Medicaid Reimbursement for CHW Services: Model State Plan Amendment & Other Guidance

Medicaid Reimbursement for Community Health Worker Services: Model State Plan Amendment & Other Guidance

Overview

Community health workers, promotores, and community health representatives (CHW/P/CHR) address health-related social needs through resource navigation, peer social support, health coaching, and advocacy. A large body of research suggests that well-designed CHW/P/CHR programs improve chronic disease control and mental health, promote healthy behaviors, reduce hospitalizations, and increase participation in primary care. CHW/P/CHR programs have historically relied on a patchwork of grants for funding, but more than half of state Medicaid programs have now implemented some form of CHW/P/CHR coverage and payment policy. This toolkit provides model language for state Medicaid leaders and CHW/P/CHR advocates to use as they develop State Plan Amendments and accompanying guidance documents to establish coverage and payment for CHW/P/CHR services. 

To learn more CLICK HERE