Community Health Integration (CHI): What Medicare Covers and Who Qualifies

Community Health Integration is a Medicare service that pairs you with a trained helper for ongoing, monthly support. Their job is to clear the everyday obstacles that make it hard to follow your doctor's plan - no ride to the pharmacy, not enough food, a home that's making you sicker, instructions nobody explained twice. You need one regular visit with your doctor first, and after that help can continue every month for as long as you need it. Most people with a Medicare supplement plan pay nothing.

If you’re managing a health condition and real life keeps interfering, CHI is the Medicare service built for exactly that.
Your doctor hands you a plan. Take this. Come back then. Change this habit.

Then you go home, and life has other ideas. The bus doesn’t run near the clinic. Money runs out before the month does. The paperwork made no sense and you didn’t want to seem difficult by asking again.

Community Health Integration

Nearly everyone shortens it to CHI – exists because Medicare recognized something simple. Treatment doesn’t work if a person can’t reach it. So Medicare now covers ongoing help with the non-medical problems standing in your way. The purpose isn’t to add another appointment to your calendar. It’s to remove the things that keep the appointments you already have from doing you any good.

What CHI Is

CHI gives you a trained helper who works on your practical barriers, month after month, alongside your regular care. CHI is not another doctor and not a one-time referral. It's a person - sometimes a small team - whose actual job is clearing your path. They start by learning your situation properly. Where you live. How you get around. What you can afford. Who helps you, if anyone. What you've already tried that didn't work. Then they build a plan around the specific things blocking your care, and they follow through on it. Not once. Every month, for as long as you need it. One thing worth knowing: Medicare widened this service in 2026. It used to be described narrowly around social needs. The current rules use a broader idea - CMS calls them upstream drivers - which covers more ground, including habits like smoking, eating, activity, and substance use when those are what's standing between you and getting better.

Who Qualifies

You may qualify if your clinician finds that something in your life is seriously limiting their ability to diagnose or treat you. There’s no required diagnosis and no minimum number of conditions.

Core eligibility

CHI is for people with Original Medicare, and the test is refreshingly practical. Your clinician has to identify a real obstacle that’s limiting their ability to diagnose or treat the problem you came in about. Things that commonly count:

No dependable way to get to appointments, the lab, or the pharmacy
Not enough food, or not the kind of food your condition requires
A home that's unstable, unsafe, too cold, or hard to move around in
Worry about the power being shut off when you need it for medicine or equipment
Language or reading difficulties that make medical instructions impossible to follow
Managing everything alone, with no one to help
Money pressure that's led you to skip doses, split pills, or delay care
Habits like smoking or drinking that are actively working against your treatment

Here's what surprises people: you don't need a specific illness, and you don't need several conditions. Some Medicare services set a bar like that — CHI doesn't. What matters is the obstacle, not the diagnosis.

The visit you need first

Before CHI can begin, you need one regular visit with the clinician who'll oversee it. During that visit, they write down what's getting in your way and set the service up. This visit is billed the way any visit is. A few kinds of visits can serve this purpose, including a standard office visit, a behavioral health evaluation, or your yearly wellness visit when the same clinician will be overseeing your CHI. A quick heads-up so nothing surprises you: an emergency room trip, a hospital stay, or a nursing facility visit can't be used as this starting visit. It needs to be an outpatient visit of the right type.

Your consent

Nothing starts without your okay. Before your first month, someone will explain the service, tell you what you can expect to pay, and mention one rule: only one clinician can bill Medicare for CHI in the same month. Then they ask if you'd like to go ahead. You can say yes out loud - nothing has to be signed. And you only do this once. It's only revisited if you change to a different treating clinician.

What You Get Each Month

A plan built around your barriers, plus a person who does the legwork - calls, connections, explanations, and follow-up. CHI is deliberately flexible, because no two people are stuck on the same thing. Over a typical month it might include:

A proper assessment at the start - your goals, your strengths, and what's genuinely in the way
A plan aimed at your specific obstacles, not a generic checklist
Arranging rides to appointments and the pharmacy
Connecting you to food help - pantries, meal programs, grocery benefits
Working on housing or utility problems that are affecting your health
Explaining things again, plainly, as many times as you need
Handling calls and paperwork - scheduling, referrals, forms, applications
Coaching you to speak up, so you leave your next visit with real answers
Keeping your care team in sync, including pharmacies and specialists
Checking in, so you're not carrying all of this by yourself

You won't receive every item every month. Your team does whatever is reasonable and necessary for you right now, and keeps a record of it.

Who Provides CHI

A clinician oversees the service; trained staff such as community health workers, nurses, and navigators do the day-to-day work.

The clinician who did your starting visit stays responsible for the service. Around them sits a team of trained people who handle the ongoing work – often community health workers, nurses, social workers, or patient navigators.

These team members can work directly for the practice, or they can come from an organization the practice partners with, including community groups already rooted in your area. Either way, they have to meet their state’s requirements or be trained and certified in a specific set of skills Medicare spells out: communicating with patients and families, building trust, coordinating services, navigating systems, advocating for patients, professional and ethical conduct, and knowing what resources actually exist locally.

You should never be handed off to someone untrained. That’s not how this service is designed.

How CHI Reaches You

A mix of in-person visits, phone calls, and video – whatever suits you. A regular phone call counts.

Medicare expects some face-to-face contact, and there’s a good reason. Sitting in someone’s home reveals things a phone call never will – the stairs, the empty shelf, the pile of unopened mail.

But plenty of CHI happens by phone or video, and that’s fully covered. Audio-only calls count. You don’t need a smartphone, a computer, or reliable internet to receive this service.

What It Costs With Original Medicare

After your yearly deductible, you generally pay 20%. With a Medicare supplement plan, that’s often $0.

Here’s the honest breakdown:

CHI falls under Medicare .
Once you've met your yearly deductible, you pay 20% of the Medicare approved amount for each month you receive the service.
If you have a Medigap or other supplement plan, that 20% is frequently covered - many people pay nothing at all.
If you're on a Medicare Advantage plan, most cover CHI, but your share depends on your plan.
Commercial insurance varies. Worth checking before you start.

We’ll go over your costs before your first month begins. You shouldn’t ever learn about a charge from a statement.

How Screening Fits In

Many people first hear about CHI when a clinician asks about food, housing, transportation, or utilities during a visit.

Clinicians increasingly ask a short set of questions about everyday needs – whether you have enough food, stable housing, a way to get around, and the ability to keep the lights on. If the answers point to a problem that’s affecting your care, CHI is often the next step.

One note if you’ve read older articles on this: the coding around this screening changed in 2026, so guidance published before then may not match what your clinic does now. What hasn’t changed is the substance. If your clinician learns that something in your life is blocking your treatment, that’s the doorway to CHI.

CHI Compared With Other Medicare Services

CHI targets life barriers. Other services target the illness itself. You can sometimes receive both. Medicare has several monthly support services, and the names blur together. The plainEnglish differences:

Community Health Integration (CHI) - for when everyday obstacles are blocking your treatment. Defined by the barrier.
Principal Illness Navigation (PIN) - for guiding you through one serious illness expected to last at least three months, such as cancer, HIV, or substance use disorder. Defined by the illness.
Chronic Care Management (CCM) - for coordinating the medical side when you have two or more long-term conditions. Medications, specialists, care plans.
Principal Care Management (PCM) - similar, but focused on one complex condition.

You can receive more than one of these at the same time when they're addressing genuinely different things. The one firm rule is that the same work can't be counted twice.