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

Authors: Rush C, WIlkniss S, Higgins E
Year: 2022
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Policy: Building partnerships, Lessons learned from other states, MCO contract language and reimbursement models
Sustainable Financing: 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, Reimbursement TA for FQHCs Medicaid etc.

This brief provides an overview of recent developments in Medicaid State Plan Amendments (SPAs). States can use SPAs to shape Medicaid benefits to address enrollee needs and reimburse for CHW services as part of a sustainable financing approach. With a SPA, benefits must be offered statewide and without targeting populations. Twenty or more states have also used Section 1115 demonstration waivers and Medicaid managed care organization (MCO) contracts for similar purposes — each of these approaches has opportunities and limitations.

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