Community Health Worker Form

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 Education
  • Health 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.

Type of Organization:
CHW Benefit Point of Contact Phone
Are you currently contracted with L.A. Care?
Contracting Point of Contact Phone
Which Service Planning Area (SPAs) would you cover?
Which services can your agency provide?

Should you have any questions please reach out to CHWBenefit_NetworkInquiries@lacare.org

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