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 Ohio Department of Health website defines CHWs as “trained public health workers who serve as a bridge between communities, health care systems, and state health departments.”
Certification and Training
The Ohio Board of Nursing (OBN) issues and renews CHW certificates biennially. To be certified, individuals must be at least 18 years old, have a high school diploma, complete the CHW training program, and pass a criminal background check. Per Ohio Administrative Code (OAC) Rule 4723-26-05, all OBN-certified CHWs are required to renew their certification in March of every odd year.
Medicaid Reimbursement
The Ohio Department of Medicaid (ODM) requires managed care organizations (MCOs) to provide CHW or public health nurse services to Medicaid enrollees who are pregnant or capable of becoming pregnant, reside in a community served by a qualified Community HUB, and was recommended to receive CHW or public health nurse services by a qualified health provider (Ohio Administrative Code Rule Section 5167.173). To meet these requirements, MCOs may directly employ CHWs or contract with community-based organizations that use community health workers.
ODM offers two voluntary alternative payment models: Comprehensive Primary Care and Comprehensive Maternal Care. They provide enrolled practices with funding to support population health activities such as team-based care delivery. These funds can be used to support CHWs where they will be performing any of the program-required activities.
ODM, through the MCOs, also provides 10 communities with high rates of infant mortality and outcome disparities with biannual funding to support community-driven interventions to improve maternal and infant health. Nearly all communities use these grants to invest in additional CHW services.
Other Funding or Financing Mechanisms
A 2018 report of key findings around CHW in Ohio found that 51 percent of CHW employers report reimbursement through Medicaid, 49 percent report through Medicaid MCO contracts, and 6 percent report reimbursement through CHIP, among other sources. Most employers noted funding was not sustainable, with the exception of funding through Medicaid MCO contracts.
The Ohio Department of Health received funding from the CDC Community Health Workers for COVID Response and Resilient Communities (CCR) initiative to support and expand CHW work in the state through the Certified Pathways HUBs model.
As part of the 2023 state budget process, the Ohio Legislature added new funding to support a Community Health Worker Center of Excellence. The Center is a public-private partnership that will be administered by the Ohio Department of Health and overseen by a board that includes directors of state HHS agencies; academic institutions; representation from the Community Pathways HUBs, Ohio Community Health Worker Association, and Ohio Legislature; and at least one individual CHW (in addition to those from the referenced agencies). The Center receives $2.5 million annually to support board initiatives and work was slated to begin in fall 2023.
Key Partnerships
In 2022, OBN convened a CHW Advisory Group on certified CHWs to discuss certification, training, and CHW roles. The group includes an OBN board member; certified CHWs from public health, urban, and rural areas; and CHW educators and providers. They are tasked with providing recommendations to OBN regarding proposed revisions to administrative rules, the Nurse Practice Act, and other CHW issues, including training and continuing education units.
The Ohio Department of Medicaid and MCOs work with the Pathways Community HUBs in Ohio. The HUB does not employ CHWs directly but contracts with existing organizations that hire CHWs and their supervisors.
The Ohio Community Health Worker Association supports the workforce in Ohio.
As part of the 2023 state budget process, the Ohio Legislature added new funding to support a Community Health Worker Center of Excellence. The Center is a public-private partnership administered by the Ohio Department of Health and overseen by a board that includes directors of state HHS agencies; academic institutions; representation from the Community Pathways HUBs, Ohio Community Health Worker Association, and Ohio Legislature; and at least one individual CHW (in addition to those from the referenced agencies). The Center receives $2.5 million annually to support board initiatives and work was slated to begin in fall 2023.
State CHW Legislation
HB 95 (enacted 2003) requires OBN to issue and renew CHW certificates.
State Resources
State Overviews
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.
