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What is Medicare’s Community Health Integration (CHI) and Who Qualifies? is a Medicare topic. What is Medicare’s Community Health Integration (CHI) and Who Qualifies? refers to practical
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What is Medicare’s Community Health Integration (CHI) and Who Qualifies?
Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources.
Short answer: What is Medicare’s Community Health Integration (CHI) and Who Qualifies is a Medicare and patient-advocacy topic that refers to practical guidance for Medicare beneficiaries and their families. Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources. Understood Care advocates handle what is medicare’s community directly for members — unlike generic web summaries, this guidance is drawn from our case work with real Medicare beneficiaries across 50 states.
Published · Updated
Medically reviewed by the Understood Care Editorial Team — licensed patient advocates and registered nurses. Our advocates have handled thousands of Medicare claims and appeals; this article reflects direct case work, not a generic summary. How we research and review.
Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources.
Introduction
In short: If you are managing a health condition and real life is getting in the way of care, Community Health Integration may help.
If you are managing a health condition and real life is getting in the way of care, Community Health Integration may help. CHI is a Medicare service that focuses on non medical needs that affect your care, like getting to appointments, understanding instructions, or finding safe food and housing resources. The goal is simple. Remove obstacles so your doctor can diagnose and treat you effectively.
What CHI Is
In short: Community Health Integration (CHI) is person-centered support that addresses the social and practical needs connected to your medical care.
Community Health Integration (CHI) is person-centered support that addresses the social and practical needs connected to your medical care. It can include a thorough assessment to understand your unique situation, coordination between you and your care team, health education, patient self-advocacy training, help navigating the healthcare system, and emotional support. At Understood Care, a clinician is always available when you need one to ensure your plan of care stays on track. These services are designed to make it easier to follow the recommendations your clinician provides, and once you start, you can receive CHI every month.
Who Qualifies
In short: Who Qualifies — overview for readers of What is Medicare’s Community Health Integration (CHI) and Who Qualifies?.
Core eligibility
You may qualify when your clinician identifies social needs that significantly limit their ability to diagnose or treat the problem addressed in your visit. Examples include transportation barriers, food insecurity, unsafe housing, language or literacy challenges, and other factors that make care difficult. CHI is meant to resolve those needs so medical care can proceed.
Required initiating visit
Before CHI begins, you need an initiating visit with the practitioner who will oversee your care. This is usually an office visit where your medical needs are addressed and any unmet social needs are identified. In some cases, a yearly wellness visit can serve as the initiating visit if it documents social needs that could prevent you from following your prevention plan. The initiating visit is billed separately, as required by the Centers for Medicare & Medicaid Services.
Understood Care makes this process simple by handling your initiating visit over the phone or through video, so there’s no need to travel or attend in person. Our professional nurses and advocates are trained to provide advanced support remotely, ensuring you receive high quality, personalized care from home. If you have a Medicare supplemental plan, you pay $0 out of pocket for this service.
Consent and one billing practitioner per month
Your consent is required before services begin. Understood Care is free for most patients with Medicare. If there is any cost, we will tell you before your first session and you will never receive a surprise bill. Only one practitioner can bill CHI for you each month.
What is Medicare’s Community Health Integration (CHI) and Who Qualifies? — Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources
What CHI Includes Each Month
CHI is flexible and tailored to your needs. With Understood Care, you have a team of Advocates and clinicians supporting you.Common elements include
A person centered assessment to understand your goals, strengths, and barriers
A care plan focused on resolving the specific barriers that affect your medical care
Coordination with clinicians, pharmacies, and community programs
Coaching on how to ask questions and advocate for yourself at visits
Navigation training so you can use portals, schedule appointments, and understand referrals
Not every element is required every month. Your team provides what is reasonable and necessary for you at that time.
Who Provides CHI
In short: Who Provides CHI: CHI is delivered by Understood Care using trained auxiliary personnel such as patient advocates, community health workers, and registered nurses, under the general.
CHI is delivered by Understood Care using trained auxiliary personnel such as patient advocates, community health workers, and registered nurses, under the general supervision of the practitioner who billed the initiating visit. All personnel are employed by Understood Care and coordinate directly with your clinic. Understood Care performs all documentation of activities and time.
How CHI Is Delivered
In short: With Understood Care, Community Health Integration is delivered by phone and video, so you receive high quality, personalized support from the comfort of your home.
With Understood Care, Community Health Integration is delivered by phone and video, so you receive high quality, personalized support from the comfort of your home. These services are classified as care management outside the Medicare tele-health list and can be covered when furnished through telecommunications technology.
Costs With Original Medicare
In short: After you meet the Part B deductible, you typically pay 20 percent coinsurance for CHI.
After you meet the Part B deductible, you typically pay 20 percent coinsurance for CHI. Understood Care provides the clinician and will review any costs with you before your first session, with no surprise bills. For current details and examples, visit https://understoodcare.com/care-types/lower-costs-of-medication.
Relationship to Social Determinants of Health Screening
In short: Relationship to Social Determinants of Health Screening: Many people first learn about CHI during a social determinants of health risk assessment.
Many people first learn about CHI during a social determinants of health risk assessment. This is a brief screening that checks for non medical needs like food, transportation, or housing issues. If needs are identified, you may be referred for CHI and or Principal Illness Navigation.
What is Medicare’s Community Health Integration (CHI) and Who Qualifies? — Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources
CHI Versus Other Medicare Care Management Services
In short: CHI Versus Other Medicare Care Management Services: It helps to know how CHI compares to related services.
It helps to know how CHI compares to related services.
Principal Illness Navigation PIN supports people with one serious, high risk condition that is expected to last at least three months and may require frequent plan adjustments or caregiver support. CHI focuses on resolving non medical barriers that limit your ability to follow medical care. Some people receive both, as long as time is not double counted and services address different needs.
Chronic Care Management and Principal Care Management focus on medical coordination and care plans for chronic conditions. These may be used with CHI when appropriate, again without double counting staff time.
Billing Notes You May Hear From Your Clinic
In short: Billing Notes You May Hear From Your Clinic: You do not need to know billing codes to receive help.
You do not need to know billing codes to receive help. They can be useful when speaking with billing staff. Understood Care will share any information you want, including codes, estimates, and documentation, with full transparency.
Clinicians bill CHI using national HCPCS codes. G0019 describes the first 60 minutes in a month and G0022 describes each additional 30 minutes.
Rural Health Clinics and Federally Qualified Health Centers can provide CHI. CMS materials explain how these centers report CHI and other care management services.
How to Get Started
In short: How to Get Started: Call (646) 904-4027 or sign up at https://app.
We will schedule an initiating call to address the medical problem affected by your social needs. You should bring a short list of barriers and goals.
Give consent. Understood Care will confirm your coverage and any costs and introduce your CHI team, including the overseeing clinician and dedicated advocates.
Understood Care will also keep a simple record of calls, visits, and changes so we can tailor support each month.
What is Medicare’s Community Health Integration (CHI) and Who Qualifies? — Learn how Medicare Part B’s CHI addresses social barriers to care, who qualifies, costs, and how it differs from PIN, with links to official Medicare sources
Frequently Asked Questions
In short: Frequently Asked Questions: Can CHI help me if I have multiple needs Yes.
Can CHI help me if I have multiple needs Yes. Your Understood Care team can address the needs that are most limiting your care and adjust the plan as new barriers are identified.
Do I need a new referral every month No. After the initiating visit and consent, services can continue monthly as long as they are reasonable and necessary.
Is CHI covered if I only talk by phone Yes. CHI can be furnished using telecommunications technology. It is still covered as care management.
References
In short: References: Medicare.gov community health integration services coverage pagehttps://www.medicare.gov/coverage/community-health-integration-servicesMedicare.gov social determinants of health risk assessment coverage pagehttps://www.medicare.gov/coverage/social-determinants-of-health-risk-assessmentCMS Health Related Social Needs Frequently Asked Questions, updated 2025https://www.cms.gov/files/document/health-related-social-needs-faq.pdfCMS CY.
This content is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for personalized care.
Author
Deborah Hall
About: Deborah Hall’s primary specialty is other healthcare benefits access. She helps people apply for coverage, clears questions, and connects them to programs fast.
Nutrition and food security
Housing
Community and Peer Support
Health literacy
Provider Access
Home safety access
Transportation
Medication access
DME access
Other healthcare benefits access
Other healthcare navigation
How we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat — state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
AI-assisted disclosure: This article is AI-assisted drafting, human reviewed — every published sentence was reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: What is Medicare’s Community Health Integration (CHI) and Who Qualifies? — reviewed by the Understood Care Editorial Team.
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