Advancing the Role of CHWs and Promotoras in Asthma Management: What We’re Doing

As a core part of our Health Care Equity goal, RAMP advocates for policies and programs to integrate CHWs and promotoras into the health care system, focusing on Medi-Cal given the disproportionate impact of asthma on low-income communities. RAMP also works to build the capacity of CHWs and promotoras to improve asthma management.

Why CHWs and Promotoras?

Community Health Workers (CHWs) and promotoras serve an essential role in asthma management. Robust evidence shows that CHWs and promotoras provide effective asthma self-management and environmental education, bridge the gap between patients and their providers, offer social services such as interpretation and referrals, and perform care coordination.

CHWs/promotoras are recognized as uniquely effective in delivering culturally competent home-based asthma interventions because they often have shared cultural backgrounds with participants. Even in cases where there is not a shared cultural background, effective asthma educators practice cultural humility, which is the process of bringing into check the power imbalances between the provider and the individual or family. The CHW/promotora approach to a culturally humble process involves asking questions to gain knowledge, achieving mutual respect, and moving toward shared goal-setting and decision-making.

Innovations in state approaches to Medicaid, as well as the leadership of some private payers, are creating more opportunities for CHWs, promotoras and other non-licensed providers to be reimbursed for providing services in home and community settings.

Advocacy to integrate CHWs and promotoras into the health care system

Largely resulting from advocacy efforts of organizations and networks across the state, the California Department of Health Care Services (DHCS) is currently drafting two State Plan Amendments (SPAs) to allow Medi-Cal reimbursement to non-licensed professionals, such as CHWs and promotoras. The SPAs will be submitted to the federal Centers for Medicare and Medicaid Services for approval by mid-2022.

The first SPA would allow Medi-Cal reimbursement to CHWs and promotoras for a broad range of work in communities across California. DHCS has convened a group of stakeholders to guide this process. RAMP’s Director, Anne Kelsey Lamb, was appointed to the stakeholder group and brings the experience of two decades of working with asthma CHWs to the conversations.

The second SPA would allow Medi-Cal reimbursement to CHWs, promotoras, and other non-licensed professionals specifically for Asthma Preventive Services, which include home-based asthma education and environmental asthma trigger assessments. DHCS is working directly with RAMP and our partners to develop this SPA. RAMP’s Associate Director, Joel Ervice, is working closely with the California Asthma Financing Workgroup to guide this process. If you’re interested in learning more or being added to the Workgroup list, please contact Joel at joel@rampasthma.org.

Building the capacity of CHWs and promotoras to improve asthma management

RAMP hosts regular convenings for CHWs, promotoras, and others providing asthma education. Each year, the participants identify topics of interest and RAMP staff bring in expert speakers on those topics. Topics include: clinical issues related to asthma care, such as guidelines updates or medication reviews; topics relevant to home visiting, such as understanding tenants’ rights or how to identify and remediate mold; and emerging topics impacting their work, like wildfire smoke or COVID-19.

The free convenings are held via Zoom every six to eight weeks and last 90 minutes to 2 hours. If you are interested hearing about upcoming convenings, please contact Anne Kelsey Lamb at anne@rampasthma.org.

For a selection of recordings of past CHW meetings, click here.

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