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 Texas Department of State Health Services (DSHS) CHW certification website defines a CHW as someone who “with or without compensation is a liaison and provides cultural mediation between health care and social services, and the community. A promotor(a) or [CHW] is a trusted member, and has a close understanding of, the ethnicity, language, socio-economic status, and life experiences of the community served. A promotor(a) or community health worker assists people to gain access to needed services and builds individual, community, and system capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, patient navigation and follow-up, community health education and information, informal counseling, social support, advocacy, and participation in clinical research.”
Texas Health and Safety Code Chapter 48 defines a CHW or promotora as “a person who, with or without compensation, provides a liaison between health care providers and patients through activities that may include activities such as assisting in case conferences, providing patient education, making referrals to health and social services, conducting needs assessments, distributing surveys to identify barriers to health care delivery, making home visits, and providing bilingual language services.”
State CHW Governance
Texas has a dedicated state office of CHWs. The Community Health Worker (CHW) or Promotor(a) Training and Certification Program is part of the Texas Department of State Health Services, Health Promotion and Chronic Disease Prevention Section.
Certification and Training
Certification is required for any CHW that receives compensation in Texas, per Texas Health and Safety Code Chapter 48. Texas Department of State Health Services continues to operate the Community Health Worker (CHW) or Promotor(a) Training and Certification Program, which trains and certifies CHWs and CHW instructors. Many trainings are offered in English and Spanish.
Medicaid Reimbursement
As of 2023, Texas Medicaid managed care organizations may categorize CHW expenditures as quality improvement costs under HB113.
Texas HB 1575, which passed during the 2023 regular session, requires the Department of Health and Human Services to establish a Case Management for Children and Pregnant Women Medicaid benefit.
Case managers may be registered nurses, social workers, doulas, or CHWs and help people access needed support such as medical, educational, or social services.
Other Funding or Financing Mechanisms
The Texas Department of State Health Services (DSHS) and the Texas Association of Promotores and CHWs conducted a 2020 CHW Statewide Employer Survey to understand the role, training, funding, and job scope of CHWs across worksites and employers. Of the 137 respondents:
- 27 percent said their organizations received funding from the Centers for Medicaid and Medicare Services.
- Title X funding, Title V funding, Department of Housing and Urban Development, Substance Abuse and Mental Health Services Administration were also cited as funding sources.
- 25 percent said their organizations received state grants.
- 24 percent said their organizations did not receive any state funding.
- Over half of respondents said their organizations either did not use any private sector funding to pay for CHWs or they were not sure if they used private sector funding.
Key Partnerships
The CHW Advisory Committee was established in 2011 to advise the Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission on the implementation of standards, guidelines, and requirements relating to the training and regulation of persons working as promotores or CHWs.
The Texas Association of Promotores and Community Health Workers (TAPCHW) was established in 2019. TAPCHW collaborates with community organizations and the Texas Promotora/Community Health Worker Training and Certification Advisory Committee (supported by DSHS) to support CHW work and opportunities in Texas.
State CHW Legislation
Texas Health and Safety Code Chapter 48 provides authority to the Texas Department of State Health Services to establish and operate a certification program for CHWs.
HB 113 was enacted in 2023 and allows Medicaid managed care organizations to categorize CHW expenditures as quality improvement costs.
HB 1575, passed during the 2023 regular session, for purposes of enrollment as a provider and reimbursement under Medicaid, requires the Health and Human Services Commission to establish a separate provider type for a CHW who provides case management services under the Case Management for Children and Pregnant Women Program.
State Resources
- Texas Department of State Health Services CHW or Promotor(a) Training and Certification Program: The program provides three types of certifications, assists the CHW Advisory Committee and provides resources, reports, articles, and research materials to assist current and future CHWs.
- DSHS-certified CHW/P training programs
- Texas Association of Promotores and Community Health Workers
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.
