Headline
This toolkit provides key considerations and templates for state Medicaid leaders seeking to establish coverage, payment, and policy guidance for community health workers (CHWs).
Background
As trusted individuals who share life experiences with the people they serve, CHWs address health-related social needs (HRSN) by providing navigation, advocacy, and direct support to underserved communities. Grounded in principles of inclusion, empowerment, and evidence, this toolkit offers model language that states can incorporate into their Medicaid state plan amendments to establish coverage and payment mechanisms for CHW services.
About this Tool
The toolkit includes the following sections:
- CHW State Plan Amendment Model Text: Includes options for language that state Medicaid agencies can use to define CHW services, eligible populations, and related billing, supervision, delivery location, and documentation requirements.
- CHW Model Text Rationale: Provides references and state examples to support the model language suggested in the toolkit for state plan amendments.
- Principles of CHW Reimbursement Rates: Shares considerations for states interested in creating or adjusting the payment rates offered for CHW services.
- Glossary: Offers definitions for key terms used throughout the toolkit such as service initiation, services covered, and duration of services.
The toolkit also references research on CHW programs and highlights select state requirements for training and certification.
Policy/Program Takeaways
State Medicaid leaders can use this toolkit to develop inclusive policies, establish coverage and payment for CHW services, and ensure sustainable funding to make evidence-based decisions.