The community health worker (CHW) workforce saw an infusion of funds during the COVID-19 pandemic from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and American Rescue Plan of approximately $300 million and $200 million, respectively. Other federal entities like the National Institutes of Health (NIH) awarded grants to complement state efforts, all with the intention of linking communities with vaccines and other important public health information during the global pandemic.
But what happens when these funds run out? And what does it mean for this freshly trained CHW workforce?
A recent report from Politico highlighted the growing gap between the number of trained CHWs and the number of jobs available. Even rarer still are CHW jobs with sustainable funding sources. Politico’s report highlighted that the North Carolina Community Health Worker Association has already had to lay off hundreds of workers and have been meeting with state lawmakers to explore options for permanent funding.
As we’ve written about previously, funding for CHW roles and services is a patchwork of sources that include private funding, hospital system funding, government grants, and more. As a permanent and flexible program, Medicaid is an important avenue for sustainable funding for CHW services. According to the National Academy of State Health Policy, approximately half of states allow for Medicaid reimbursement of CHWs or allow for MCOs to hire or reimburse for CHW services, and the trend is growing.
For example, a health system in Tennessee is in talks with the Medicaid agency and managed care organizations about offering reimbursement through the state program following years of funding CHWs with health system funds, grants, and participation in the Medicaid Transformation Project. Connecticut is considering a bill (SB991) that would direct the state to amend their state plan to reimburse for services by CHWs. Covered services listed in the bill are broad and include “coordination of medical, oral and behavioral health care services, health systems navigation, self-management education, and prenatal, birth, lactation and postpartum supports.” The range of covered services for CHWs in Medicaid can vary widely and is often limited to chronic disease management, so the inclusion of maternal health supports in the Connecticut proposal is exciting to see for us here at CCF.
While it is exciting to see more states seeking CHWs to address maternal health, there appears to be much room for improvement in deploying CHWs beyond chronic care to support children and their families. A few states offer potential: Minnesota allows CHWs to be reimbursed as home visiting providers and Washington lawmakers dedicated state funds to pilot the use of CHWs in pediatric primary care, seeking federal match through the state’s waiver application currently pending at CMS. While these are bright spots, there is likely more to be done to consider the role CHWs can play in ensuring children and their families access the right care at the right time, helping states to realize EPSDT’s full potential to support healthy childhood development. As states consider Medicaid as a tool to increase sustainable funding, the role and greater potential of this workforce in child and family health should also be considered.
We are just at the beginning of understanding the potential reach CHWs have to more effectively serve families in their communities. CHWs offer important potential to ensure the health system is family- and community-driven and promotes health equity. As pandemic-era funding of CHWs dwindles, states, localities, and other health entities will need to find alternatives to fund – and ideally grow – this workforce, or continue to face layoffs and loss of resources in communities. Though not a silver bullet, Medicaid can be an important tool to sustain and grow the CHW workforce as the future of federal funding becomes increasingly uncertain.