The Brief

Fortina Hernández is called “the one who knows it all.”

For more than two decades, the community health worker has supported hundreds of families throughout southeast Los Angeles by helping them sign up for food assistance, sharing information about affordable health coverage, and managing medications for their chronic illnesses. She’s guided by the expression “an ounce of prevention is worth a pound of cure.”

But she makes only around $20 an hour from a community health organization and must hold down a second job to make ends meet. “They pay us very little and expect too much,” she said in Spanish. "We build trust. We offer support. We’re the shoulder people rely on, but we don't get fair wages."

California looked to professionalize thousands of community health workers such as Hernández to improve the health of immigrant populations, particularly Hispanic residents, who often experience higher rates of chronic diseases, are more likely to be uninsured, and face more cultural and linguistic barriers when trying to access services. Studies show their work may reduce hospitalizations as well as emergency room and urgent care visits.

The state hewed closely to a series of expert recommendations put out in 2019 to standardize training and certification, integrate these workers into the health care workforce, and provide fair wages, including reimbursements through Medi-Cal, the state’s Medicaid health insurance program, to compensate for work that traditionally has been done on a volunteer basis or for low pay. But six years in, California has backed out of many of those initiatives.

The state has eliminated a certification program and rolled back nearly all funding to train and expand this workforce even though it set a goal of 25,000 workers by this year. Although Medi-Cal began covering their services, participating health plans set uneven billing requirements, making it difficult for workers to get reimbursed. And the state didn’t follow through on a planned pay raise.

With federal funding cuts just passed and President Donald Trump targeting immigrants for deportation — even sharing personal Medicaid data with the Department of Homeland Security — advocates fear California is abandoning its health equity initiative for immigrants, people of color, and people with low incomes when they say that effort is needed most.

“We're in a very dire situation right now,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network, a statewide health equity advocacy group.

A spokesperson for Gov. Gavin Newsom, Elana Ross, said “the state has taken difficult but necessary steps to ensure fiscal stability” and that the administration continues to have a dialogue with community health workers. Ross added that the Democratic governor, a potential presidential candidate, remains committed to defending immigrants being targeted by the Trump administration.

‘Our office is on the street’

Lourdes Bernis (left) chats with a resident about Latino health issues. Bernis is a community health worker, or promotora, who helps people manage chronic illnesses, connects them to social services, and promotes healthy lifestyles.

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Elisa Ferrari

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for KFF Health News

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There are more than 60,000 community health workers nationwide, including roughly 9,200 in California, and this workforce is projected to grow 13% over the next decade, three times as fast as for all occupations, according to 2024 data from the U.S Bureau of Labor Statistics. But experts say these numbers are an undercount given the various titles community health workers hold and that many work outside of health care and governmental institutions.

Community health worker is an umbrella term that includes peer supporters and community health representatives. These workers, often known as promotores, tend to be women who work in clinics, hospitals, public health departments, and local nonprofits, places where they are trusted and have a grasp of their community’s most pressing health needs.

Besides helping people manage chronic illnesses such as heart disease and diabetes, they promote reproductive health, children’s health, and oral hygiene, and they help seniors with dementia prevent injuries and review medications. They can make people feel safe when reporting domestic violence and other abuses. They also connect people to housing and food assistance. "The community health worker is not sitting at a desk," Hernández said. "Our office is on the street."

Back in 2019, the California Future Health Workforce Commission recommended integrating community health workers into the health care system, and in 2022, the state authorized $281 million over three years for the California Department of Health Care Access and Information, which oversees health care workforce development, to recruit, train, and certify them.

The agency sought to standardize training and certification, but some community groups feared that would create barriers to entry by not giving enough credit for lived experiences and cultural competency. But just as the agency offered more flexibility and allowed community-based training, the state slashed $250 million in funding last year due to budget constraints. This year, the certification program was officially eliminated.

Spokesperson Andrew DiLuccia said the agency is now considering a program to accredit community organizations rather than individual workers and plans to spend its remaining $12 million on technical assistance, workforce development, and salaries for those working with immigrant communities.

According to the National Academy for State Health Policy, 32 other states offer a voluntary or mandatory community health worker certification program.

Some community health advocates say California’s missing an opportunity to carve a career path for this workforce. Currently, some courses offered by nonprofits, counties, and colleges require a fee, a degree, English fluency, or prior experience. Most are concentrated in the San Francisco or Los Angeles area, leaving training deserts in much of the state.

Lourdes Bernis received training that allowed her to move into a full-time role with the Los Angeles County Department of Mental Health. She says many community health workers remain stuck in low-paying positions and can’t afford training to advance.

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Elisa Ferrari for KFF Health News

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Lourdes Bernis, a dentist from Ecuador, is a model for how community health workers could be integrated into the health care system. She began as a volunteer promotora more than a decade ago and in 2019 received free training from Los Angeles County, allowing her to move into a full-time job with benefits for the county’s Department of Mental Health to help Spanish-speaking women manage depression and anxiety as they recover from drug use.

Bernis now plans to become a peer-to-peer support specialist inside hospitals and clinics. Meanwhile, many of her colleagues with decades of experience remain stuck in low-paying roles and can’t afford training to advance. “There are promotoras who have 20 to 25 years of experience, but they are still volunteering,” Bernis said in Spanish.

Medi-Cal's role

To pay community health workers, Medi-Cal began covering their services in July 2022, but California suspended a planned pay increase for them after voters approved Proposition 35, which hiked the pay of physicians, hospitals, community clinics, and other providers instead. Since then, the state has yet to establish a uniform system for how health plans should contract with organizations that employ community health workers.

“We have to jump through hoops,” said Maria Lemus, executive director at Visión y Compromiso, a Los Angeles-based nonprofit representing community health workers. “It just causes havoc, because each plan could have different requirements.”

Lemus said it took the organization nearly six months to establish payment with one health plan.

And though Medi-Cal reimbursements are tied to individual tasks, ranging from $9.46 to $27.54 for 30 minutes of work, advocates say they aren’t fully compensated for the time they spend building trust and following up with patients. Advocates say these workers should earn at least $30 a visit, with benefits, but many earn about $21 an hour, often without benefits.

Advocates say they’re surprised by how infrequently these services are used in a program with 15 million Californians. More than 16,000 Medi-Cal enrollees used these services in the first year, rising to 68,000 last year, according to state data. “I don't think it's reached the potential that the governor talked about, and that we all imagined that it could possibly achieve,” Sanders said.

Griselda Melgoza, a spokesperson for the California Department of Health Care Services, said the agency, which administers Medi-Cal, has seen “a steady, upward trend” and believes the data underestimates utilization because the benefit is sometimes bundled with other services.

A proposal to assess whether Medi-Cal managed care plans are doing enough outreach and education to enrollees about community health services died this year.

More crucial than ever

With health funding cuts from the Trump administration and passage of the GOP’s tax and spending legislation, advocates fear there will be even less funding and support for community health worker positions, shrinking a workforce tackling health disparities. Already, Fresno County’s Department of Public Health said it has cut its community health workers by more than half, from 49 positions to 20.

Yet, outreach is more crucial than ever. As the Trump administration continues immigration raids, which appear to have targeted at least one health clinic in the state, advocates and policy researchers say community health workers could act as intermediaries for immigrant patients afraid to seek medical care in hospitals and clinics.

Without a state certification program, no raises, and dwindling training funds, the path to professionalizing community health workers is unclear, leaving workers feeling left behind.

"The community trusts me,” said Hernández, the veteran community health worker, “but at the government level, there’s still a long way to go before this work is valued and fairly compensated."

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.

Southern California was built on radio.

"I can still hear the jingle KFWB News 98,” wrote  Taline in Los Feliz, during a recent conversation on LAist's daily news show, AirTalk, which airs on 89.3 FM. “I grew up hearing that in my dad's minivan on the way to and from school. It has a special place in my heart.”

Back in April, broadcast company Audacy announced KNX News — one of the last-remaining all-news FM stations — was leaving the FM dial where it had simulcast on 97.1 FM since 2021. The station, which is also one of the oldest in L.A., is not budging from 1070 AM where it has been on the air for more than 100 years. The move away from FM officially happened in May to make way for a new sports talk station, which Audacy officials called an area of growth for advertisers in today’s media landscape.

The move is one in a long line of changes for radio and a reminder that before podcasts, playlists and algorithms, many Southern Californians built their days around radio broadcasts.

Radio, a daily ritual

The construction of KNX

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Herman J. Schultheis

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Los Angeles Public Library

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Michael Jackson, a well-known KNX, personality

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Los Angeles Public Library

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Larry Mantle, now in his 41st year hosting AirTalk, remembers being a kid and dreaming of what it might be like to be behind the mic at one of these radio stations.

“ I grew up with KNX," he said. “My dream job as a kid was to be an anchor on KNX or KFWB, the two local all-news radio stations, 'cause there was nothing like hosting AirTalk that even existed at that point.”

Mantle opened up the phone lines on a recent show to hear from his fellow SoCal radio lovers about the shows they miss and the memories they have. Here's what they had to say:

A love for radio, then and now  

A pilot of KMPC's traffic alert helicopter pictured with his daughter and grandson.

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Los Angeles Public Library

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A 1963 picture of Valley State College (now Los Angeles Valley College) preparing to launch KVCM

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Larry Leach

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Los Angeles Public Library

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“When you'd walk down Hollywood Boulevard where the station was, you could hear it playing as you went down the street,” said  Olivia in Glendale about KLAC 570 with Al Jarvis.

 Larry in Yorba Linda shouted out KBCA Jazz for its 24-hour jazz, saying “When I first moved out here in '68 from Phoenix, which had like an hour a week, it was a real wonder.”

 Mark in Glassell Park emailed that he loves KCRW’s Henry Rollins, writing, “I used to bristle at his unique DJ persona, but over time, I came to love him and his crazy eclectic playlists. I find his knowledge in history and punk rock fascinating. He's a gem and a legend."

"I'd like to give a shout-out to all the DJs working at KXLU, the college station at Loyola Marymount University, said  Jeremy in Culver City in an email. “That station's been on the air for nearly 60 years. I believe it's one of the best examples of what's possible with radio."

"KFWB and KRLA back in the day when they were rock music stations —  Dr. Demento, one of my favorite on-air personalities, also had eclectic music taste," said  Carrie in Desert Edge.

“ Dr. Demento was must listening when I was a kid in junior high school at Le Conte Junior High in Hollywood,” Mantle added. “Every Sunday night on KMET, we would make sure we were listening to Dr. Demento and his funny records.”

The question remains…

An 11-year-old winning a car in a KMPC contest in 1963.

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Los Angeles Public Library

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Listener support is vital to any radio station, and it’s clear KNX has many lifelong fans. AirTalk listeners highlighted their support for household KNX names over the decades like Bill Keene, Melinda Lee, Mike Roy and Jackie Olden.

As KNX makes changes, many are watching closely and thinking about the future of radio.

Listeners like Tommy in La Quinta are left wondering if the radio dial will be the same…

“I’m a hardcore listener, but I don't know about casual listeners [and] if they'll tune to AM,” he said.

After months of hand-wringing, Los Angeles and LA28 have come to a tentative agreement on how Olympics organizers will reimburse the city for its expenses for the 2028 Summer Games.

According to the deal, the private Olympic organizing committee will pay upfront for the estimated cost of services that are not eligible for federal reimbursement, like trash pick-up and traffic control. Under another proposal, the city would also be able to tap an LA28 contingency fund if it isn't fully repaid by the federal government for policing costs at Olympic venues.

The agreement is nearly nine months overdue and still needs approval by Mayor Karen Bass and the City Council.

The 2028 Olympics are intended to be privately financed, and an existing city agreement with LA28 states that the Olympics organizers, not L.A., will pay for extra costs for public services in support of the Games. But L.A. is the financial back-stop for the Olympics, meaning if LA28 goes in the red, taxpayers will pick up the bill.

Beyond that, the city services agreement presents another area where L.A. could incur additional unexpected expenses for hosting the Games. L.A. City Councilmember Monica Rodriguez warned LA28 CEO Reynold Hoover earlier this year that a bad deal could "bankrupt" the city.

Jacie Prieto Lopez, an LA28 spokesperson, and Paul Krekorian, who leads the city's office of major events, said in statements that the freshly inked agreement would help deliver a fiscally responsible Games.

"Mayor Bass’ priority is that the 2028 Olympic and Paralympic Games be fiscally responsible, protect taxpayers, and benefit Angelenos for decades to come. This agreement helps deliver that commitment," Krekorian said.

But the contract between the two parties doesn't fully resolve one of the biggest areas of financial risk for the city: the enormous cost of security for an event as extensive and high-profile as the summer Olympics and Paralympics.

Organizers are counting on the federal government to pay for public safety at Olympic venues that are considered part of a "national special security event." That includes costs for LAPD staffing. LA28 has not included security costs in its $7.1 billion budget — a fact that City Attorney Hydee Feldstein Soto criticized earlier this year.

The federal government has so far allocated $1 billion for security costs for the Olympics. Exactly where those federal funds will go has not yet been determined, and there's no guarantee they will cover all of L.A.'s policing costs.

To address this, city officials have also proposed an amendment to a 2021 agreement between the city and LA28. That amendment would establish that if L.A. is not reimbursed by the federal government for all its eligible expenses, it could dip into LA28's contingency fund of $270 million before the private organizing committee could use those funds for any legacy projects.

But that bucket of money will first be used for any costs that Olympics organizers still owe if they run out of revenue — meaning if the Olympics don't turn a profit, the city's access to that money will depend on how much is left for the taking.

Civil rights attorney Connie Rice, who has been tracking the city's negotiations with LA28, told LAist the agreement was a "PR document" not a deal. She pointed out that if the federal government does not pay up for security spending as expected, L.A. could be in trouble.

" It leaves the taxpayers with a GoFundMe strategy," she said.

The city services agreement lays the groundwork for more negotiations between LA28 and the city. Each venue will require its own agreement, to be negotiated by July 1, 2027. Venues in the city of L.A. include Dodger Stadium, the L.A. Convention Center, L.A. Memorial Coliseum and the Venice Beach Boardwalk.

The City Council's ad-hoc committee on the 2028 Games will meet Tuesday afternoon to vote on the agreement.