23-577 Street Medicine Benefit for Medi-Cal Members
Date: 06/21/23
Providing health care services directly to unsheltered individuals in their own environment
California Health & Wellness Plan (CHWP) covers street medicine for Medi‐Cal members experiencing unsheltered homelessness. Street medicine is a set of health and social services developed specifically to address the unique needs and circumstances of individuals experiencing unsheltered homelessness.
The street medicine benefit covers up to the full array of services necessary to meet immediate needs, including but not limited to, preventive services, and the treatment of acute and chronic conditions.
Services are provided by CHWP contracted street medicine providers, such as a member’s assigned primary care physician (PCP), stand‐alone street medicine teams, an Enhanced Care Management (ECM) provider or a Community Supports provider. For more information about street medicine benefit requirements, refer to the Department of Health Care Services (DHCS) All Plan Letter (APL) 22‐0231 (PDF).
Verify member eligibility
Providers are responsible for verifying benefits and member eligibility each time a member is scheduled to receive services.
Check eligibility through either of the following:
- The provider portal (preferred method). Log into the secure provider portal, then select Eligibility Verification under Provider Resources.
- The Automated Eligibility Verification System (AEVS) on the Department of Health Care Services Medi‐Cal eligibility website.
Coordinating services
Street medicine providers are responsible for coordinating member care with the member’s primary care physician (PCP) and/or independent practice association (IPA) and initiating specialist referrals, including behavioral health, Community Supports and social services, when needed.
Claims billing
Claims are paid based on the eligibility of the individual, for appropriate and applicable services within their scope of\ practice. Providers may bill Place of Service (POS) codes to Fee‐for‐Service Medi‐Cal or CHWP when rendering medical services for street medicine. For more information on billing for street medicine refer to the DHCS billing guidelines.
Additional information
Providers are encouraged to access CHWP’s provider portal for real‐time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877‐658‐0305.
1DHCS All Plan Letter 22‐203 at https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22‐023.pdf
This Information applies to Physicians, Hospitals, Ancillary providers, Independent Practice Associations (IPAs), Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.