Charting the Course for Community Health Workers: Identifying Challenges and Opportunities to Secure Medicaid Reimbursement for CHWs in State Medicaid Programs

Improved integration of the community-based health care workforce, such as community health workers (CHWs), is an evidence-based, cost-effective way to help communities. Through their work, CHWs aim to help address challenges in accessing critical health and social services that can improve health and well-being while lowering overall health care costs. Uniquely position within the community, CHWs are able to help patients address the social factors that drive negative health outcomes by providing culturally congruent care, health education, care coordination for patients with chronic health conditions, and advocacy for patients navigating the complexity of the health care system.

Unfortunately, despite the important role that they play in our communities, CHWs have not been able to access a sustainable source of funding. Strengthening funding for CHW services remains a challenge that requires a “braided” approach, leveraging and improving upon multiple funding sources to ensure CHWs can continue to serve communities and individuals. As our nation’s largest health insurance provider, funding through Medicaid offers a unique opportunity to both expand access to CHW services for patients and provide greater sustainability to the community health workforce.

To better understand how CHWs are affected when Medicaid programs cover their services, Families USA conducted two listening sessions with 14 CHWs across 11 states. The listening sessions surfaced key insights into how CHWs and the organizations that employ them are paid for services, the shortcomings and benefits of Medicaid reimbursement for CHW services, and innovative ideas for how to design Medicaid payments to better leverage the important and unique role that CHWs play in the health care system.

To learn more about the key insights and our recommendations for how to improve the existing health care payment and delivery system, read the full analysis for more.