Community health workers (CHWs) are individuals with strong ties to the communities they serve and in which they often reside, providing a range of services addressing the health and social needs of their clients. CHWs can facilitate connections and greater trust between the community and health care systems. They may also be members of communities that are typically underrepresented in health care settings and can have an important role in promoting health equity. However, Medicaid coverage of services provided by CHWs is limited.
A review of publicly available information conducted by MACPAC in 2021 identified at least 21 states that provide Medicaid payment for certain CHW services, in their state plan or under managed care arrangements. In most cases, state Medicaid programs allow coverage of a limited range of CHW-provided services or limit CHW services to specific populations.
This issue brief begins with an overview of the various types of CHWs and the services they provide. It then reviews selected studies documenting the effects of CHW programs on health outcomes and costs. The brief describes state approaches to covering CHW services in Medicaid, including the various authorities they use to provide Medicaid payment, the services they cover, the populations served, and training and certification requirements.
