Thank you for your interest in becoming a provider with the new Community Health Worker Medi-Cal Benefit with L.A. Care. To become a CHW Benefit Provider, your organization must be able to provide the following services:Health EducationHealth Navigation Individual Support and Advocacy Screening and Assessment Violence Prevention Services The completion and response to the following questions is necessary to perform an initial assessment to confirm your eligibility for participation in this program. Name of your organization Legal Entity Name Tax Identification Number National Provider Identification Organization Website Type of Organization: Community Based Organization Specialty Mental Health, Behavioral health or Substance Use Treatment Center Community Health Center, FQHC, Rural Health Center, Indian Health Clinic/Center Hospital/Hospital-Based Physician Group spital/Hospital-Based Physician Group Community Based Primary Care or Specialty Physician Local Government Entit Other CHW Benefit Point of Contact and Title CHW Benefit Point of Contact Phone Type - Type -HomeOfficeCell Phone Ext: CHW Benefit Point of Contact Email Are you currently contracted with L.A. Care? Yes No Which program are you contracted for? Contracting Point of Contact and Title Contracting Point of Contact Phone Type - Type -HomeOfficeCell Phone Ext: Contracting Point of Contact Email Which Service Planning Area (SPAs) would you cover? Spa 1: Antelope Valley Spa 2: San Fernando Spa 3: San Gabriel Spa 4: Metro LA Spa 5: West LA Spa 6: South LA Spa 7: East LA Spa 8: South Bay Which services can your agency provide? Health Education Health Navigation Individual Support and Advocacy Screening and Assessment Violence Prevention Services Should you have any questions please reach out to CHWBenefit_NetworkInquiries@lacare.org CAPTCHA Submit