7 Elements of Successful Community Health Worker Integration
Several Medicaid programs have taken various approaches to integrating community health workers into their coverage policies and services.
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- Medicaid programs are leveraging community health workers (CHWs) to improve patient navigation, quality of care, and cultural competency, a Manatt Health newsletter found.
“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,” the newsletter explained.
“This trend has continued nationwide in Medicaid programs, with at least 29 states, including Washington, DC, reimbursing CHWs for services provided to Medicaid members.”
The writers explored how five states leveraged CHWs and offered program design elements of successful CHW partnerships.
California has used multiple reimbursement channels for CHWs, including Enhanced Care Management (ECM), a Medicaid benefit for beneficiaries with complex needs, and Community Supports, which are covered services that address social determinants of health (SDOH). Both programs may employ CHWs.
The state also initiated a Medicaid program overhaul in 2022 that, in part, sought to integrate CHWs better. Later that year, CMS green-lighted the state to cover CHW services for those with chronic diseases or who had experienced violence or trauma.
In Michigan, managed care plans must provide at least one full-time CHW equivalent for every 5,000 Medicaid members and incentivize plans to partner with CHWs specifically. CHWs may become a covered managed care benefit if CMS approves Michigan’s preventive services state plan amendment (SPA).
Contractually, CHWs, as well as community health representatives and certified peer support workers, serve at least 3 percent of beneficiaries in each of New Mexico’s managed care contracts. This share increases each year.
Oregon has a statewide registry of CHWs and other traditional health workers. Medicaid managed care organizations can integrate traditional health workers, including CHWs. Plans have to report on the utilization, integration, and payment of traditional health workers.
Lastly, the state of Washington incorporates CHWs in the home health program and covers CHWs and health navigators through a grant program. Medicare Advantage plans also have adopted this approach to overcome some technological challenges that members face.
Manatt Health experts urged Medicaid programs considering improvements to their CHW integration to keep certain considerations in mind. First, they should assess why they want to use CHWs. Second, they should conduct a landscape assessment to familiarize themselves with how CHWs operate in their states.
Third, Medicaid agencies will have to decide whether to establish their programs through Medicaid managed care contracts or preventive services SPAs. As part of this decision, they should determine how they plan to fund CHW initiatives, whether CHWs will need to become Medicaid providers, and what supervision CHWs will need.
Fourth, the agencies may want to target certain beneficiary populations for their CHW interventions. Fifth, they will want to decide what services the CHWs can deliver. Additionally, states should establish training requirements for CHWs with whom they partner, leveraging existing training guidelines and potentially implementing new certification processes.
Finally, states need to determine monitoring and oversight policies. These policies might include a plan for deploying CHWs, regular check-ins, and quality measures.
CMS has made various avenues for CHW integration available. In 2022, the agency issued guidance on leveraging home health CHWs to serve children with complex care needs.
