This information was collected through a combination of state surveys and NASHP staff research. It offers a snapshot of how the state is defining, training, certifying, and paying for the CHW workforce — as well as how the state is developing cross-agency and state-to-local strategies to improve community health in partnership with CHWs.
This is a dynamic policy space, and states are continuing to develop new approaches. We will continue to make periodic updates to this page. Learn more about state CHW policies across the U.S.
State CHW Definition
The North Carolina Department of Health and Human Services Office of Rural Health website uses the APHA definition of CHWs.
State CHW Governance
North Carolina has a dedicated office of CHWs. The North Carolina Community Health Workers (CHW) section sits within the Office of Rural Health and provides a dedicated area for community health workers and allies to access information at the local, state, and national levels. It also serves as the home for the North Carolina CHW Alliance and hosts a compendium of resources, events, and news about opportunities for certification, core competency training, and specialty training offerings.
Certification and Training
The North Carolina CHW Association (NCCHWA) operates a Standardized Core Competency CHW training program at a number of community colleges across the state that are rooted in the National C3 Council competencies. CHWs who complete this course are eligible for certification through NCCHWA. Additionally, NCCHWA offers a legacy track for certification, which honors the lived experience of CHWs. NCCHWA also includes four levels of supervisory certification.
The North Carolina Department of Health and Human Services (NCDHHS) also provides a variety of optional self-paced free virtual training modules developed in partnership with NC AHEC. These NC AHEC training modules, along with others offered by different partners across the state, are collected through data reporting for the CDC Community Health Workers for COVID Response and Resilient Communities (CCR) initiative.
Medicaid Reimbursement
As part of North Carolina’s section 1115 demonstration waiver, “North Carolina Medicaid Reform Demonstration,” the state will provide training and certification supports as well as recruitment and retention bonus payments to eligible providers, including CHWs, who make a 3-year full-time commitment to working at an organization with a panel that includes at least 30 percent Medicaid and/or uninsured members under the Behavioral Health and Long-Term Services and Supports Workforce Program.
CHWs are explicitly permitted to be part of the care management team in managed care via the Medicaid Standard Medicaid Plan and Tailored Plan contracts. Additionally, CHWs are permitted to assist in administering Healthy Opportunities Pilot care management services.
Other Funding or Financing Mechanisms
The North Carolina Department of Health and Human Services Office of Rural Health received funds from the CDC Community Health Workers for COVID Response and Resilient Communities (CCR) initiative to support CHW training and certification programs.
Key Partnerships
The North Carolina CHW Association (NCCHWA) and the North Carolina AHEC are key partners of the state. The North Carolina Community Health Center Association is also involved in integrating CHWs into health care teams. Partners such as University of North Carolina at Pembroke and Partners In Health support evaluation efforts.
State CHW Legislation
North Carolina Administrative Code 10A 48B.0803 states that the local health department shall ensure that program planning and implementation involve community health advocates that represent populations being served in the local health department.
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 Funding – Community 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
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.
