We’ve written about several of the exciting health provisions in the Consolidated Appropriations Act of 2023 that was signed into law in December here on Say Ahhh!: to recap, Joan Alker wrote about the permanent mandatory 12-month continuous eligibility requirement and other important provisions, Tricia Brooks detailed the new guardrails and transparency requirements as states prepare for the unwinding of the Medicaid continuous coverage provision, Maggie Clark wrote about the permanent postpartum coverage state option and workforce investments to support maternal health, Edwin Park covered Medicaid funding for Puerto Rico and the territories, and Anne Dwyer unpacked the new law’s mental health provisions. CCF also published a brief explaining all of the Medicaid and CHIP provisions.
In addition to all of these important changes, the law also strengthened language and authorized $50 million annually for fiscal years 2023 through 2027 for community health workers (CHWs), who are a vital and growing part of the healthcare workforce.
“Community health worker” is a broad term for a trusted frontline public health worker who supports individuals and families in communities, providing information or linkages to needed resources and helping to facilitate improved quality and cultural competence of service delivery from current health and social service systems. In some states, CHWs are reimbursed by Medicaid to provide services such as patient education and health navigation.
Generally, the new law shifts the language of the Public Health Service Act toward recruiting, hiring, training, and retaining a CHW workforce that reflects the needs of communities. Specifically, Section 2222 of the law directs the HHS Secretary to award grants, contracts, and cooperative agreements to “promote positive health behaviors and outcomes for populations in medically underserved communities by leveraging community health workers, including by addressing ongoing and longer-term community health needs, and by building the capacity of the community health worker workforce.”
The law directs this future funding towards community health workers who provide education and outreach to medically underserved communities and other at-risk populations, including people living in geographic areas that may require additional support during future public health emergencies. The law specifies that priority in grant-making decisions by the Secretary should be given to CHWs serving communities with high rates of infant mortality, high rates of maternal morbidity and mortality, and in medically underserved areas, as well as racial and ethnic minority populations and rural populations. The statutory language also includes specific mention of the role of community health workers in addressing health disparities and promoting resources that increase access to mental health and substance use services, child services, housing services, educational and employment services, technology, and more.
While often serving adults with chronic conditions, the broad nature of ways entities can use these funds to develop a CHW workforce to meet equity or health access goals alongside growing state traction in using Medicaid to fund CHW services raise an important question: In what ways can CHWs be deployed and targeted to help children and postpartum parents in ensuring access to needed care and supports? For instance, Washington state’s Medicaid program received state funding to pilot use of CHWs in pediatric primary care settings, and is requesting matching funds for the pilot through its pending 1115 waiver application currently under federal review.
Washington’s pilot offers a means to better learn how states can target CHWs to provide preventive services as part of pediatric primary care teams or home visiting teams with Medicaid funds. CHWs can also help states more effectively support underserved communities through relationships with trusted community members who bring knowledge and experience with communities’ unique experiences and cultures, offering potential to live up to the goal of child- and family-centered care.
The multi-year authorization for CHWs in the law is a promising boost to CHW workforce funding nationally that comes on the heels of a large one-time investment in the American Rescue Plan Act for the Community Health Worker Training Program. However, the patchwork of funding from Medicaid reimbursement and grants will continue to pose sustainability challenges for this workforce. CHWs have long played an important role in the healthcare landscape, and the inclusion of this provision in the Consolidated Appropriations Act of 2023 indicates the federal government’s increasing, and hopefully continuing, recognition of the value of this workforce.