What Are the Roles of Community Health Workers in Medicaid Managed Care? Results from a National Study

Authors: Ashley Wennerstrom, PhD, MPH, Catherine G. Haywood, BSW, CHW, Denise O. Smith, MBA, CHW, PN, Dakshu Jindal, MA, Carl Rush, MRP, and Geoffrey W. Wilkinson, MSW
Year: 2022
State: NatDoc: National Document
Website link: https://nachw.org/wp-content/uploads/2023/03/Wennerstrom-2022-Roles-of-CHWs-in-MCOs.pdf
Publicly Available: Yes
Certification: CHW role scope of practice
Evidence Generation: Documentation of how CHWs can work within care teams
Policy: MCO contract language and reimbursement models
Sustainable Financing: Expand evidence base, How to engage and work with Medicaid, Including community-based CHWs, MCO or bundled payment reimbursement models, Documentation of how CHWs can work within care teams, Evidence-based interventions
Workforce Development: CHW training programs (not cert.), General other (including mention of “employment practices”), Training- Content modes delivery

Managed care organizations (MCOs) are increasingly engaging community health workers (CHWs) to support service delivery for their members, particularly in the realm of social determinants of health. Some states now require MCOs to offer CHW services. Although the roles and activities of CHWs working in other contexts (eg, clinics, hospitals, community-based organizations) are well established, there is sparse knowledge about how MCOs are operationalizing CHW roles and whether CHW activities differ based on whether CHWs are employed directly by MCOs or contracted through other organizations. In 2021, 2 CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs. Respondents represented 29 states. CHWs employed by MCOs reported receiving significantly more training and benefits from their employers than CHWs who were contracted through other organizations. MCO based CHWs were more likely to support members with high-cost conditions and high service use, whereas contracted CHWs were more likely to engage in population-focused interventions, which may produce less immediately visible financial returns. Health plans would do well to ensure the CHWs they support, whether through contract or direct hiring, receive appropriate compensation and training, and have the freedom to engage in the full range of CHW roles, including community-level interventions.

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