Tackling Homelessness Through Street Medicine: How California FQHCs Are Redefining Care Delivery

Introduction: Making Telehealth a Permanent Part of the Safety Net

California, home to over 1,000 Federally Qualified Health Center (FQHC) sites, serves millions of low-income and underserved patients every year. During the COVID-19 pandemic, telehealth emerged as a critical lifeline—allowing FQHCs to provide care while keeping both patients and staff safe. But once the public health emergency ended, so did many temporary telehealth reimbursement flexibilities in other states.

California, however, took a different path.

In 2022, Medi-Cal, the state’s Medicaid program, granted permanent payment parity for telehealth visits, including audio-only consultations. This means FQHCs are reimbursed at their full Prospective Payment System (PPS) rate for telehealth services, just as they are for in-person visits.

The result? Telehealth has become an integral, sustainable part of care delivery in California’s safety-net system. FQHCs have embraced this flexibility to expand access, especially for behavioral health, chronic disease management, and follow-up care. It has been particularly impactful for patients facing transportation barriers, language obstacles, or mobility limitations.

This article explores how California’s policy leadership, supported by AI and digital innovation, has changed the face of primary care delivery—and what other states can learn from this model.

1: Process Innovation – Payment Parity and Integration with AI Workflows

At the heart of California’s success is the process innovation of telehealth parity itself. Before the pandemic, many FQHCs were limited in their ability to offer virtual care because telehealth visits were reimbursed at lower rates—or not at all. The 2022 Medi-Cal policy change ensured:

• Full PPS reimbursement for video and audio-only visits
  
  
• No geographic restrictions, allowing patients to access care from anywhere in the state
  
  
• Flexibility in clinical services, especially for mental health and chronic care follow-up
  
  

To manage the increased volume of telehealth visits while maintaining quality, many FQHCs turned to AI-powered tools to optimize their workflows:

• Smart scheduling systems help assign the right clinician to each telehealth visit based on complexity, specialty, and patient history.
  
  
• AI transcription and documentation assistants like Suki or DAX Copilot reduce clinician burden by automatically capturing clinical notes during virtual consultations.
  
  
• Automated eligibility checks and AI-assisted billing platforms ensure correct coding and payment processing, minimizing denials and delays.
  
  

The combination of supportive reimbursement policy and intelligent back-end systems has made telehealth sustainable—not just a temporary fix.

2: Product and Technology – Expanding Virtual Care for Chronic and Behavioral Health

Beyond policy, technology is playing a major role in how California FQHCs deliver care virtually, particularly in high-demand areas like behavioral health and chronic disease.

Behavioral Health Access

California faces a major shortage of behavioral health providers, especially in rural and inner-city communities. Telehealth has become the default modality for mental health services at many FQHCs. AI tools are supporting this transformation by:

• Screening and risk stratification: Chatbots and mobile apps like Valera Health or Wysa help patients self-screen for depression, anxiety, or substance use. High-risk cases are flagged for same-day virtual appointments.
  
  
• Virtual therapy support: AI platforms provide supplemental cognitive behavioral therapy (CBT) modules between visits, boosting patient engagement and reducing clinician caseloads.
  
  

Chronic Disease Management

Conditions like diabetes, hypertension, and asthma benefit from ongoing management, and telehealth has improved continuity of care. FQHCs use:

• Remote patient monitoring (RPM) devices, connected via AI dashboards, to track key vitals and alert providers if values go outside safe ranges.
  
  
• Digital care plans, supported by AI recommendations, help NPs and physicians personalize treatment goals based on trends and adherence data.
  
  

These technologies enable longitudinal care even when patients can’t visit the clinic in person—keeping them healthier and out of the emergency room.

3: Real-World Examples – California FQHCs Leading the Charge

One leading example is La Clínica de La Raza, an FQHC network serving over 90,000 patients across Northern California. After Medi-Cal approved permanent telehealth parity, La Clínica scaled its virtual offerings significantly:

• More than 30% of behavioral health visits are now conducted via audio-only or video consults.
  
  
• Follow-up care for chronic conditions has a 60% no-show reduction when delivered virtually.
  
  
• The organization integrated AI note-taking tools to reduce administrative time for clinicians, allowing them to spend more time in direct patient care.
  
  

Another example is Community Health Centers of the Central Coast, which serves a largely agricultural population. For many patients, travel to clinics is a major barrier.

• The clinic deployed bilingual telehealth platforms, accessible via mobile phones.
  
  
• AI-based language translation tools allow NPs and social workers to hold sessions in patients’ preferred languages without delays.
  
  
• With Medi-Cal’s payment parity, these visits are fully reimbursed, ensuring financial viability.
  
  

This has enabled consistent care even during wildfire season or extreme heat waves—situations where traditional in-person visits become impractical or unsafe.

Conclusion: A Model for the Nation

California’s decision to make telehealth a permanent, reimbursable mode of care for FQHCs has redefined how low-income and underserved populations receive healthcare. With over 1,000 FQHC sites now equipped to offer audio and video visits at full reimbursement rates, access has improved dramatically—especially for:

• Behavioral health patients, who often need regular touchpoints
  
  
• Chronic care patients, who benefit from proactive check-ins and monitoring
  
  
• Rural or transportation-limited populations, for whom travel to a clinic is a barrier
  
  

The key lesson is that policy, technology, and people must move together. California’s parity policy would not have succeeded without the parallel use of AI scheduling tools, smart documentation assistants, and remote monitoring platforms. These tools reduce burden on providers and increase patient touchpoints without requiring more staff.

Policy leaders in other states: Take note of California’s success. Telehealth parity isn’t just about convenience—it’s about equity. Ensuring that FQHCs get reimbursed for virtual care makes healthcare more accessible to the patients who need it most.

FQHC administrators and care teams: If your state has parity policies in place, invest in AI-powered workflows to optimize telehealth delivery. If not, advocate for them—because the future of equitable healthcare is hybrid, digital, and scalable.

Patients and community members: Ask your local health centers about telehealth options. Whether it's a video check-up or a phone-based therapy session, virtual care might be the key to better health on your terms.

References

1. California Department of Health Care Services (DHCS). Medi-Cal Telehealth Policy Update, 2022.
   
   
2. California Primary Care Association (CPCA). Telehealth Adoption in California FQHCs, 2023.
   
   
3. La Clínica de La Raza. Annual Report, 2022–2023.
   
   
4. Community Health Centers of the Central Coast – Internal Press Briefings.
   
   
5. Health Affairs. Telehealth Use in Medicaid and Safety-Net Settings, 2022.
   
   
6. National Association of Community Health Centers (NACHC). The State of Telehealth in FQHCs.

‍