, healthy nutrition, and mindfulness and medication practices;
      4. Validation of existing strengths and protective factors;
      5. Referral to patient resources; and,
      6. Follow-up as necessary.
    1. Providers. Screening is reimbursable for providers who have taken a certified training and self-attested to their completion of the training. ACE screening is reimbursable in all inpatient and outpatient settings in which billing occurs through Medi-Cal fee-for-service (FFS) or to network providers of a Medi-Cal managed care plan (MCP). Providers who are eligible to bill for ACEs screening include the following; however, the provider must meet all requirements of the billing code:
       1. Certified Nurse Midwife;
       2. Certified Nurse Practitioner;
       3. Group Certified Nurse Practitioners;
       4. Early and Periodic Screening, Diagnostic, and Treatment Services Providers;
       5. Licensed Clinical Social Worker – Individual, Group;
       6. Licensed Nurse Midwife;
       7. Licensed Professional Clinical Counselor – Individual, Group;
       8. Marriage and Family Therapist – Individual, Group;
       9. Physician;
       10. Physician Group;
       11. Psychologist;
       12. County Hospital – Outpatient;
       13. County Clinics not associated with a Hospital;
       14. Indian Health Services/Memorandum of Agreement;
       15. Otherwise Undesignated Clinic;
       16. Outpatient Heroin Detox Center;
       17. Rehabilitation Clinic;
       18. Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC); and,
       19. In-state and border providers.
    2. Frequency Limits. Children under age 21 may receive periodic rescreening as determined appropriate and medically necessary, not more than once per year, per provider, or per provider per managed care plan (for beneficiaries enrolled in plans) Adults age 21 and over may be screened once in their adult lifetime up to age 65, per provider, or per provider per managed care plan (for beneficiaries enrolled in plans).
  1. CHWs and Doulas. In an effort to improve health equity and outcomes, Medi-Cal recently began covering the services of CHWs and doulas through the CHW and doula Medi-Cal benefits. These new provider types and benefits can often offer a more tailored and culturally relevant care experience. CHWs and doulas can also improve health equity by offering support, education, advocacy and linkages to resources to Medi-Cal enrollees who may be at particular risk for worse health outcomes. Although there is some overlap in the allowable services, CHWs and doulas are distinct in their training and experience, as well as the specific services Medi-Cal covers under each benefit. Key provisions of both benefits, as described in the Medi-Cal provider manual, are listed below.
     1. Doula Services. Doulas are defined as birth workers who provide health education, advocacy, and physical, emotional and nonmedical support for pregnant and postpartum persons before, during and after childbirth (perinatal period) including support during miscarriage, stillbirth and abortion. Doulas are not licensed or clinical providers, and they do not require supervision. Doulas offer various types of support, including perinatal support and guidance; health navigation; evidence-based education and practices for prenatal, postpartum, childbirth, and newborn/infant care; lactation support; development of a birth plan; and linkages to community-based resources. Coverage also includes comfort measures and physical, emotional, and other nonmedical support provided during labor and delivery, as well as for miscarriage and abortion.

Doula services are defined as a “preventive service” under federal regulation; therefore, services must be recommended by a licensed health care provider. To increase access to services, on November 1, 2023, the DHCS Medical Director, Karen Mark, MD, PhD, issued a standing recommendation for doula services, which fulfills the requirement for a recommendation for an individual who is pregnant or was pregnant within the past year.

• • 1. CHW Services. DHCS added CHW services, including violence prevention services, as a Medi-Cal benefit starting July 1, 2022. The benefit was codified through AB 2697 (Aguiar-Curry), Chapter 488, Statutes of 2022. CHW services are defined to include those delivered by promotores, community health representatives who work in tribal communities, navigators, and other non-licensed public health workers. Like doula services, CHW services are also defined as preventive services and the services must therefore be recommended by a licensed health care provider. There is no standing recommendation in place for CHW services, but CHW services are defined as medically necessary for individuals with a broad range of health conditions.

With respect to billing procedures, CHWs cannot bill independently; CHW services are always billed by the supervising provider. The supervising provider, who submits claims for services, is an enrolled Medi-Cal provider who oversees the services provided and ensures a CHW meets the defined qualifications. The supervising provider can be a licensed provider, a hospital, an outpatient clinic, a LHJ, or a CBO. CBOs and LHJs do not need a licensed provider on staff in order to supervise CHWs. Effective January 8, 2024, CBO and LHJ providers may apply for enrollment in the Medi-Cal program.

CHW services include health education; navigation to health care and other community resources that address health-related social needs; screening and assessment that does not require a license and that assists a beneficiary to connect to appropriate services to improve their health; and individual support and advocacy that assists a beneficiary in preventing a health condition, injury, or violence.

CHWs can address a range of health conditions, including but not limited to control and prevention of chronic conditions or infectious diseases; mental health conditions and substance use disorders; perinatal health conditions; sexual and reproductive health; environmental and climate-sensitive health issues; child health and development; oral health; aging; injury; domestic violence; and violence prevention.

• • 1. CHW and Doula Qualifications. Unlike most health care professionals, there are no required qualifications for CHWs or doulas at the state level, such as a license or certificate. Accordingly, minimum qualifications for CHWs and doulas were defined through the Medi-Cal State Plan Amendment that added the service.

CHWs must demonstrate minimum qualifications through either earning a certificate of completion that attests to skills and/or training in defined core competencies, or meeting the requirements for an experience pathway based on 2,000 hours of work, whereby an experienced individual can provide services for a maximum of 18 months without a certificate of completion. A Violence Prevention Certificate allows individuals to provide CHW violence prevention services. CHWs must also have lived experience that aligns with and provides a connection between the CHW and the community being served.

Similarly, doulas must prove qualification either through a training pathway that includes 16 hours of training and providing support at a minimum of three births, or an experience pathway that requires at least five years of active doula experience and attestation to skills in prenatal, labor, and postpartum care as demonstrated by client testimonial letters or professional letters of recommendation from a health care provider or CBO.

These qualifications only apply to CHWs and doulas for purposes of Medi-Cal billing; there are no minimum qualifications one must meet to work as a CHW or doula outside of Medi-Cal.

1. RECENT AMENDMENTS. Doulas and CHWs may provide care outside of traditional health care settings. As noted above, a patient's status as intermediate risk or high risk, and the presence or absence of ACE-associated health conditions, informs clinical treatment planning and follow-up care. To ensure the results of ACEs screening can be integrated into clinical care and treatment as needed, this bill was recently amended to require CHWs and doulas to make clinical or other appropriate referrals based on the results of the screenings, as a condition of reimbursement for ACEs trauma screenings.
2. SUPPORT. This bill is supported by a large number of consumer, public health, children’s and ethnic-focused health advocacy groups. Co-sponsors, Black Wellness & Prosperity Center and the Fresno Community Health Improvement Partnership, write in support that this bill can enhance access to mental health services, reduce the stigma associated with mental health, and promote healthier communities. The co-sponsors note CHWs and doulas offer culturally and linguistically appropriate care and are uniquely positioned to conduct ACEs screenings. The County Health Executives Association of California (CHEAC) writes in support that California local health departments employ CHWs who serve as vital community links for prevention and care. CHEAC notes that expanding the pool of eligible providers in California who can screen for ACEs, particularly those who work with underserved communities, presents a critical opportunity to better serve and improve the health and well-being of individuals and families.
3. RELATED LEGISLATION.
   1. AB 403 (Ortega), pending in the Assembly Appropriations Committee, would require DHCS to report annually on several aspects of the Medi-Cal CHW benefit, including assessing outreach and education efforts by managed care plans, CHW spending and utilization, referrals by provider type, and demographic disaggregation of CHWs and Medi-Cal members receiving CHW services.
   2. AB 73 (Jackson), pending in the Assembly Appropriations Committee, would require the Department of Health Care Access and Information (HCAI) to develop, upon appropriation by the Legislature, as a component of an existing CHW certificate program, criteria for a specialty certificate program and specialized training requirements for a Black Mental Health Navigator Certification, and report related program data.
   3. AB 96 (Jackson), pending in this committee, would deem a certified peer support specialist to have satisfied all education and training requirements developed by DHCS for certification as a CHW.
4. PREVIOUS LEGISLATION.
   1. AB 2110 (Arambula) of 2024, was similar to this bill and was held on suspense in the Assembly Appropriations Committee.
   2. AB 2250 (Weber) of 2024, would have required a health plan, health insurer, and Medi-Cal to provide coverage for, and provid reimbursement of, social determinants of health (SDOH) screenings; required a health plan or insurer to provide to physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or CHWs, as defined; and provided for reimbursement of SDOH screenings at the Medi-Cal FFS rate for federally qualified health centers and rural health clinics. AB 2250 was vetoed by Governor Newsom, who expressed support for the overall goal of this proposal, but stated that it is duplicative of existing efforts.
   3. AB 85 (Weber), of 2023, was similar to AB 2250 (Weber), above, and required HCAI to convene a working group. AB 85 was vetoed by Governor Newsom, who expressed support for the overall goal of the proposal, but that it is duplicative of existing efforts, such as ACEs screenings and the work DHCS is doing through the CalAIM initiative. The Governor also cited that the bill may be premature given a standardized SDOH screening tool does not yet exist.
   4. AB 1110 (Arambula) of 2023 would have required, subject to an appropriation, DHCS and CA-OSG to develop guidance for culturally and linguistically competent ACEs screenings through improved data collection methods, as specified. AB 1110 was held on the suspense file of the Senate Appropriations Committee.
   5. AB 2697 (Aguiar-Curry) Chapter 488, Statutes of 2022, codifies CHW services as a covered Medi-Cal benefit.
   6. SB 428 (Hurtado), Chapter 641, Statutes of 2021, requires health plans and insurers that cover pediatric services and preventive care to also cover ACEs screenings.
   7. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, authorizes the use of General Fund, in place of funding from Proposition 56 (the California Healthcare, Research and Prevention Tobacco Tax Act of 2016) for supplemental payments for specified Medi-Cal providers, for, among other services, ACEs screenings.
   8. AB 74 (Ting), Chapter 23, Statutes of 2019, among other things, appropriates Proposition 56 funding for ACEs screening in Medi-Cal. 
   9. AB 2691 (Jones-Sawyer) of 2018, would have established within the State Department of Education the Trauma-Informed Schools Initiative to address the impact of ACEs on the educational outcomes of California pupils. AB 2691 was vetoed by Governor Brown. The veto message concurred that schools should be sensitive to the unique and diverse characteristics of all students; however, it noted alarm at the amount of “jargon” the bill would have created and “inevitable labeling” it would have encouraged. The Governor indicated these issues are best handled by local schools.
   10. ACR 235 (Arambula), Res. Chapter 99, Statutes of 2018, designated May 22, 2018, as Trauma-Informed Awareness Day in California, in conjunction with National Trauma-Informed Awareness Day, to highlight the impact of trauma and the importance of prevention and community resilience through trauma-informed care.
   11. AB 340 (Arambula), Chapter 700, Statutes of 2017, requires screening services provided under the Early and Periodic Screening, Diagnostic and Treatment Program to include screening for trauma, as defined for the purpose of screening. AB 340 requires DHCS, in consultation with DSS, behavioral health experts, child welfare experts, and stakeholders to adopt, employ, and develop tools and protocols for the screening of children for trauma, as specified.
   12. ACR 8 (Jones-Sawyer), Res. Chapter 139, Statutes of 2017, recognized ACEs, also known as post-traumatic “street” disorder in communities of color, as having lasting negative outcomes to both physical and mental health with growing implications for our state.

REGISTERED SUPPORT / OPPOSITION:

Support

Black Wellness & Prosperity Center (co-sponsor)

Fresno Community Health Improvement Partnership (co-sponsor)

Adventist Health
Alliance of Catholic Health Care, INC.
California Family Resource Association
California Wic Association
Child Abuse Prevention Center and Its Affiliates Safe Kids California, Prevent Child Abuse California and The California Family Resource Association; the
County Health Executives Association of California (CHEAC)
First 5 California
Saint Agnes Medical Center
Steinberg Institute
Western Center on Law & Poverty

Opposition

None on file.

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097