Momentum for Community Health Workers in Medicaid Continues in the New Year

For some good news to start 2024, the gains for community health workers (CHWs) in the Medicaid world continue to increase. We’ve written about the value of Medicaid as a sustainable funding source for CHW services and growing efforts in states previously here on Say Ahhh!…but wait, there’s more!

Michigan has integrated CHWs in targeted case management, health homes, and managed care contract requirements for nearly a decade, but as of January 1, 2024, CHW services are now reimbursable through Medicaid. Their approved state plan amendment (SPA) can be found here. CHW services eligible for reimbursement will include health system navigation and resource coordination, health promotion and education, and screening and assessment.

Changes are also brewing in Colorado. SB23-002, which was passed and signed into law last spring, directs the state Medicaid agency to seek approval from CMS no later than July 1st of this year to provide reimbursement for CHW services.

While CHWs are often focused on adult populations or specific condition groups, research has been growing on the use of CHWs for the improvement of maternal and child health. Researchers in Arizona examined Health Start, a statewide CHW home visiting program focused on maternal and child health that connected clients to prenatal care, provided education and screening for behavioral and social needs, and supported care continuity during and after pregnancy. The study found that the home visiting intervention reduced rates of low to extremely low birth weight and preterm births, noting that even improvement in birth weight  for a small number of infants can equate to large healthcare cost savings. Adding to this work, CCF’s recent report on maternal and infant mental health during the 12-month postpartum period, discusses the importance of a community-based workforce, including CHWs, doulas, peer supports, and the gap that they could be leveraged to fill in supporting pregnant and postpartum mothers and their babies.

To help you keep track of the latest across the country, the National Academy for State Health Policy (NASHP) recently updated their tracker of state CHW policies. Their interactive map allows you to see if the state is using a SPA or an 1115 waiver for Medicaid coverage of services, or whether they are leveraging MCOs to increase the availability and utilization of CHWs. A new chart below the interactive map also displays state CHW definitions, reimbursement, relevant legislation, and more. We are excited to follow along as more states across the country include and integrate CHWs in their Medicaid programs through 2024 and beyond.

Natalie Lawson is a Senior State Policy Analyst at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.