Medicaid Managed Care Organizations and Community Health Workers (CHWs)
State: NatDoc: National Document
Publicly Available: Yes
Billing and Reimbursement:
Certification: CHW role scope of practice
Policy: General other, MCO contract language and reimbursement models
Sustainable Financing: General other, How to engage and work with Medicaid, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models
Managed Care Organizations (MCOs) are increasingly engaging community health workers (CHWs) (including workers with other titles under the CHW umbrella such as community health navigator, peer educator, outreach specialist, etc.). MCOs have voluntarily implemented CHW programs in some cases and have been required to do so by state contracts in others. This document is NACHW’s MHPA 2-pager.