State Approaches to Community Health Worker Financing through Medicaid State Plan Amendments

Carl Rush
Elinor Higgins
Sandra Wilkniss
December 2022
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Leveraging Medicaid State Plan Amendments (SPAs) can support sustainable funding approaches for community health workers.


Many states are actively pursuing partnerships with and investing in community health workers (CHWs) to address health-related social needs, particularly among low-income populations and in underserved communities. Medicaid plays a role in financing CHWs and this brief describes states using Medicaid SPAs as a sustainable funding source for CHW services. Medicaid SPAs can be applied statewide and not limited to certain areas or groups, as with other Medicaid mechanisms such as Section 1115 demonstration waivers.


This brief outlines state Medicaid SPAs used to cover CHW services, effective December 2022. It details covered services and special features of SPAs in 10 states including California, Indiana, Louisiana, Maine, Minnesota, Nevada, North Dakota, Oregon, Rhode Island, and South Dakota. The authors highlight trends in authorizing approaches, types of services covered (health education, health promotion and coaching, and care coordination and resource referral), payment approaches and rates, billing codes and service limits, among many other areas.


Given increased federal investment in addressing health-related social needs, many states are creating blended and braided funding strategies to more sustainably cover CHW services. This brief can inform policymakers interested in designing SPAs to support CHW services. States should consider how to engage CHW leaders in SPA development and new trends in payment approaches when developing and implementing SPAs.

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