Existing law establishes, within the Health and Welfare Agency, the Department of Health Care Access and Information, which is responsible for, among other things, administering various health professions training and development programs. Existing law requires the department to develop and approve statewide requirements for community health worker certificate programs. Existing law defines community health worker to mean a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery.

This bill would require the department to develop criteria for a specialty certificate program and specialized training requirements for a Black Mental Health Navigator Certification, as specified. The bill would require the department to collect and regularly publish data, not less than annually, including, but not limited to, the number of individuals certified, including those who complete a specialty certificate program, as specified, and the number of individuals who are actively employed in a community health worker role. The bill would make these provisions subject to an appropriation by the Legislature.

Date of Hearing: April 9, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 73

Author:(Jackson) – As Introduced Ver:December 12, 2024

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

SUMMARY:

This bill requires, upon appropriation, the Department of Health Care Access and Information (HCAI) to develop a Black Mental Health Navigator Certification as part of an existing Community Health Worker (CHW) certificate program, and to collect and regularly publish specified data on the certification program.

Specifically, this bill:

1. Requires HCAI to develop criteria and specialized training requirements for a Black Mental Health Navigator Certification, and requires the criteria to include comprehensive training in mental health resources and awareness, including entry-level assessments, crisis intervention training for nonemergency cases, navigation support, and Afrocentric practices relative to delivering public health and mental health assistance to help connect individuals with state resources, licensed mental health professionals, and wellness services.
   
2. Requires HCAI to solicit stakeholder feedback on criteria for the certificate and allows HCAI to engage a community-based organization to advise on or to develop the criteria.
   
3. Requires HCAI to collect and regularly publish data, not less than annually, on individuals who earn a certificate, including a specialty certificate, as well as the number who are actively employed in a CHW role.

FISCAL EFFECT:

General Fund cost pressures of an unknown amount, potentially exceeding high hundreds of thousands of dollars in the first year of implementation, and low to mid-hundreds of thousands annually thereafter.

COMMENTS:

1. Purpose. According to the author:

California must ensure equal access and quality healthcare for our African American communities. Studies consistently highlight disparities in health outcomes among people of color, particularly within our black communities. This inequity stems partly from a lack of cultural competency among healthcare providers. This bill aims to address these disparities by implementing better training and monitoring of healthcare professionals, paving the way for long-term policy solutions.

1. Background.
   
   CHWs. CHWs are frontline public health workers who are trusted members, or have an unusually close understanding, of the community they serve. This trusting relationship enables CHWs to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.
   
   State Initiatives. The state recently enacted two major initiatives related to CHWs, promotores, and community health representatives (CHW/P/Rs). First, DHCS added CHW services as a Medi-Cal benefit starting July 1, 2022 and leverages CHW/P/Rs in specific roles under the Medi-Cal transformation project called California Advancing and Innovating Medi-Cal (CalAIM). Under Medi-Cal, supervising providers may bill for the services CHW/P/Rs provide, including behavioral health.
   
   Second, the Budget Act of 2022 included $281.4 million over three years to support a new program administered by HCAI to recruit, train, and certify 25,000 new CHW/P/Rs by 2025. However, before resources were deployed to train CHWs, $250 million was cut from HCAI CHW initiatives as a budget-balancing reduction in the 2024-25 fiscal year. According to HCAI, this budget cut left insufficient funds to implement CHW certificate or program accreditation functions. HCAI maintains $12M in one-time funds for the CHW/P/R workforce and has developed a proposed expenditure framework for these funds, which includes technical assistance and direct funding for community-based organizations to develop Medi-Cal billing infrastructure, as well as other items.
2. Related and Prior Legislation.
   
   AB 96 (Jackson) deems a certified peer support specialist to have satisfied all education and training requirements developed by DHCS for certification as a CHW. AB 96 is pending in the Assembly Committee on Health.
   
   AB 403 (Ortega) requires DHCS to regularly report on utilization and other aspects of the CHW benefit. AB 403 is pending in this committee.
   
   AB 1970 (Jackson), of the 2023-24 Legislative Session, was identical to this bill and was held on suspense in the Senate Committee on Appropriations.
   

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

Date of Hearing: March 25, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 73

Author:(Jackson) – As Introduced Ver:December 12, 2024

SUBJECT: Mental Health: Black Mental Health Navigator Certification.

SUMMARY: Requires the Department of Health Care Access and Information (HCAI) to develop, upon appropriation by the Legislature, as a component of an existing Community Health Worker (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. Specifically, this bill:

1. Requires HCAI to develop criteria for a specialty certificate program and specialized training requirements for a Black Mental Health Navigator Certification.
2. Includes, in the criteria developed pursuant to 1) above, comprehensive training in mental health resources and awareness, including, but not limited to, entry-level assessments, crisis intervention training for nonemergency cases, navigation support, and Afrocentric practices relative to delivering public health and mental health assistance to help connect individuals with state resources, licensed mental health professionals, and wellness services.
3. Requires HCAI to solicit stakeholder feedback on criteria for the certificate and allows HCAI to engage a community-based organization with relevant expertise about mental health and wellness in Black communities to advise on or to develop the criteria.
4. Requires HCAI to collect and regularly publish data, not less than annually, on the number and overall demographics of individuals who earn a certificate, including a specialty certificate, as well as the number of individuals who are actively employed in a community health worker role.

EXISTING LAW:

1. Specifies CHW services as a covered benefit under Medi-Cal. [Welfare & Institutions Code (WIC) § 14132.36]
2. Defines CHW to mean a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery. States that a CHW is a frontline health worker either trusted by, or who has a close understanding of, the community served, and requires a CHW’s lived experience to align with and provide a connection to the community being served. [WIC § 18998]
3. States that CHWs include Promotores, Promotores de Salud, community health representatives, navigators, and other nonlicensed health workers, including violence prevention professionals. [ibid.]
4. Requires HCAI to develop statewide requirements for CHW certificate programs in consultation with stakeholders, including, but not limited to, the Department of Health Care Services (DHCS), the California Department of Public Health, CHWs, Promotores and Promotores de Salud, or representative organizations. [ibid.]
5. Requires, as part of 4), above, HCAI to determine criteria for specialty certificate programs and specialized training requirements that build on the lived experience of CHWs. [ibid.]
6. Allows HCAI to, in consultation with stakeholders, request that an individual who is either enrolled in, or who has completed, a CHW certificate program submit data, and allows HCAI to determine the frequency and manner of data submission. [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, California must ensure equal access and quality healthcare for our African American communities. Studies consistently highlight disparities in health outcomes among people of color, particularly within our black communities. This inequity stems partly from a lack of cultural competency among healthcare providers. This bill aims to address these disparities.
2. BACKGROUND.
   1. Mental Health Disparities in Black/African American Communities. Racial and ethnic disparities in health and health care remain a persistent challenge in the United States (US). Compared with non-Hispanic whites, Black and African Americans with any mental illness have lower rates of mental health service use including prescription medications and outpatient services, but higher use of inpatient services. Black people are also less likely to utilize psychiatric services, and if they receive care, it is usually of lower quality than care provided to white people. Consequently, unmet need for mental health care is greater among Black and African Americans than white people.

According to KFF’s 2024 reprt “Key Data on Health and Health Care by Race and Ethnicity,” among adults with any mental illness, Black (39%), Hispanic (36%), and Asian (25%) adults were less likely than white (52%) adults to receive mental health services as of 2021. Overall rates of mental illness and substance use disorder were lower for people of color compared to white people but could be underdiagnosed among people of color. Research suggests that a lack of culturally sensitive screening tools that detect mental illness, coupled with structural barriers, could contribute to underdiagnosis of mental illness among people of color.

• 1. Barriers to Mental Health Care. According to the American Psychiatric Association, despite recent efforts to improve mental health services for African Americans and other minority groups, barriers remain regarding access to and quality of care. The barriers include:
     1. Stigma associated with mental illness;
     2. Distrust of the health care system;
     3. Lack of providers from diverse racial/ethnic backgrounds;
     4. Lack of culturally competent providers; and,
     5. Lack of insurance or underinsurance.

Additional barriers reported in the Black population include the importance of family privacy, lack of knowledge regarding available treatments, and denial of mental health problems. Concerns about medications, not receiving appropriate information about services, and dehumanizing services have also been reported to hinder Black and African Americans from accessing mental health services.

• 1. CHWs. According to the National Association of Community Health Workers, “CHW” is used as an umbrella term to describe community health representatives, promotores de salud or promotoras, outreach workers, and many other different work titles. CHWs share life experience with the people they serve and have firsthand knowledge of the causes and impacts of health inequity. In the US, the majority of CHWs serve communities that have experienced structural oppression and who may be marginalized by traditional health care systems, including Black, Latinx, American Indian/Alaska Native, and Asian/Pacific Islander communities, as well as rural and low-income communities.

According to the American Public Health Association (APHA), CHWs are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy. APHA’s definition is commonly cited by other organizations. California’s Welfare and Institutions Code Section 18998 contains a similar definition, and emphasizes that a CHW’s lived experience aligns with and provides a connection to the community being served. Although CHW is commonly used as an umbrella term, promotores and Community Health Representatives (CHRs) have distinct histories and footprints in California. Promotores, promotores de salud, or promotoras, are lay health workers who most often provide culturally congruent services informed by their lived experiences to Spanish-speaking communities, while CHRs serve in tribal communities.

• 1. State Efforts to Promote CHWs. On March 12, 2024, the Assembly Health Committee and Budget Subcommittee #1 on Health held a hearing examining state efforts on CHWs, titled, “Bright Spots and Remaining Barriers to Realizing the Potential of Community Health Workers, Promotoras, and Representatives to Improve Health in California.”

DHCS added CHW services as a Medi-Cal benefit starting in July 1, 2022, and has leveraged CHW/P/Rs in specific roles under the Medi-Cal transformation project called California Advancing and Innovating Medi-Cal (CalAIM). Under Medi-Cal, supervising providers can bill for the services CHW/P/Rs provide, including health education, navigation, limited screening and assessment to determine need for services, and individual support and advocacy across a wide range of health conditions, including behavioral health.

The 2022 Budget Act included $281.4 million over three years to support a new program administered by HCAI to recruit, train, and certify 25,000 new CHW/P/Rs by 2025, including those with specialized training to work with specific populations or on specific issues. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, the 2022 Health Trailer Bill, described the HCAI CHW initiative. It requires HCAI to develop statewide requirements for CHW certificate programs in consultation with stakeholders. Specifically, it requires HCAI to do the following:

• • 1. Consult evidenced-based and community-defined materials;
    2. Determine necessary curriculum to meet certificate program objectives;
    3. Determine criteria for specialty certificate programs and specialized training requirements that build on the lived experience of CHWs;
    4. Determine a structure of statewide oversight that reduces barriers to training;
    5. Determine how past experience as a CHW may provide a pathway to certification, and how to verify past experience; and,
    6. Approve statewide requirements for the development of certificate programs for CHWs, approve the curriculum for such programs, and review, approve, or renew evidence-based curricula and community-defined curricula for core competencies, specialized programs, and training. The statute allows organizations to submit an application for HCAI approval of a CHW certificate program.

However, before resources were deployed to train CHWs, $250 million was cut from HCAI CHW initiatives as a budget-balancing reduction in the 2024-25 fiscal year. According to HCAI, this left insufficient funds to implement any ongoing functions, including individual certificate or program accreditation functions. HCAI maintains $12M in one-time funds for the CHW/P/R workforce and has developed a proposed expenditure framework for these funds, which includes technical assistance and direct funding for community-based organizations (CBOs) for Medi-Cal billing infrastructure development as well as other items.

This bill would require HCAI to develop the criteria specialty certificate contingent on a legislative appropriation for the purpose.

• 1. Implementation of this Bill. As noted above, state law requires HCAI to determine criteria for specialty certificate programs and specialized training requirements that build on the lived experience of CHWs. HCAI has not yet adopted curricula for specialty certificates. This bill would require adoption of a specialty certificate specific to the mental health needs of Black/African American people, as described above, and require reporting on the number of people who earn certificates, including the specialty certificates. Once the state approves the curriculum, training entities would make available the applicable training, and individuals earn the certificates, then providers, including community-based organizations, can employ these trained CHWs who are trained and possess the Black Mental Health Navigator Certification. Providers would then be able to bill Medi-Cal through the CHW benefit for provision of covered CHW services, including navigation, screening and assessment, health education, and individual support and advocacy, to Medi-Cal eligible individuals.

1. SUPPORT. A number of mental health and consumer advocacy organizations support this bill, explaining Black communities face unique and significant barriers in obtaining mental health care, including cultural stigma, service provider bias, and systemic inequalities. Supporters indicate providing targeted mental health support tailored to the specific needs and experiences of Black communities is essential for addressing disparities and promoting overall well-being.
2. OPPOSITION. Californians for Equal Rights Foundation, an advocacy organization founded to support California’s ban on affirmative action, opposes this bill, expressing a belief that public policies should treat all individuals with mental health challenges without regard to race or color.
3. RELATED LEGISLATION.
   1. AB 29 (Arambula), pending in this committee, would allow doulas, as well as community-based organizations and local health jurisdictions that provide health services through CHWs, to provide Adverse Childhood Experiences trauma screenings (ACEs screening) and make them eligible for Medi-Cal reimbursement for the screening.
   2. 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.
   3. AB 403 (Ortega), pending in this committee, would require DHCS to regularly report on utilization and other aspects of the CHW benefit.
4. PREVIOUS LEGISLATION.
   1. AB 2110 (Arambula) of 2024, was similar to AB 29 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 fee-for-service 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 would have required the Department of Health Care Access and Information to convene a working group. AB 85 was also vetoed by Governor Newsom, who expressed support for the overall goal of the proposal, but stated that it is duplicative of existing efforts.
   4. AB 2697 (Aguiar-Curry), Chapter 488, Statutes of 2022, codifies CHW services as a covered Medi-Cal benefit.
   5. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022 codifies the HCAI CHW workforce initiative.

REGISTERED SUPPORT / OPPOSITION:

Support

California Alliance of Child and Family Services

California Black Health Network (CBHN)

California Black Health Policy Advisory Council

California Black Women's Health Project

California Family Resource Association

Cal Voices

Child Abuse Prevention Center

County Behavioral Health Directors Association (CBHDA)

Disability Rights California

Drug Policy Alliance

First 5 California

Greater Sacramento Urban League

Roberts Family Development Center

Seneca Family of Agencies

Western Center on Law & Poverty

5 Individuals

Oppose

Californians for Equal Rights Foundation

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