Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States

Authors: Cason D. Schmit, JD; David J. Washburn, ScD; Megan LaFleur, MPH; Denise Martinez, MPH; Emily Thompson, MHA; and Timothy Callaghan, PhD
Year: 2022
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies
Evidence Generation: Documentation of how CHWs can work within care teams
Policy: General language around CHW WD, Legislative language
Sustainable Financing: [CDC] 1305/1422 and now 1815/1817 funding, CMS and CDC engagement from a national level, General other, How to engage and work with Medicaid, Billing/CPT codes, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models, National-level guidance

A 2016 review of state CHW laws conducted by the Centers for Disease Control and Prevention (CDC) revealed that states have taken various approaches to using laws to establish funding mechanisms for CHW services. States can establish funding mechanisms for CHWs in laws in numerous ways, including grants, state programs, Medicaid reimbursement, or other social service or entitlement programs. Not all of these funding mechanisms are created equal. Grants and other programs that depend on annual or periodic appropriations are often less reliable for ongoing sustainability than social service entitlement programs such as Medicaid. In this rapidly evolving CHW field, this research updates and expands on the CDC review of CHW funding laws from 2016. Specifically, it examines whether states are funding CHWs to perform specific activities or excluding CHWs from overtime compensation, in addition to identifying general types of funding mechanisms (eg, Medicaid).

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