Community health workers (CHWs) are frontline public health workers who come from and/or have deep roots in the communities they serve. Many states are leveraging CHWs to build trusting relationships with patients, including Medicaid members, to serve as a link between health and social services, to provide assistance navigating the health care system, and to improve the quality and cultural responsiveness of service delivery. The use of CHWs increased during the COVID-19 pandemic, during which states relied on CHWs to help supplement workforce shortages and build a more equitable care delivery system. In September 2022, the Biden-Harris administration announced $225 million in funds to train over 13,000 CHWs to support COVID-19 vaccination efforts and ensure trusted messengers on health care were deployed to communities in need. This trend has continued nationwide in Medicaid programs, with at least 29 states, including Washington, DC, reimbursing CHWs for services provided to Medicaid members.
This article offers examples of how states have leveraged CHWs to support Medicaid members as well as design considerations for states looking to implement CHW programs in Medicaid.
State Examples of CHWs in Medicaid
CHWs have been working with and in their communities for decades to assist with the provision of health care. Many state Medicaid programs have successfully integrated CHWs to improve the health of individuals, children, and families enrolled in Medicaid and help address unmet health and social needs. The following examples illustrate the different approaches that states have pursued to utilize CHWs to serve Medicaid members:
Design Considerations for Leveraging CHWs
The examples above demonstrate the various ways states can use CHWs to serve their Medicaid members. Since every state is different, state Medicaid programs must assess various factors when considering how to design a program that leverages CHWs to support Medicaid members. The below design components provide states with a potential framework for incorporating CHWs into their Medicaid programs.
Conclusion
CHWs have unique skills and deep connections to their communities that can be especially impactful in serving Medicaid members. States have increased their use of CHWs to address the effects of the COVID-19 pandemic and have continued integrating CHWs into their Medicaid programs as the Public Health Emergency concluded. While every state is different, the framework presented in this article is intended to help guide states interested in designing CHW programs that maximize the effectiveness of this important workforce and improve the health outcomes and patient experiences of Medicaid members.
1 The National Association of CHWs maintains a repository of state and regional CHW networks and associations by state as well as certification and training programs.