California’s Community Health Worker Crisis: CPR in Immigrant Healthcare, Training Cuts, and Unequal Pay for CHWs

#Tags: California community health workers, CHW certification, CPR training, healthcare workforce shortage, Medi-Cal reimbursement, immigrant health equity, community health initiatives, health disparities California, public health outreach, CHW training programs

The Forgotten Backbone of California’s Healthcare System

For over 20 years, Fortina Hernández has served her community in southeast Los Angeles — guiding families through public assistance, teaching chronic disease management, and promoting mental health support. But despite being hailed as “the one who knows it all,” Hernández earns just $20 an hour and relies on a second job to survive.

California once pledged to professionalize thousands of community health workers (CHWs) like Hernández. The aim was to address widespread health disparities among underserved populations, especially Hispanic and immigrant communities. These workers build trust and break cultural and linguistic barriers in healthcare — roles that research shows lead to fewer emergency room visits and hospitalizations.

But in 2025, that promise is unraveling.

California Backs Away from CHW Certification and Support

In 2019, a state commission outlined steps to formalize the CHW profession: standardized training, statewide certification, fair wages, and Medi-Cal reimbursement. The state initially committed $281 million to this initiative, setting a target of 25,000 workers by 2025.

Today, most of that funding is gone.

• The statewide CHW certification program has been eliminated.
• $250 million in workforce development funding has been cut.
• Medi-Cal reimbursements are inconsistent and insufficient.
• A planned wage increase was scrapped.

Now, instead of certifying individuals, the state is exploring accreditation for community organizations. Just $12 million remains for technical support, development, and partial salaries — a sharp contrast to the program’s original vision.

Who Are Community Health Workers?

CHWs, or promotores, are trusted members of underserved communities. Many are women working in clinics, nonprofits, and public health agencies. Their roles go far beyond basic care:

• Managing chronic illnesses like diabetes and hypertension
• Supporting reproductive and mental health
• Aiding seniors with dementia and injury prevention
• Helping immigrants access food, housing, and legal aid
• Encouraging safe reporting of domestic violence and abuse

As Hernández puts it, “Our office is on the street.”

Despite their vital role, most CHWs earn around $21/hour, often without benefits or long-term job security.

Medi-Cal Coverage Fails to Deliver Full Support

Since 2022, Medi-Cal has reimbursed CHW services, ranging from $9.46 to $27.54 per 30-minute session. But community health advocates argue this model undervalues the relational aspect of their work, such as building trust and conducting follow-ups.

The lack of a uniform contracting system across health plans adds another layer of confusion. Some organizations spend months negotiating payment terms with providers, delaying compensation for services already rendered.

Advocates recommend raising the reimbursement rate to at least $30 per visit — with full-time benefits — to reflect the depth and importance of CHW responsibilities.

Real Lives, Real Impact: A Success Story and a Systemic Setback

Lourdes Bernis, once a volunteer promotora, used free county training to secure a full-time role with the LA County Department of Mental Health. She now supports Spanish-speaking women in addiction recovery.

Bernis represents what the CHW model can achieve. Yet, most of her colleagues — some with over 20 years of experience — remain unpaid or underpaid volunteers due to limited access to affordable training or formal recognition.

Federal Politics and Local Cuts Threaten CHW Future

As federal funding shrinks and the Trump administration increases immigration enforcement, fears mount that the safety net for immigrant health will collapse. Clinics have already been targeted in ICE raids, and Medicaid data has allegedly been shared with Homeland Security.

CHWs could be vital intermediaries, especially as fear keeps many immigrants away from hospitals. But with Fresno County already slashing its CHW workforce by more than half, that frontline is rapidly thinning.

The Bottom Line: California’s Missed Opportunity

California has the chance to lead the nation in addressing health disparities through a robust community health workforce. Instead, cuts to certification, training, and fair pay are pushing that vision out of reach.

“There’s a long way to go before this work is respected,” Hernández says. “The community trusts us — but we need the government to trust and support us too.”

If California wants to truly close its health equity gap, restoring investment in CHWs is not just urgent — it’s essential.