November 25, 2024

Toolkit

CHW State Plan Amendment Model Text

Focus Area:

Topic:

1. (Definition) A community health worker, promotore, and community health representative (CHW/P/CHR) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

2. Population Eligible for CHW Services)

(Option 2a. Prioritizes Access) CHW/P/CHR services are available to all Medicaid beneficiaries.

(Option 2b. Prioritizes Rising Risk Population) CHW/P/CHR services are available to beneficiaries with at least two chronic conditions or at least one chronic condition and one identified health-related social need.

3. (Services Covered)

(Option 3a. Prioritizes Comprehensive Evidence-Based Services) The following services are covered when performed by CHW/P/CHRs:

Leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals.
Person-centered assessment, performed to better understand the individualized context of the intersection between the SDOH need(s) and the problem(s) addressed in the initiating visit.
- Conducting a person-centered assessment to understand a patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet SDOH needs.
- Facilitating patient-driven goal setting and establishing an action plan.
- Providing tailored support to the patient as needed to accomplish the practitioner’s treatment plan.
Facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the SDOH need(s), and adjusting daily routines to better meet diagnosis and treatment goals.
Building patient self-advocacy skills so that the patient can interact with members of the health care team and related community-based services addressing the SDOH need(s) in ways that are more likely to promote personalized and effective diagnosis or treatment.
Facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals.
Practitioner, Home-, and Community-Based Care Coordination
- Coordinating receipt of needed services from health care practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregivers (if applicable).
- Communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors.
- Coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities, or other health care facilities.
- Facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the SDOH need(s).
Health education – helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, and preferences, in the context of the SDOH need(s), and educating the patient on how to best participate in medical decision-making.
Healthcare access/health system navigation — helping the patient access health care, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them.

(Option 3b. Prioritizes Defined Service Package) Covered CHW/P/CHR services include system navigation, health promotion, and clinical support. These services include but are not limited to:

Addressing basic needs such as food and shelter
Navigating health and social systems
Assisting with enrollment in health programs and services
Coaching on problem-solving, self-care, and self-management,
Promoting understanding of health information and health education materials
Leading educational and support groups
Conducting home safety assessments
Measuring and responding to vital signs
Providing feedback to medical providers

4. (Requirements for Billing Entity)

(Option 4a. Prioritizes Evidence and CHW/P/CHR Work Environment) CHW/P/CHR program must meet state-approved accreditation standards that consider, at a minimum:

Hiring of authentic CHWs
CHW wage transparency
Use of person-centered work practices
Manageable caseloads
Adequate training, support, and supervision for CHWs
CHW career ladders

(Option 4b. Prioritizes Ease of Requirement) CHW/P/CHR program must employ individuals who have been trained on CHW core competencies, including relationship building and system navigation.

5. (Service Initiation & Supervision)

(Option 5a. Prioritizes Access & Flexibility) This standing order authorizes CHW/P/CHRs and agencies that provide CHW/P/CHR services to provide covered CHW/P/CHR services to eligible individuals.

(Option 5b. Prioritizes Access & Provider Relationships) A Medicaid-enrolled provider may establish a standing order with a contracted community-based organization that allows CHW/P/CHRs to provide covered CHW/P/CHR services to eligible individuals.

(Option 5c. Prioritizes Role of the Provider) CHW/P/CHRs must deliver services under the general supervision of a Medicaid-enrolled, licensed provider who orders CHW/P/CHR services for eligible individuals. The CHW/P/CHR may be external to, and under contract with, the practitioner or their practice, such as through a community-based organization.

6. (Delivery Location & Mechanism)

(Option 6a. Prioritizes Access) Services may be delivered in person in the clinic, in person in the home or community, telephonically, or via telehealth. Service time billed must be for either direct contact (in person, telephonically, or via telehealth) with a beneficiary or for services performed as part of an individual’s care plan even if the individual is not present.

There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service.

(Option 6b. Prioritizes Access, Favors in Person) Services may be delivered in person in the clinic, in person in the home or community, telephonically, or via telehealth. Service time billed must be for either direct contact (in person, telephonically, or via telehealth) with a beneficiary or for services performed as part of an individual’s care plan even if the individual is not present.

Payment rates may differ based on modality of delivery.

There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service.

7. (Provider Billing)

(Option 7a. Prioritizes Empowering CHWs) CHW/P/CHRs may enroll as a CHW/P/CHR provider to be able to provide and bill for services for Medicaid beneficiaries.

(Option 7b. Prioritizes Role of the Provider) CHW/P/CHR services are reimbursed incident to the Medicaid-enrolled, licensed provider providing general supervision to the CHW/P/CHR.

The CHW/P/CHR may be external to, and under contract with, the practitioner or their practice, such as through a community-based organization.

8. (Duration of Services/Frequency Limits)

(Option 8a. Prioritizes Access and Cost Containment) Covered CHW/P/CHR services are limited to 4 units (or 2 hours) per day, per beneficiary. Covered CHW/P/CHR services are limited to 24 units (or 12 hours) per month, per beneficiary.

(Option 8b. Prioritizes Access) There is no monthly or annual limit to the number of allowed CHW/P/CHR visits/hours per beneficiary.

9. (Documentation) CHW/P/CHRs are required to document the amount of time spent with the patient and the nature of the activities.

CHW Model Text Rationale

Model Text	Option	Source of Text /Supporting Research	Pros and Cons	Policy Vehicle for Text
1. Definition	N/A	American Public Health Association definition for CHWs: “A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/ intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.” ¹	Pro: Adopts broadly used definition.	SPA Legislation Regulation
2. Population Eligible for CHW Services	2a. Prioritizes Access	New York has close to universal CHW coverage for all Medicaid beneficiaries. It “covers CHW services for the following NYS Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) members: A. children under 21 years of age; B. pregnant and postpartum individuals during pregnancy, and up to 12 months after pregnancy ends, regardless of the pregnancy outcome; C. adults with chronic conditions; D. individuals with justice system involvement within the past 12 months; E. individuals with an unmet health-related social need in the domains of housing, nutrition, transportation, or interpersonal safety, which have been identified through screening using the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool; and F. individuals who have been exposed to community violence or have a personal history of injury sustained as a result of an act of community violence, or who are at an elevated risk of violent injury or retaliation resulting from another act of community violence.”²	Pro: Broad population eligibility improves health for a large portion of the state’s Medicaid enrollees. Con: Not all beneficiaries have baseline health spending high enough to drive a return on investment with a CHW/P/CHR program.	SPA Guidance (e.g., policy manual)
	2b. Prioritizes Rising Risk Population	Research has shown that evidence-based CHW programs serving the adult population with two or more chronic conditions can reduce readmissions, decrease hospital days, improve engagement, ³ and result in Medicaid return on investment.⁴ In South Dakota, CHW services are a “preventive health service to prevent disease, disability, and other health conditions or their progression” available to “individuals with a chronic condition or at risk for a chronic condition who are unable to self-manage the condition or for individuals with a documented barrier that is affecting the individual’s health.”⁵	Pro: Strong evidence of impact of CHW/P/CHR services on populations with rising health risks (e.g., individuals with chronic conditions and/or health-related social needs).	SPA Guidance (e.g., policy manual)
3. Services Covered	3a. Prioritizes Comprehensive Evidence-Based Services	Medicare’s Community Health Integration services include (but are not limited to) providing socioemotional support, building self-advocacy skills, and facilitating access to community-based resources, care coordination, and health system access/navigation.⁶	Pro: Reimbursement for a comprehensive set of evidence-based CHW/P/CHR services.	SPA Guidance (e.g., policy manual, toolkit)
	3b. Prioritizes Defined Service Package	In New Mexico, “CHWs are able to provide system navigation, health promotion, and clinical support. These services include but are not limited to: Addressing basic needs such as food and shelter, Navigating health and social systems, Assisting with enrollment in health programs and services, Coaching on problem solving, self-care, and self-management, Promote understanding or health information and health education materials, Lead educational and support groups, Conduct home safety assessments, Measure and respond to vital signs, and Provide feedback to medical providers.” ⁸ In South Dakota, covered CHW services include: Health system navigation and resource coordination. These services help individuals access needed health system and community resources. This includes, but is not limited to, helping individuals find and select a Medicaid provider, make an appointment, arrange transportation to a Medicaid covered medical appointment, and attend an appointment for a covered medical service. Health promotion and coaching. These services may include topics such as cessation of tobacco use, reduction in the misuse of alcohol or drugs, improvement in nutrition, Improvement of physical fitness, and family planning. Health education. Covered services include teaching or promoting methods and measures that have been proven effective in avoiding illness and/or lessening its effects. Topics may include immunizations, preventative services, control of high blood pressure or diabetes, and appropriate utilization of health care facilities.⁸	Con: Narrower coverage omits services like socioemotional support, which has been proven to be a key driver of effectiveness.	SPA Guidance (e.g., policy manual, toolkit)
4. Requirements for Billing Entity	4a. Prioritizes Evidence and CHW/P/CHR Work Environment	The Utilization Review Accreditation Commission’s (URAC) Community Health Worker Program Accreditation is a national accreditation program for organizations that employ or contract directly with CHWs.⁹ The Tennessee Community Health Worker Association (TNCHWA), Tennessee Medicaid (TennCare), and the National Committee for Quality Assurance developed Tennessee Community Health Worker (CHW) Program Accreditation Standards for agencies employing CHWs.¹⁰ These standards are based on CHW/P/CHR input and implementation science.	Pro: Evidence- informed accreditation standards for CHW/P/CHR programs are associated with high-quality outcomes and a positive CHW/P/CHR work environment.	SPA Guidance (e.g., accreditation standards)
	4b. Prioritizes Ease of Requirement	CHWs delivering Medicare Community Health Integration (CHI) services must meet applicable state requirements. “In states with no applicable requirements, auxiliary personnel must be certified and trained in the following competencies: Patient and family communication Interpersonal and relationship-building skills Patient and family capacity building Service coordination and systems navigation Patient advocacy, facilitation, individual and community assessment Professionalism and ethical conduct Development of an appropriate knowledge base, including local community-based resources.”¹¹ In New York, “CHW services are covered when the following training or work experience requirements have been met by the CHW providing the direct service: 20-hour minimum training that includes the CDC-endorsed CHW Core Consensus Competencies (C3) OR 1400 hours of experience working as a CHW in formal paid or volunteer roles within the past three years. Basic HIPAA training. For CHWs providing community violence prevention services, the training and work experience requirements detailed in Sections 11 and 11.2 apply.”¹² Despite this precedent, an Agency for Healthcare Research and Quality (AHRQ) review found that individual CHW training-based certification had no effect on quality of CHW programs and “weeded out” many qualified CHW/P/CHRs.¹³ Another study of the effects of state certification policies found that they may entrench pay inequities, raising wages for white male CHWs while resulting in no significant effect on wages for CHWs of color and women, who make up the majority of the workforce. The study found that while pay overall increased for CHWs in states with certification, inequities in wages among CHWs widened.¹⁴	Pro: Strong precedent for individual certification requirements and consensus-based core CHW/P/CHR competencies. Con: Individual CHW/P/CHR certification/ training has not been associated with improvements in quality. Con: Certification can be a barrier to entry for otherwise qualified CHW/P/CHRs. Con: Allows individuals who have completed a training but may not share lived experience with the communities they serve to enter the CHW/P/CHR workforce.	SPA Guidance (e.g., policy manual)
5. Service Initiation & Supervision	5a. Prioritizes Access & Flexibility	New Mexico’s chief medical officer of the Medical Assistance Division (Medicaid) issued a standing order that “authorizes any New Mexico Community Health Workers (CHW) and Community Health Representatives (CHR), for system navigation, health promotion and health coaching, and clinical support services.… This standing order may be used by a CHW, CHR & agencies that provide CHW/CHR services for New Mexico Medicaid eligible recipients as a valid order.”¹⁵	Pro: Standing order allows members of the care team (CHW/P/CHRs) to provide specific services for eligible individuals without individual provider order. Pro: Allows services to reach the large numbers of beneficiaries that face barriers getting an order from a clinical provider. Con: A state’s Medicaid agency would need to identify a provider (e.g., state Medicaid program’s chief medical officer) to issue and sign the standing order. Con: States should also consider quality guardrails (e.g., accreditation, program requirements, quality measurement) to guard against low-quality or misuse of services.	Guidance (e.g., statewide order)
	5b. Prioritizes Access & Provider Relationships	Rhode Island’s CHW Coverage Policy states that “as a preventive health service, CHW services must be recommended for a patient by a licensed practitioner of the healing arts … A licensed practitioner of the healing arts may establish a standing order or protocol as their mechanism to implement the recommendation.” ¹⁶ In Minnesota, “some CHW employers have developed and implemented CHW standing orders or similar vehicles.” The orders may be used “to provide authorization by the Medicaid-enrolled ordering provider for the CHW certificate-holder employed by the partnering agency to provide patient education and self-management services to MHCP [Minnesota Health Care Programs] enrollees that are included in the approved benefit set.”¹⁷	Pro: Standing order between provider and community-based organization allows employed CHW/P/CHRs to provide services to eligible individuals without an order for a specific beneficiary. Pro: Addresses barriers to access and reduces CHW/P/CHR and provider documentation burden.	Guidance (e.g., policy manual)
	5c. Prioritizes Role of the Provider	Medicare Community Health Integration (CHI) services may be performed by an auxiliary personnel, including CHWs, “incidental to the professional services of a physician or other billing practitioner, under general supervision…The auxiliary personnel may be external to, and under contract with, the practitioner or their practice, such as through a community-based organization (CBO) that employs CHWs or other auxiliary personnel, if they meet all ‘incident to’ requirements and conditions for payment of CHI services.”¹⁸	Pro: CHW/P/CHRs provide services under the direction of the provider, but provider does not need to be present. Creates flexibility in site of CHW/P/CHR service delivery. Con: Provider order, referral, and general supervision requires clinical providers to be involved in identifying need, referring patients to CHW/P/CHRs, and ongoing care management. This severely limits access to CHW/P/CHR services. Con: Requiring CHW/P/CHRs to be under general supervision of clinical providers risks over- medicalization of CHW/P/CHR services and can exclude community-based organizations that have been delivering CHW/P/CHR services for decades.	SPA Guidance (e.g., policy manual)
6. Delivery Location & Mechanism	6a. Prioritizes Access	Medicare Community Health Integration (CHI) services may be performed “using a combination of in-person and virtual via audio-video or via two-way audio since evidence shows that there should be some in-person interaction.”¹⁹ Under Louisiana’s Medicaid policy, “there is no restriction as to the site of service, which may include, but is not limited to: a health care facility, clinic setting, community setting or the beneficiary’s home. Delivery of the service through a synchronous audio/video telehealth modality is also permissible.”²⁰ In Rhode Island, “service time billed must be for either direct contact with a beneficiary (in-person or through telehealth) or for collateral services on an individual basis. Collateral services are those delivered on behalf of an individual beneficiary but that are not delivered in that beneficiary’s presence/directly to the beneficiary. The collateral service must actively involve the beneficiary in the sense of being tailored to the beneficiary’s individual needs. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service.”²¹	Pro: Allows services to be delivered in the most appropriate and low-cost setting (e.g., health care or community setting; in person, telephonically, or via telehealth). Con: Creates incentives for organizations to skimp on in-person CHW/P/CHR services in favor of less costly remote services. The evidence for CHW/P/CHR effectiveness is primarily based on in-person services and there is less conclusive supportive evidence for remote CHW/P/CHR services.	SPA Guidance (e.g., policy manual)
	6b. Prioritizes Access, Favors in Person	States have the option to reimburse differently for covered services delivered via telehealth vs. face-to-face.²² (A SPA is needed if a state plans to cover or pay for services delivered via telehealth differently than they do for services delivered face-to-face).	Pro: Enables services to be delivered in person or virtually but allows state to vary payment levels based on modality to reward in-person care.	SPA
7. Provider Billing	7a. Prioritizes Empowering CHWs	In New Mexico, CHWs and CHRs can bill Medicaid if they: “Enroll with New Mexico Medicaid as a provider and complete a Provider Participation Agreement, Verify a member’s Medicaid eligibility using the New Mexico Medicaid portal, Complete a standing order form for each date of service, and Follow all claims submissions requirements.”²³ Rhode Island permits certified CHWs to enroll and bill as an “Atypical” provider type .²⁴	Pro: Allows CHW/P/CHRs to enroll as a provider type and bill directly, streamlining the billing process and claims submission. Con: Many CHW/P/CHRs may lack the capability and systems to bill. States should also consider support for infrastructure and/or technical assistance for billing.	Guidance
	7b. Prioritizes Role of the Provider	Louisiana Medicaid will reimburse CHW services “‘incident to’ the supervising physician, APRN, or PA.”²⁵ Medicare Community Health Integration (CHI) services may be performed by CHWs “incidental to the professional services of a physician or other billing practitioner, under general supervision.”²⁶	Con: “Incident to” may place additional administrative burden on providers due to supervision requirements. Con: Limits ability for CHW/P/CHRs to use their professional judgment to provide most appropriate covered services to patients. Con: Approach creates challenges for individuals without a usual source of care.	Guidance (e.g., policy manual)
8. Duration of Services/ Frequency Limits	8a. Prioritizes Access and Cost Containment	Indiana coverage of CHW services is “limited to 4 units (or 2 hours) per day, per member” and “24 units (or 12 hours) per month, per member.”²⁷ In Nevada, “services provided by a CHW are limited to four units (30 minutes per unit) in a 24-hour period, not to exceed 24 units per calendar month per recipient.”²⁸ CHW programs with the strongest evidence deliver an average of 90 minutes per week for a 6-month period, building trust by achieving regular progress on the issues most important to the patient over a specific program duration.²⁹	Pro: Allows a state to set reasonable limits on frequency of CHW/P/CHR services.	Guidance (e.g., provider bulletin)
	8b. Prioritizes Access	In Rhode Island, “there is no limit to the number of visits/hours allowed per member.³⁰ Providers can bill for Medicare Community Health Integration services as medically reasonable and necessary.³¹	Pro: No limits on the number of CHW/P/CHR services allows services to be delivered at a frequency most appropriate for meeting a patient’s care needs and person-centered goal(s).	Guidance (e.g., policy manual)
9. Documentation Requirements	N/A	Rhode Island requires CHW providers “to maintain notes reflecting the dates and time/duration of services provided to beneficiaries. The notes should also reflect information on the nature of the service provided and support the length of time spent with the patient that day. The notes may also need to document how a patient meets criteria in a standing order or protocol to be recommended for CHW services.”³²	Pro: Supports integration of CHW/P/CHR services into the patient record through minimal documentation requirements. Pro: Aligns with Medicare Community Health Integration documentation requirements, reducing burden for providers submitting claims to both Medicare and Medicaid.	Guidance (e.g., policy manual)

American Public Health Association, “Community Health Workers”, Accessed November 21, 2024.
New York State Department of Health. Community Health Worker Services Policy Manual, eMedNY New York State Medicaid Provider Policy Manual. Published October 2024.
Kangovi S, Mitra N, Norton L, et al. Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(12):1635–1643. doi:10.1001/jamainternmed.2018.4630
Kangovi S, Mitra N, Grande D, Long JA, Asch DA. Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs 2020;39(2):207–213
South Dakota. State Plan Amendment (SPA) #: 22-0007. Approved August 29, 2022.
Centers for Medicare and Medicaid Services. Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074. January 2024.
New Mexico Health Care Authority. New Mexico Medicaid Community Health Workers (CHWs) & Community Health Representatives (CHRs). July 1, 2024.
South Dakota Medicaid Billing and Policy Manual. Community Health Worker Services. Community Health Workers Services – Eligible Providers. Updated October 2024.
Utilization Review Accreditation Commission. Community Health Worker Program Accreditation. Accessed November 21, 2024.
Tennessee Community Health Worker Program Accreditation Standard. Updated January 16, 2024.
Centers for Medicare and Medicaid Services. Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074. January 2024.
New York Department of Health. Community Health Worker Services Policy Manual, eMedNY New York State Medicaid Provider Policy Manual. October 2024.
Ibe CA, Wilson LM, Brodine J et al. Impact of Community Health Worker Certification on Workforce and Service Delivery for Asthma and Other Selected Chronic Diseases [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Mar. (AHRQ Comparative Effectiveness Technical Briefs, No. 34.)
Jones TM, Jeung C, Schulte A, Lewis CM, Maddox PJ. Hourly Wages and Turnover of Community Health Workers According to US State Certification Policy and Medicaid Reimbursement, 2010-2021. Am J Public Health. 2022 Oct;112(10):1480-1488. doi: 10.2105/AJPH.2022.306965. Epub 2022 Aug 11. PMID: 35952329; PMCID: PMC9480469.
New Mexico Health Care Authority. New Mexico Statewide Standing Order & Form for Community Health Workers (CHW) and Community Health Representatives (CHR) services in an outpatient setting Starting July 1, 2023. MAD 872.
Rhode Island Executive Office of Health and Human Services Medicaid Program. RI Medicaid, Community Health Workers, Version 2.2. October 2023.
Minnesota Community Health Worker Alliance. Fact Sheet Community Health Worker Standing Orders. June 2017.
Centers for Medicare and Medicaid Services, Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074. January 2024.
Centers for Medicare and Medicaid Services, Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074 January 2024.
Louisiana Department of Health, Professional Services, Chapter Five of the Medicaid Services Manual, Section 5.1: Covered Services, “Community Health Workers.” August 12, 2024.
Rhode Island. State Plan Amendment (SPA) #: 21-0012. Approved May 23, 2022.
Centers for Medicare and Medicaid Services. State Medicaid & CHIP Telehealth Toolkit Policy Considerations for States Expanding Use of Telehealth COVID-19 Version. Accessed November 21, 2024.
New Mexico Health Care Authority. New Mexico Medicaid Community Health Workers (CHWs) & Community Health Representatives (CHRs), July 1, 2024.
Rhode Island Executive Office of Health and Human Services Medicaid Program. RI Medicaid, Community Health Workers, Version 2.2. October 2023.
Louisiana Medicaid Program. Chapter 5: Professional Services. Section 5.1: Covered Services, “Community Health Workers.” June 20, 2022.
Centers for Medicare and Medicaid Services. Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074 January 2024.
Indiana Health Coverage Programs (IHCP) Bulletin Indiana Health Coverage Programs. BT201826. “IHCP Adds Coverage Of Community Health Worker Services.” May 31, 2018.
Nevada, Division Of Health Care Financing And Policy, Medicaid Services Manual Transmittal Letter. Medicaid Services Manual Changes Chapter 600 Physician Services, Section 605. January 31, 2023.
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Clinical Trial. Am J Public Health. 2017 Oct;107(10):1660-1667. doi: 10.2105/AJPH.2017.303985. Epub 2017 Aug 17. PMID: 28817334; PMCID: PMC5607679.
Rhode Island Executive Office of Health and Human Services Medicaid Program. RI Medicaid, Community Health Workers, Version 2.2. October 2023.
Centers for Medicare and Medicaid Services, Health Equity Services in the 2024 Physician Fee Schedule Final Rule, MLN Booklet, MLN9201074, January 2024.
Rhode Island Executive Office of Health and Human Services Medicaid Program. RI Medicaid, Community Health Workers, Version 2.2 October 2023.

Notes

McGough M, Winger A, Kurani N, and Cox C. How much is health spending expected to grow? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/how-much-is-health-spending-expected-to-grow/. Published October 7, 2024. Accessed November 7, 2024.
Trilliant Health. 2024 trends shaping the health economy report. https://www.trillianthealth.com/hubfs/2024 Website Redesign/Reports/2024 Trends Shaping the Health Economy Report | Trilliant Health.pdf. Published 2024. Accessed November 7, 2024.
Magnan S. Social determinants of health 101 for health care: five plus five. National Academy of Medicine. https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/. Accessed November 7, 2024.
Association of State and Territorial Health Officials and National Academy of Community Health Workers. Community health workers: evidence of their effectiveness. ASTHO. https://www.astho.org/globalassets/pdf/community-health-workers-summary-evidence.pdf. Accessed November 10, 2024.
Kangovi S, Mitra N, Grande D, Huo H, Smith R, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. Am J Public Health. 2017;107(10):1660–1667.
Roman LA, Gardiner JC, Lindsay JK, et al. Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial. Arch Women Ment Health 2009;12:379–391. https://doi.org/10.1007/s00737-009-0083-4.
Kangovi S, Mitra N, Grande D, et al. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med. 2014;174(4):535–543. doi:10.1001/jamainternmed.2013.14327.
Kangovi S, Mitra N, Norton L, et al. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Intern Med. 2018;178(12):1635–1643. doi:10.1001/jamainternmed.2018.4630.
Patient-Centered Outcomes Research Institute. Expanding the use of IMPaCT: a community health worker program. https://www.pcori.org/research-results/2019/expanding-use-impact-community-health-worker-program. Published 2024. Accessed November 10, 2024.
Kangovi S, Mitra N, Grande D, Long JA, Asch DA. Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs 2020;39(2):207–213.
Centers for Medicare and Medicaid Services. Calendar year (CY) 2024 Medicare physician fee schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule. Published November 2, 2023. Accessed November 10, 2024.
Gyurina C, Victoriano L. Environmental scan on community health workers: a fifty-state scan of Medicaid reimbursement approaches for the CHW workforce. Connecticut Health Foundation. https://www.cthealth.org/wp-content/uploads/2024/01/CHW-Medicaid-Policies-and-Reimbursement-Approaches-by-State.pdf. Published January 2024. Accessed November 10, 2024.
D’Alessandro M, Higgins E, Wilkniss S. Updates and FAQs: developing and implementing a Medicaid state plan amendment to authorize community health worker reimbursement. National Academy for State Health Policy. https://nashp.org/updates-and-faqs-developing-and-implementing-a-medicaid-state-plan-amendment-to-authorize-community-health-worker-reimbursement/. Published August 5, 2024. Access November 10, 2024.
American Public Health Association. Community health workers. https://www.apha.org/apha-communities/member-sections/community-health-workers. Accessed November 10, 2024.
Indian Health Services. About us. https://www.ihs.gov/chr/aboutus/. Accessed November 10, 2024.
US Bureau of Labor Statistics. Occupational employment and wage statistics: community health workers. https://www.bls.gov/oes/current/oes211094.htm. Last modified April 3, 2024. Accessed November 10, 2024.
UN Enable. International Day of Disabled Persons, 2004. https://www.un.org/esa/socdev/enable/iddp2004.htm. Accessed November 10, 2024.

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cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
li_gc	2 years	LinkedIn - Used to store consent of guests regarding the use of cookies for non-essential purposes
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Cookie	Duration	Description
__atuvc	1 year 1 month	AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated.
__atuvs	30 minutes	AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated.
bcookie	2 years	LinkedIn sets this cookie from LinkedIn share buttons and ad tags to recognize browser ID.
lang	session	This cookie is used to store the language preferences of a user to serve up content in that stored language the next time user visit the website.
lidc	1 day	LinkedIn sets the lidc cookie to facilitate data center selection.

Cookie	Duration	Description
_ga	2 years	The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors.
_ga_0JXFP3TZJG	2 years	This cookie is installed by Google Analytics.
_gat_UA-35374969-1	1 minute	This is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites.
_gcl_au	3 months	Provided by Google Tag Manager to experiment advertisement efficiency of websites using their services.
_gid	1 day	Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously.
_hjAbsoluteSessionInProgress	30 minutes	No description available.
_hjFirstSeen	30 minutes	This is set by Hotjar to identify a new user’s first session. It stores a true/false value, indicating whether this was the first time Hotjar saw this user. It is used by Recording filters to identify new user sessions.
_hjid	1 year	This is a Hotjar cookie that is set when the customer first lands on a page using the Hotjar script.
_hjIncludedInPageviewSample	2 minutes	No description available.
_hjTLDTest	session	When the Hotjar script executes we try to determine the most generic cookie path we should use, instead of the page hostname. This is done so that cookies can be shared across subdomains (where applicable). To determine this, we try to store the _hjTLDTest cookie for different URL substring alternatives until it fails. After this check, the cookie is removed.
AnalyticsSyncHistory	1 month	LinkedIn - Used to store information about the time a sync with the lms_analytics cookie took place for users in the Designated Countries
at-rand	never	AddThis - Used by social sharing platform AddThis
CONSENT	16 years 3 months 17 days	These cookies are set via embedded youtube-videos. They register anonymous statistical data on for example how many times the video is displayed and what settings are used for playback.No sensitive data is collected unless you log in to your google account, in that case your choices are linked with your account, for example if you click “like” on a video.
uvc	1 year 1 month	Set by addthis.com to determine the usage of addthis.com service.
vuid	2 years	Vimeo installs this cookie to collect tracking information by setting a unique ID to embed videos to the website.
xtc	1 year 1 month	AddThis - Registers the users sharing of content via social media

Cookie	Duration	Description
_fbp	3 months	This cookie is set by Facebook to display advertisements when either on Facebook or on a digital platform powered by Facebook advertising, after visiting the website.
bscookie	2 years	This cookie is a browser ID cookie set by Linked share Buttons and ad tags.
fr	3 months	Facebook sets this cookie to show relevant advertisements to users by tracking user behaviour across the web, on sites that have Facebook pixel or Facebook social plugin.
IDE	1 year 24 days	Google DoubleClick IDE cookies are used to store information about how the user uses the website to present them with relevant ads and according to the user profile.
loc	1 year 1 month	AddThis sets this geolocation cookie to help understand the location of users who share the information.
personalization_id	2 years	Twitter sets this cookie to integrate and share features for social media and also store information about how the user uses the website, for tracking and targeting.
test_cookie	15 minutes	The test_cookie is set by doubleclick.net and is used to determine if the user's browser supports cookies.
UserMatchHistory	1 month	Linkedin - Used to track visitors on multiple websites, in order to present relevant advertisement based on the visitor's preferences.
VISITOR_INFO1_LIVE	5 months 27 days	A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface.
YSC	session	YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages.
yt-remote-connected-devices	never	YouTube sets this cookie to store the video preferences of the user using embedded YouTube video.
yt-remote-device-id	never	YouTube sets this cookie to store the video preferences of the user using embedded YouTube video.
yt.innertube::nextId	never	These cookies are set via embedded youtube-videos.
yt.innertube::requests	never	These cookies are set via embedded youtube-videos.

CHW State Plan Amendment Model Text

Medicaid Reimbursement for Community Health Worker Services: Model State Plan Amendment & Other Guidance

Authors:

Related Content:

Medicaid Reimbursement for Community Health Worker Services: Model State Plan Amendment & Other Guidance

Leveraging a Standardized State Methodology that Measures Behavioral Health Clinical Spending to Improve Care

The Commonwealth Fund 2024 State Health Disparities Report: Milbank State Leadership Network Post-Briefing Fact Sheet

CHW Model Text Rationale

Notes

Related Content:

Medicaid Reimbursement for Community Health Worker Services: Model State Plan Amendment & Other Guidance

Leveraging a Standardized State Methodology that Measures Behavioral Health Clinical Spending to Improve Care

The Commonwealth Fund 2024 State Health Disparities Report: Milbank State Leadership Network Post-Briefing Fact Sheet