Including Community Health Workers (CHWs) in State Health System Transformations

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Will statewide CHW certification help advance CHW inclusion?

State health system transformations may create new sustainable financing mechanisms and CHW employment opportunities. It is important for CHW stakeholders to connect with state-level planning groups, so that they can promote CHW engagement and, when appropriate, leverage CHW certification as support for increased inclusion of CHWs.

Potential actions for stakeholders
  • Reviewing CDC technical assistance [PDF – 515 KB] on strategies for including CHWs in healthcare systems and teams
  • Identifying opportunities to add the CHW workforce as a priority in state-level public health plans
  • Determining if CHW certification could help advance CHW payment under the state Medicaid program—for example, in certain circumstances or in certain settings
  • Participating in state-level groups working to advance value-based care and assessing the potential of a statewide CHW certification process to support CHW inclusion in new models of care
  • Considering how existing certification programs could be provided to CHWs in Federally Qualified Health Centers and publicly funded health programs and interventions

Case examples

  • A group of health professionals at a conference table.

    CHW stakeholders should consider connecting with state-level planning groups so they can promote CHW engagement.

    Rhode Island has integrated CHW certification into its healthcare redesign and workforce development plan. Certified CHWs are engaged as community liaisons within Rhode Island Health Equity Zones (HEZs) to link patients to evidence-based chronic disease programs.

    In 2017, the Rhode Island Department of Health reported that many HEZ residents were taking advantage of the new statewide CHW training and certification programs. In addition, Federally Qualified Health Centers in Rhode Island have begun including certified CHWs in their administrative oversight teams.

  • As part of its healthcare reform, Oregon has created Coordinated Care Organizations (CCOs), which are required to employ CHWs or other traditional health workers. Medicaid financing for CHWs in Oregon was made available through implementation of the state plan amendment that created the CCOs.Oregon authorizes certified CHWs to apply for a National Provider Index number in order to become an Oregon Medicaid provider and bill Medicaid. Stakeholders have reported some confusion around billing for CHWs in CCOs, but this is likely to be resolved through technical assistance.
  • The New York State Department of Health is participating in the State Health Innovation Plan workgroup to assess the support for CHW certification and inclusion of CHWs in health plans in New York.
  • In Connecticut, Senate Bill 126, which passed in June 2017, tasked the director of the State Innovation Model, in collaboration with the Connecticut CHW Advisory Committee, to complete a study on the feasibility of establishing statewide CHW certification and the fiscal impact.