Committed to improving the health and well-being of all people across every state.

State Community Health Worker Policies

Community health workers (CHWs) played a key role in reaching and supporting communities — particularly those that experience health disparities — during the COVID-19 pandemic. The value of this frontline public health workforce, which includes tribal community health representatives and promotores, was magnified during the pandemic. State, federal, and local partners are increasingly recognizing the value of ongoing partnership with CHWs to meaningfully bridge state and community divides and intentionally address health and health-related inequities. States are building sustainable financing approaches to increase access to CHW supports. An increasing number of states are authorizing Medicaid reimbursement for CHW services, and many are pursuing braided funding approaches — leveraging Medicaid authorities and other grant funding to create sustainable financing models that cover the array of CHW activities.

The information below was collected through a combination of state surveys and NASHP staff research. It offers a snapshot of how states are defining, training, certifying, and paying for the CHW workforce — as well as how states are developing cross-agency and state-to-local strategies to improve community health in partnership with CHWs. This is a dynamic policy space, and many states are continuing to develop new approaches. For the latest information, please email Elinor Higgins.

State Overviews

Explore each state's policies and partnerships that support a sustainable CHW workforce. Use the dropdown below to see how each state is defining, training, certifying, and paying CHWs.
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ACO – Accountable care organization

AHEC – Area Health Education Centers

APHA – American Public Health Association

APM – Alternative payment model

CBO – Community-based organization

CDC – Centers for Disease Control and Prevention

CDC CCR FundingCommunity Health Workers for COVID Response and Resilient Communities Funding

CHR Community health representative

CHW – Community health worker

CPT Codes – Current Procedural Terminology Codes

C3 Project CHW Core Competency Project

FFS – Fee for services

HCSPCS Codes – Healthcare Common Procedure Coding System Codes

HRSA – Health Resources & Services Administration

MCO – Managed care organization

NACHW National Association of Community Health Workers

SDOH – Social determinants of health

VBP – Value-based payment

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State CHW Definition: This category indicates where states have a formal definition of a CHW. In some cases, where there is not a definition in statute, this category may draw information from provider manuals and state websites or reports. 

Certification and Training: This category includes information about how CHWs are trained in the state, which entities provide training, whether or not the state runs or recognizes a CHW certification program, and information about the entities that administer existing certification programs.

Medicaid Reimbursement: This category includes information about state Medicaid strategies that provide enrollees access to CHW services. Entries indicate whether state Medicaid programs currently reimburse for CHW services or incorporate CHWs into alternative payment models under the authority of a state plan amendment (SPA), or where states have earmarked funds to support CHW services under the authority of an 1115 demonstration waiver. It also indicates where CHW services might be supported through managed care approaches (e.g., where MCOs are paying for CHW services using administrative dollars or where states are using managed care contracts to incentivize or require MCOs to cover CHW services).

Other Funding or Financing Mechanisms: This category includes information about other state funding or financing approaches that cover CHW services or CHW positions. It includes information about federal grant dollars for which the state is the grantee.

Key Partnerships: This category offers information about key partners outside state government, including state CHW associations and CHW training entities, and highlights formal cross-agency partnerships within the state that support alignment of funding and resources for the CHW workforce.

State CHW Legislation: This category highlights any state legislation relevant to the CHW workforce. This might include statutory language directing agencies to develop a Medicaid reimbursement approach, laws that established state CHW certification, or other relevant statutes.

State Resources: This category offers links to any key reports or resources that states elected to highlight as critical to CHW policy and partnership. 

Map

States are using a variety of approaches to pay for CHW services, including Medicaid state plan amendments (SPAs), 1115 demonstration waivers, and managed care organization (MCO) approaches. Select the approach you’re interested in from the dropdown below to see which states are using that approach.

Chart

The chart below offers more details on state CHW models, including state definitions, certification and training, Medicaid reimbursement, other funding mechanisms, key partnerships, and state legislation. Use the dropdown below to select the topic you’re interested in.

Acknowledgements

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.

Thanks to Carl Rush, principal consultant for Community Resources, LLC. for his contributions to this resource.

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