State Community Health Worker Models
Updated December 10, 2021
Community Health Worker (CHW) is an umbrella term that encompasses several categories of frontline public health workers — including Community Navigator, Promotora, Health Coach, Community Health Advisor, Community Health Aid, or Outreach Worker—who are often also trusted members of the community they serve. CHWs reach out to and engage with communities and individual community members, facilitate care coordination with health and health-related providers, enhance access to community-based services, address social determinants of health, and provide health education. Read More Many states are looking to build on their community-based workforce and are looking for sustainable funding sources for CHWs. The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches to integrating CHWs into evolving health care systems in key areas such as financing, education and training, certification, and state definitions, roles and scope of practice. The map reflects one of three possibilities: (1) the state’s Medicaid program reimburses for CHW services, (2) the state’s Medicaid program does not cover CHW services, and (3) a state’s Medicaid program does not reimburse directly for CHW services, but Managed care plans or entities in the state do reimburse for CHW services or directly hire CHWs through their administrative dollars. A note: All Medicaid managed care organizations (MCOs) can reimburse for CHW services through administrative dollars, so unless a state explicitly noted their MCOs do reimburse for services, that is not included in the category.
The map identifies state approaches for Medicaid reimbursement of CHW services and the chart provides details about other ways that states are supporting a CHW workforce.
Acronym Guide
| ACO Accountable Care Organizations
APM Alternative Payment Model CBCM Community Based Care Management Program CBO Community Based Organization CDC Centers for Disease Control and Prevention CEU Continuing Education Units CHW Community Health Worker CHA/P Community Health Aid/ Practitioner CRF Coronavirus Relief Funding DSRIP Delivery System Reform Incentive Payment FFS Fee for Service |
FQHC Federally Qualified Health Centers
HRSA Health Resources and Services Agency MA Medical Assistance MCO Managed Care Organizations MCE Managed Care Entities MIECHV Maternal, Infant, and Early Childhood Home Visiting Program MHP Medicaid Health Plans NCQA National Committee for Quality Assurance NIH National Institutes of Health |
PCCM Primary Care Case Management
PCMH Patient Centered Medical Home PH-MCO Physical Health Managed Care Organization PHW Pandemic Health Worker PMPM Per Member Per Month Payments RAE Regional Accountable Entity SPA State Plan Amendment USPSTF United States Preventative Services Task Force VBP Value Based Payment |
| State | Medicaid Reimbursement |
| AL | Alabama does not reimburse for CHW services through its Medicaid program. |
| AK | Alaska Medicaid reimburses for CHW services through MCOs as authorized under the state plan.
A State Plan Amendment effective July 1, 2017, allows all levels of certified Community Health Aides/Practitioners (CHA/Ps) to be reimbursed for services to Medicaid beneficiaries. |
| AZ | Arizona does not currently reimburse for CHW services through its Medicaid program.
Anticipated Medicaid reimbursement strategies: The Arizona Health Care Cost Containment System (Arizona’s Medicaid agency) intends to create a funding mechanism once the state has finalized a voluntary certification. |
| AR | Arkansas does not reimburse for CHW services through its Medicaid program. |
| CA | The Department of Health Care Services (DHCS) pays managed care plans a capitated rate, and some plans fund CHWs through their administrative budget.
Anticipated Medicaid reimbursement strategies: California anticipates reimbursing CHWs through MCOs and FFS starting in July 2022 following CMS approval of their SPA. DHCS anticipates activating CPT codes 98960, 98961, 98962 to reimburse for CHWs through the Medicaid program following CMS approval of their SPA. |
| CO | Colorado does not reimburse for CHW services through their Medicaid FFS program.
The Department of Health Care Policy and Financing (the Medicaid program administrator) does not specifically require the Regional Accountable Entities (RAEs), care coordinating entities contracted with Colorado’s Medicaid program, or other managed care entities to cover CHW services, nor does the Department pay for CHW services under FFS. But the RAEs and their contracted medical homes may use their administrative per member per month funding from Colorado’s Medicaid program to pay for CHW services. However, the Department has created performance payments for improvements in outcomes for targeted conditions, such as diabetes and maternity. |
| CT | Connecticut does not reimburse for CHW services through its Medicaid program. |
| DE | Delaware does not reimburse for CHW services through its Medicaid program. |
| DC | The District of Columbia (DC) does not reimburse for CHW services through its Medicaid program. |
| FL | Florida does not reimburse for CHW services through its Medicaid program. |
| GA | Georgia reimburses CHW services for limited population-use, through a section 1115 demonstration, implemented through Medicaid MCOs.
CMS approved Georgia’s request for approval to expand postpartum coverage from 60 days to 6 months post birth in April 2021. A component of the section 1115 demonstration is the use of “Resource Mothers” which is a population-specialized CHW model. This benefit will be funded through a capitation model through Medicaid managed care as one component of the postpartum service array. |
| HI | Hawaii does not reimburse for CHW services through its Medicaid program. |
| ID | Idaho reimburses for CHW services through its Medicaid managed care (Primary Care Case Management) program.
The PCCM program incentivizes primary care providers to incorporate CHWs into their care coordination model by offering a higher per member per month (PMPM) case management payment. |
| IL | Illinois does not currently reimburse for CHW services through its Medicaid program.
Anticipated Medicaid Reimbursement Strategies: The state is in the process of implementing Public Act 102-0004 (HB0158), which adds CHW services as a covered FFS and MCO benefit. |
| IN | Indiana reimburses CHW services through its Medicaid MCO and FFS programs.
A state plan amendment was approved in 2018 to add coverage of CHW services. Indiana Medicaid’s community health worker policy is detailed in Bulletin 201826, “Indiana Health Coverage Program (IHCP) adds coverage of community health worker services.” Indiana Medicaid’s FFS program reimburses for the following procedure codes in billing for CHW services (1 unit =30 min): 98960 – Self-management education & training, face-to-face, 1 patient ($9.70) 98961 – Self-management education & training, face-to-face, 2–4 patients ($4.67) 98962 – Self-management education & training, face-to-face, 5–8 patients ($3.43) |
| IA | Iowa does not reimburse for CHW services through its Medicaid program. |
| KS | Kansas does not reimburse for CHW services through its Medicaid program.
However, MCOs are required to implement Medicaid Care Coordination, and two of the three MCOs in Kansas partner with CHWs to do so. |
| KY | Kentucky does not reimburse for CHW services through its Medicaid program.
Anticipated Medicaid Reimbursement Strategies: Department for Medicaid Services (DMS) and other state agencies have been discussing financial sustainability for several years. |
| LA | Louisiana reimburses for CHW services through their Medicaid MCOs.
Louisiana also pays for CHW services through some alternative payment models (APMs) and value-based payment (VBP) models. |
| ME | Maine reimburses for CHW services through its Medicaid Community Care Teams program.
This is a MaineCare (Maine’s Medicaid program) service, and services are funded through a PMPM payment. Community Care Teams have the option to employ a CHW as an additional staff member, per policy. The per member per month payment allows Community Care Teams to fund CHW services/positions. |
| MD | Maryland does not reimburse for CHW services through its Medicaid program. |
| MA | Massachusetts provides funds to MCOs to support partnerships with and hiring of CHWs.
Through Massachusetts’ current section 1115 demonstration, Delivery System Reform Incentive Payment (DSRIP) funds were directed to MassHealth ACOs to assist with hiring and training significant numbers of CHWs. MassHealth ACOs are not required to hire CHWs or to reimburse for CHW services, but many have used DSRIP funds to do so. MassHealth ACOs, which are part of their managed care delivery system, serve about 1 million MassHealth members. In the next 1115 demonstration proposal, state officials intend to ask for authority to sub-capitate primary care in ACOs, which will be used to support team-based care, which can be supported with CHWs. |
| MI | Michigan reimburses CHW services through its Medicaid MCO and FFS programs. Michigan reimburses through its FFS program in their Medicaid Health Home Model.
Medicaid health plans (MHPs) are required to employ CHWs at a ratio of 1:5,000 members. These CHWs may be hired by the MHP or contracted out to a community-based organization or clinical setting. The state does not reimburse through its general FFS model, although Michigan Medicaid does operate a Health Home model for individuals with physical/behavioral health comorbidities through selected Federally Qualified Health Centers (FQHCs) that offers CHW services to those participants who may experience concerns about social resources. The Health Home model is reimbursed through a service bundle code that is billed monthly. The billing/coding model is not specific to CHW services and does not incorporate data specific to CHW services. In addition to the contractual requirements, financial relief is provided for meeting the ratio requirement when an MHP decides to contract with a community-based organization or a clinic for CHW services. |
| MN | Minnesota reimburses for CHW services through its Medicaid MCOs and FFS program.
Minnesota´s Medicaid program, known as Minnesota Health Care Programs (including Medical Assistant and MinnesotaCare), has covered CHW services since 2009. At this time, covered services are defined as “diagnosis–related health education” as specified by the CHW´s authorized ordering provider. According to Minnesota Statute 256B.0625, Subdivision 49, the state´s Medical Assistance (MA) program covers care coordination and patient education services provided by a CHW if the CHW has received a certificate from the Minnesota State Colleges and Universities System approved community health worker curriculum. Providers must bill the member’s MCO for patient education services provided by a CHW. |
| MS | Mississippi does not reimburse for CHW services through its Medicaid program. |
| MO | Missouri does not reimburse for CHW services through its Medicaid program. |
| MT | Montana does not reimburse for CHW services through its Medicaid program. |
| NE | Nebraska does not reimburse for CHW services through its Medicaid program. |
| NV | Nevada does not reimburse for CHW services through its Medicaid program.
Currently, some Managed Care Entities (MCEs) partner with CHWs under the administrative portion of their capitated rate. Nevada Medicaid will only reimburse for CHW services in the medical setting and not behavioral health setting. The codes and potential reimbursement rates include: 98960 – Education and training for patient self-management by a qualified, nonphysician health care professional…, 30 minutes, individual patient. ($18.34) 98961 – 2 to 4 patients. ($8.82) 98962 – 5 to 8 patients. ($6.44) Anticipated Medicaid Reimbursement Strategies: Nevada will begin reimbursing for CHW services under the Medicaid state plan as of 01/01/2022. On January 1, 2022, Nevada will begin covering CHW services under the Medicaid state plan. CHWs will be a new provider type that will be added to the State Plan and Medicaid Services Manual. Once the policy for services is implemented, the MCEs will be required to cover CHWs as a provider type, and the associated services will be included in the medical portion of the capitation payment. Care coordination will not be part of CHW state plan covered services. Managed Care Entities (MCEs) can elect to partner with CHWs for care coordination purposes, however those services would be required to be funded through the administrative portion of their capitation rate. |
| NH | New Hampshire does not reimburse for CHWs through its Medicaid program. |
| NJ | New Jersey does not reimburse for CHWs through Medicaid, however doula and substance use disorder peer support specialist services are covered through Medicaid. MCOs are encouraged to explore community partnerships that may include CHWs.
Medicaid managed care organizations are encouraged to explore community partnerships that may include CHWs. The state’s most recent section 1115 demonstration application includes a proposed CHW pilot program that earmarks $25 million over the five-year waiver period for MCOs that want to implement and evaluate specific interventions using CHW services. |
| NM | New Mexico reimburses for CHW services through its MCOs.
Centennial Care has leveraged contracts with Medicaid managed care organizations (MCOs) to require partnerships with CHWs in serving Medicaid enrollees. CHW salaries, training, and service costs are covered through MCO administrative costs and embedded in capitated rates paid to Medicaid managed care organizations. |
| NY | New York does not reimburse for CHW services through its Medicaid program.
New York’s Delivery System Reform Incentive Payment (DSRIP) program included projects that incentivized partnerships with CHWs for home visiting to members. However, the DSRIP programs ended as of March 31, 2020. |
| NC | North Carolina does not reimburse for CHW services through its Medicaid program. |
| ND | North Dakota reimburses tribal community health representatives through the Medicaid state plan for targeted case management for members in need of long-term care services.
Tribal community health representatives are able to bill Medicaid for targeted case management for members in need of long-term care services, as part of the ND Medicaid state plan. Medicaid reimburses the tribal community health representatives through the code T1023 at $519 per encounter (daily rate). |
| OH | Ohio requires MCOs to provide CHW services to certain beneficiaries.
Ohio requires MCOs to provide community health worker or public health nurse services to Medicaid enrollees who are pregnant or capable of becoming pregnant, reside in a community served by a qualified community hub, and was recommended to receive community health worker or public health nurse services by a qualified health provider (Ohio Administrative Code Rule Section 5167.173). |
| OK | Oklahoma does not reimburse for CHWs through its Medicaid program. |
| OR | Oregon reimburses CHWs through the state plan and additionally requires MCOs to include traditional health workers, such as CHWs, on their care teams.
CHWs are included as authorized providers for four of the six health home services covered under Oregon’s health home/ Patient-Centered Primary Care Homes (PCPCH) state plan amendment. CHWs are included for health promotion, comprehensive transitional care, individual and family support services, and referral to community and social supports. In addition, Coordinated Care Organizations are required to include traditional healthcare workers, like CHWs, on their care teams. CHWs must be certified and supervised by a health professional to qualify for Medicaid reimbursement. |
| PA | Pennsylvania requires MCOs to implement Community-based Care Management Programs which may include CHWs. Pennsylvania requires the Physical Health Managed Care Organizations (PH-MCOs) to implement a Community-Based Care Management Program (CBCM) that may include the CHW as part of the CBCM team. Reimbursement and contracting approaches vary by PH-MCO and CBCM program including by contracting with providers and community-based organizations or directly hiring CHWs as part of the CBCM program. |
| RI | Rhode Island reimburses for CHW services through MCOs and FFS. Reimbursement has been added to the state plan.
Rhode Island’s Medicaid Accountable Entities (similar to ACOs) may use funds earned through the Health System Transformation Project Incentive Fund to fund CHW services. At least one MCO does reimburse providers for CHW services on an FFS basis. |
| SC | South Carolina does not reimburse for CHW services through its Medicaid program. |
| SD | South Dakota Medicaid reimburses for CHW services through FFS.
South Dakota has incorporated payment for CHW services through a State Plan Amendment. CHW services could be used for many health conditions as long as there is a care plan in place written by a physician, physician assistant, nurse practitioner, or a certified nurse midwife. Additional information can be found on page three of the CHW provider manual. The state reimburses for CHW services with the following codes and reimbursement rates for FY22: 98960 – Education and training for patient self-management by a qualified, nonphysician health care professional…, 30 minutes, individual patient. ($20.89) 98961 – 2 to 4 patients. ($10.44) 98962 – 5 to 8 patients. ($7.31) A recipient is limited to 104 units (approximately 52 hours) of services each state plan year. The limits are coded into the billing system. Staff are not otherwise tracking the utilization of services. |
| TN | Tennessee does not reimburse for CHW services through its Medicaid program. |
| TX | Texas does not reimburse for CHW services through its Medicaid program. |
| UT | Utah does not reimburse for CHW services through its Medicaid program. There are currently some Accountable Care Organizations (ACOs) that cover the cost of CHW services through Medicaid administrative payments. |
| VT | Vermont reimburses CHW services through an all-payer model.
Vermont has implemented transformative health care delivery and payment reform systems that shift a significant degree of payment for health services from a fee-for-service model to a quality and value-based payment system. The Vermont Blueprint for Health (pursuant to 18 V.S.A. §7022), in existence for over fifteen years, is a statewide network of NCQA certified Patient Centered Medical Homes (PCMHs) which are supported by regional program managers, quality improvement managers, self-management program coordinators, and a regional Community Health Team (CHT). CHTs are multi-role teams (can include RNs, Health Coaches, Substance Abuse Specialists, RDs, Pharmacists, CHWs, etc.). There are thirteen CHTs in Vermont, some of which have elected to include community health workers in their staffing configuration. Vermont has incorporated community health worker services through their Community Health Team all-payer model structure as well as incorporated CHW services through medical homes, ACOs, and other VBP models. The state has used Medicaid waivers, and state plan amendments to pay for these services, as well as other mechanisms like hospital budgets and grants. |
| VA | Virginia does not reimburse for CHW services through its Medicaid program. |
| WA | Washington reimburses for CHW services through its Medicaid program.
Washington’s section 1115 demonstration allows CHWs to be paid as a part of Medicaid value-based payment. CHWs may also be part of Washington’s Health Homes, which allows them to receive Medicaid funding for each patient served. In addition, CHWs are often included in Accountable Communities for Health (ACH). |
| WV | West Virginia does not reimburse for CHW services through its Medicaid program. |
| WI | Wisconsin reimburses for CHW services through Medicaid MCOs.
Medicaid health plans can fund CHW care coordination work via non-administrative funds as of January 2017. Medicaid funds Prenatal Care Coordination and Peer Support Specialists, some of whom are Community Health Workers. Two MCOs have VBP arrangements with the Pathways Community HUBs (Great Rivers HUB and UniteWI). |
| WY | Wyoming does not reimburse for CHW services through its Medicaid program. |
| State | Other Financing Mechanisms |
| AL | |
| AK | |
| AZ | |
| AR | The Arkansas Community Health Worker Association (ARCHWA) maintains a list of state CHW programs and their funding sources. |
| CA | |
| CO | |
| CT | CHWs in Connecticut receive grant funding through FQHCs, community-based organizations, the National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA). |
| DE | Christiana Care’s Health Ambassador Program is funded through the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. Other Federally Qualified Health Centers (FQHC) in the state fund CHW positions through the FQHC’s operational budget. FQHCs also receive funding through the Delaware Department of Public Health. |
| DC | DC uses Title V Maternal and Child Block Grant funding for some Community Health Association perinatal and maternal work. |
| FL | |
| GA | |
| HI | |
| ID | |
| IL | The Department of Healthcare and Family Services (HFS, Illinois’ Medicaid program) is also providing grant funding to Healthcare Transformation Collaboratives across the state to support the work of CHWs in many of these collaboratives. |
| IN | |
| IA | |
| KS | |
| KY | |
| LA | |
| ME | |
| MD | |
| MA | |
| MI | |
| MN | |
| MS | |
| MO | Missouri Department of Health and Senior Services funds CHW related activities (creating curricula, tuition reimbursement, etc.) through CDC 1815 and 1817 grants. There is no dedicated budget line item for CHWs. |
| MT | CDC funding supports the training of CHWs, and Montana aims to have one or two CHWs per county. The CDC funds also support a focus on employer education surrounding CHWs, as well as CHW supervisor training and best practices. |
| NE | |
| NV | |
| NH | |
| NJ | |
| NM | |
| NY | |
| NC | |
| ND | |
| OH | A majority of CHW funding comes through grants. A 2018 report of key findings around CHW in Ohio found that 51% of CHW employers report reimbursement through Medicaid, 49% report through Medicaid Managed Care contracts, and 6% report reimbursement through CHIP, among other sources. Most employers noted funding was not sustainable, with the exception of funding through Medicaid Managed Care contracts. |
| OK | |
| OR | |
| PA | |
| RI | |
| SC | Some Federally Qualified Health Centers (FQHCs) work with CHWs. |
| SD | |
| TN | |
| TX | Many grant opportunities provided by the Department of State Health Services encourage engagement of CHWs to improve the impact of grant activities and improve related health outcomes. |
| UT | |
| VT | Many of Vermont’s Community Health Workers are funded through federal and state grants and through organizational operating budgets. |
| VA | |
| WA | |
| WV | |
| WI | Pathways Community HUB Model for sustainable reimbursement mechanisms via value-based or outcome-based payments, Full 1.0 FTE CHW positions supported through braided or matched funding through grants, community foundations, health systems, health plans. The Governor’s Budget proposal included $14 million for CHW sustainability to support care-coordination, social determinant of health barrier reduction, CHW-led programs, and health equity initiatives. |
| WY |
| State | Employers and Supervision |
| AL | |
| AK | |
| AZ | Medicaid MCOs, health systems/providers, community-based organizations and health departments serve as the major CHW employers in the state. |
| AR | |
| CA | Health systems/providers, community-based organizations, and health departments serve as the major CHW employers in the state. |
| CO | Health systems and community-based organizations serve as the major CHW employers in the state. |
| CT | Community health centers, nonprofits and hospitals serve as the major CHW employers in the state. |
| DE | Health providers and health plans serve as the major CHW employers in the state. |
| DC | Washington DC Health Care Access and Finance and Department of Health serve as the major CHW employers in the state. |
| FL | Health systems/providers, community-based organization, and health departments serve as the major CHW employers in the state. |
| GA | Health departments currently serve as the major CHW employers in the state. Care management organizations using Resource Mother Outreach are required to provide supervision by a nurse case manager or similarly qualified program staff member. |
| HI | |
| ID | |
| IL | |
| IN | Medicaid MCOs, health systems/providers, and health departments serve as the major CHW employers in the state. |
| IA | Health systems/providers, community-based organization, and health departments serve as the major CHW employers in the state. MCOs do not employ CHWs, however Iowa Total Care has worked with Iowa Chronic Care Consortium to sponsor 100 individuals to complete the CHW training. |
| KS | Medicaid MCOs, health systems and providers, community-based organizations, health departments, churches, federal programs, and state health departments serve as the major CHW employers in the state. |
| KY | Health systems/providers and community-based organizations serve as the major CHW employers in the state and Medicaid MCOs employ CHWs. |
| LA | Medicaid MCOs employ CHWs in addition to reimbursing for services, and community-based organization, health departments and Federally Qualified Health Centers (FQHCs) serve as the major CHW employers in the state. The Louisiana CHW Institute and Louisiana Community Health Outreach Network (LACHON) provide CHW training, as well as training for supervisors and public education about the roles of CHWs. |
| ME | Health systems/providers, community-based organizations, and health departments serve as the major CHW employers in the state. There are no formal structures supporting supervisors currently. Supervisor training has been offered in the past and the Maine CHW Initiative is committed to offering this resource pending further funding. |
| MD | Medicaid MCOs, Health systems/providers, hospitals, Federally Qualified Health Centers (FQHCs), community-based organizations, local health departments and faith-based organizations serve as the major CHW employers in the state. |
| MA | Medicaid MCOs, ACOs, community-based organizations, local health departments, faith-based organizations, immigrant organizations and school-based health centers serve as the major CHW employers in the state. Massachusetts Department of Public Health (DPH) and the Office of CHWs encourage CHW training programs to offer CHW supervisor training and CHW employers to support the CHW supervisors to attend the training. In 2001, DPH implemented contract policy for community-based vendors requiring them to provide a certain amount of regular supervision (both clinical and programmatic) to CHW employees, including specific information about that supervision. MassHealth has developed and delivered a CHW supervisor training as part of the DSRIP Statewide Investments portfolio. |
| MI | Community-based organizations are the major employer but Medicaid health plans, health systems, and health departments are also engaging the CHW workforce. CHWs are required to have supervision as part of the Michigan Medicaid Health Home model. |
| MN | MCOs, Department of Health, providers (including dentists and hospital systems) serve as the major CHW employers in the state. Many provider types may supervise CHWs, including physicians, dentists, public health nurses and mental health professionals among others. |
| MS | Major employers of CHWs in the state include Medicaid MCOs, health systems/providers, community-based organizations, health departments and universities and colleges. |
| MO | Missouri Department of Health and Senior Services works most closely with CHWs. There is one Public Health Program Specialist that handles CHW work within the Bureau of Cancer and Chronic Disease Control. |
| MT | Montana Office of Rural Health rolled out a CHW training program in 2018. |
| NE | Health systems/providers, community-based organizations, and health departments serve as the major CHW employers in the state. |
| NV | Medicaid MCEs, health systems/providers, community-based organizations, and Federally Qualified Health Centers serve as the major CHW employers in the state. |
| NH | Health systems/providers, community-based organizations and health departments serve as the major CHW employers in the state. |
| NJ | |
| NM | New Mexico Department of Health and the University of New Mexico Health Science Center serve as the major CHW employers in the state. |
| NY | Departments of Health serve as the major CHW employers in the state. Some CHWs are employed by healthcare providers and insurers, but many are employed by other community-based organizations. |
| NC | Community organizations, religious organizations, community health centers, hospitals, local health departments, physician’s offices and other settings serve as the major CHW employers in the state. |
| ND | Tribal health departments serve as the major CHW employers in the state. |
| OH | MCOs, community-based organizations, local health departments, hospitals and Federally Qualified Health Centers serve as the major CHW employers in the state. |
| OK | |
| OR | |
| PA | Medicaid MCOs, health systems/providers, community-based organizations, and PH-MCO vendors serve as the major CHW employers in the state. |
| RI | Medicaid MCOs, health systems/providers, and community-based organizations serve as the major CHW employers in the state.
The Community Health Worker Association of Rhode Island (CHWARI) is currently in the process of creating a Supervisory Training after the nascent report publication, “Rhode Island Community Health Worker Assessment: Exploring Opportunities for Sustainability.” |
| SC | MCOs and Federally Qualified Health Centers (FQHCs) serve as the major CHW employers in the state. The state provides education for CHW supervisors. The South Carolina CHW Credentialing Council approves educational programs which include curricula, facilitators, preceptors. |
| SD | Indian Health Services/ Tribal 638 serves as the major CHW employer in the state. The Community Health Worker Collaborative of South Dakota in partnership with the Department of Health are creating guidance to support a CHW workforce. |
| TN | |
| TX | Health systems/providers, community-based organizations, and health departments serve as the major CHW employers in the state.
Trainings and presentations are available to support supervisors of CHWs and to encourage engagement and employment opportunities. |
| UT | ACOs, departments of health, and Federally Qualified Health Centers serve as the major CHW employers in the state. |
| VT | Health systems/providers, community-based organizations, and local health departments (in limited capacity) serve as the major CHW employers in the state. |
| VA | The Virginia Department of Medical Assistance Services, Virginia Department of Health, Virginia Hospital & Healthcare Association, Institute for Public Health Innovation, and other key partners continue to explore opportunities to sustain CHW activities in the Commonwealth. |
| WA | |
| WV | |
| WI | MCOs, health systems/providers, community-based organizations, health departments, Community Action Programs, and free and charitable clinics serve as the major CHW employers in the state. |
| WY |
| State | Services Provided |
| AL | |
| AK | |
| AZ | |
| AR | |
| CA | CHWs provide services in the following areas: COVID-19 (e.g., contact tracing or vaccine appointments), chronic diseases, and supportive housing services. The Department of Health Care Services (DHCS) is developing its policy for CHW services to be covered under Medicaid and expects it will include services for asthma prevention, chronic disease, maternal care, among other services, once the SPA is approved. |
| CO | The Colorado Department of Public Health and Environment has been involved in this work in the past. There is also an Alliance of Colorado CHWs, patient navigators and promotores that is active in the state. |
| CT | Connecticut Medicaid does not reimburse for CHW services, but CHWs in the state provide services in the following areas: care coordination, health education, outreach and enrollment. |
| DE | |
| DC | DC Medicaid does not reimburse for CHW services, but CHWs in DC provide services in the following areas: chronic diseases, oral health, maternal health, and perinatal health. |
| FL | |
| GA | Under the section 1115 demonstration, CHWs will be reimbursed for maternal health services. |
| HI | |
| ID | |
| IL | CHWs employed through Medicaid MCOs assist with care coordination. |
| IN | CHWs provide services in the following areas: oral health, chronic diseases, overall child health, children and youth with special health care needs, maternal health, perinatal care for pregnant populations, and addressing racial and ethnic health disparities.
Indiana Medicaid Reimbursable CHW functions include the following: -Diagnosis-related patient education towards self-managing physical, mental, or oral health in conjunction with a health care team -Use of cultural and health science knowledge and skills to negotiate with the client and the health care system for an effective, beneficial health care plan -Health promotion education to a member to prevent chronic illness -Direct preventive services or services aimed at slowing the progress of chronic diseases Indiana Medicaid Non-Reimbursable CHW Functions include the following: -Case management -Care coordination -Insurance enrollment and “Navigator” assistance -Advocacy efforts -Arranging transportation/transporting a member to and from services -Direct patient care outside of the level of training and certification an individual has attained |
| IA | |
| KS | CHWs can provide care coordination or education under other licensed providers. |
| KY | |
| LA | |
| ME | CHWs provide services for patients around chronic disease control and prevention. |
| MD | |
| MA | CHWs provide care coordination and other services in a number of different areas through MassHealth ACOs, but MassHealth does not track specific areas. |
| MI | CHWs provide services in the following areas: assistance with the COVID-19 response, chronic diseases, supportive housing services, maternal health, perinatal care for pregnant populations, and addressing racial and ethnic health disparities. The state tracks the number of beneficiaries receiving assessments and referrals but does not track services more broadly, nor conduct a time study. |
| MN | CHWs in Minnesota provide diagnosis-related patient education, health promotion, and disease management. Some CHWs work in homes, schools, and the community, and some CHWs are engaged in oral health. Some programs pay CHWs to provide preventive services to improve the home environment (e.g., reduction of asthma triggers, lead poisoning prevention). Minnesota Health Care Programs (MHCP) will not cover social services. |
| MS | |
| MO | |
| MT | |
| NE | |
| NV | As of January 1, 2022, Medicaid reimbursable activities will include screening and risk identification for conditions including diabetes, obesity, tobacco cessation, heart disease, and other chronic diseases. These preventive services are covered under Nevada Medicaid utilizing the United States Preventive Health Services Task Force (USPSTF) A and B recommended screenings required under the Affordable Care Act (ACA). |
| NH | |
| NJ | The state has a new doula benefit and an existing SUD peer provider benefit. |
| NM | |
| NY | |
| NC | CHWs provide services in primary care, dental care, and mental/behavioral health. |
| ND | |
| OH | CHWs provide services in the following areas: mental health, chronic conditions (including diabetes, high blood pressure, asthma, and obesity). |
| OK | |
| OR | The state defined a scope of practice for different types of Traditional Health Workers, including CHWs. CHWs working in community-based organizations provide in-home services, including preventive services related to improving the home environment (e.g., reduction of asthma triggers, lead poisoning prevention). As part of the Patient-Centered Primary Care Home program, they provide health promotion, comprehensive transitional care, individual and family support services, and referrals to community and social supports. |
| PA | CHW utilization varies by Physical Health Managed Care Organization (PH-MCO), but services may include chronic diseases, supportive housing services, specific focus on rural areas, overall child health, maternal health, perinatal care for pregnant populations, social determinants of health (SDOH) screenings, and community support. |
| RI | |
| SC | |
| SD | CHW services can be engaged for the following issues as long as there is a care plan in place written by a provider: oral health issues, chronic diseases, supportive housing services, specific focus on rural areas, overall child health, children and youth with special health care needs, maternal health, perinatal care for pregnant populations, and racial and ethnic health disparities. |
| TN | |
| TX | |
| UT | |
| VT | CHWs provide services in the following areas: COVID-19 services (contact tracing and vaccine appointments), chronic disease, supportive housing services, children and youth with special health care needs, and maternal health. |
| VA | |
| WA | CHWs participating in Health Homes provide administrative support for the Health Home Care Coordinator, such as mailing health promotion material, arranging for beneficiary transportation to appointments, and calling the beneficiary to facilitate face-to-face Health Home visits with the Care Coordinator. In general, CHWs may provide in-home services, including preventive services related to improving the home environment. |
| WV | |
| WI | Medicaid funds Prenatal Care Coordination and Peer Support Specialists, some of whom are Community Health Workers. |
| WY |
| State | Key Partnerships |
| AL | |
| AK | Indian Health Service |
| AZ | The Arizona Community Health Worker Association (AzCHOW) is involved in numerous efforts to support the workforce through advocacy, CHW and supervisor training, technical assistance and engagement. The UA Arizona Prevention Research Center is working with the Arizona Department of Public Health and AzCHOW to monitor the impact of certification and other efforts to support the workforce. The NAU Center for Health Equity Research is working with AzCHOW and other partners to support CHRs and CHWs across the state in COVID-19 response. |
| AR | The Community Health Worker Stakeholder Advisory Committee includes representation from the Arkansas Department of Health (ADH), the UAMS College of Public Health (COPH), and the Arkansas Community Health Worker Association (ARCHWA). |
| CA | California has built extensive partnerships with local and state organizations that aid in the strengthening and sustaining of CHWs in California. These organizations offer support and sharing of promising practices in areas such as hiring and training CHWs/Peers, integrating CHWs/Peers into care teams, organizational practices to support trauma-informed care, and strategies to sustain the CHW workforce, particularly related to certification. Under the Whole Person Care program, strong regional coalitions of public healthcare systems, behavioral health providers, Medicaid managed care plans and social service organizations were built to help support CHW work in California. California intends to leverage these relationships as the policy is developed. The Department of Health Care Services (DHCS) is also working with the California Health Care Foundation, Vision y Compromiso, and other stakeholders to develop the CHW policy. |
| CO | |
| CT | The Connecticut Area Health Education Centers (AHEC) program has worked with CHWs since 2000. The state Department of Public Health oversees the certification of CHWs and there is a CHW association that is a part of the Connecticut Public Health Association. |
| DE | A CHW sub-committee, guided by the Delaware Center for Health Innovation and Division of Public Health, was charged with developing recommendations to integrate CHWs into Delaware’s health professions’ workforce in a systemic and sustainable way. The sub-committee released its report in June 2017. The state’s CHW sub-committee recommends requiring certification for CHWs working under the supervision of a licensed Medicaid provider to allow for Medicaid reimbursement for CHW services. |
| DC | Washington DC Health Care Access and Finance, Department of Health, and other Community Based Organizations, including the Institute for Public Health Innovation. |
| FL | Florida Department of Health. |
| GA | Georgia Department of Public Health |
| HI | Hawaii Department of Health as well as Wai‘anae Coast Comprehensive Health Center’s Wai‘anae Health Academy; Hawai‘i Primary Care Association’s CHW program; Papa Ola Lokahi’s ‘Imi Hale program for cancer education and prevention among Native Hawaiians, and Hawai‘i Primary Care Association (HPCA). |
| ID | Idaho Community Health Worker Association, Bureau of Community and Environmental Health, Division of Public Health in the Idaho Department of Health and Welfare, Idaho State University. |
| IL | The Department of Health and Family Services (HFS) is currently collaborating with the Illinois Department of Public Health, the Illinois Community Health Worker Association, and a variety of providers (hospitals, health departments, etc.) and community-based organizations on implementing CHWs within the Medicaid program. |
| IN | |
| IA | Iowa Department of Public Health has a contract with University of Iowa and Iowa Chronic Care Consortium (ICCC) to complete an environmental scan for CHWs in Iowa. This is expected to be completed in 2021. |
| KS | Strong partnerships exist between the Kansas CHW workforce and:
MCOs: United Healthcare and Sunflower Health Plan Local/State/Regional Foundations: United Methodist Health Ministry Fund, Kansas Health Foundation, Health Forward Foundation Native American Organizations: Indian Health Service clinics such as Hunter Health Clinic, Sac and Fox Nation of Missouri, Hunter Health Clinic, Southern Plains Tribal Health Board Local & State Health Departments: Reno County Health Department, Sedgwick County Health Department, Crawford County Health Department, Wyandotte County Health Department. Senior leadership at the Kansas Department of Health and Environment has commissioned a work group of stakeholders seeking recommendations for CHW certification/credentialing and Medicaid billing opportunities. This work group is meeting and developing feasible recommendations. Universities and institutions of higher education: Wichita State University, Kansas State University, Johnson County Community College, Metropolitan Community College Federally Qualified Health Clinics and Safety Net Clinics: KC CARE Health Centers, Vibrant Health, Genesis Family Health, Guadalupe Center, Health Core Clinic, Grace Med Clinics, Community Health Centers of Southeast Kansas, Caritas Clinics, Flint Hills Community Health, Swope Health, Duchesne Clinic Hospitals: Bob Wilson Memorial Hospital, Salina Family Health, Wesley Medical Center, University of Kansas Health Systems, Children’s Mercy Community Based Organizations: Thrive Allen County, Kansas City Quality Improvement Consortium, NBC Community Development Corporation, KC Digital Drive, Uzazi Village, Community Health Council of Wyandotte County, Mision Alcance, Poetry for Personal Power, Neighboring Movement State Coalitions and Organizations: Kansas Breastfeeding Coalition, Oral Health Kansas, Community Care Network of Kansas (FQHC and Safety Net clinic network), El Centro, Inc., Kansas Special Olympics, Kansas State University Research and Extension, Mid America Regional Council, Kansas City Regional CHW Collaborative, Sedgwick County Medical Society, Project Access, Double Arrow Metabolism, Kansas Foundation for Medical Care, Mitchell County Regional Medical Foundation, Kansas Business Group on Health, National Alliance on Mental Illness Kansas |
| KY | Kentucky Department for Public Health houses the CHW Program within the Division of Prevention and Quality Improvement. Since 2014 they have coordinated and convened the statewide CHW Advisory Workgroup, which brings together partners from across the state to collaborate, network, discuss challenges and share resources. This workgroup meets quarterly, and the members were responsible for creating the first iterations of the CHW Certification Manual, Code of Ethics, and CHW Core Competencies. Sub-Committee meetings still occur to discuss curriculum review process and impact demonstration. |
| LA | The Louisiana CHW Institute at Louisiana State University (LSU), LACHON, and the Louisiana CHW Workforce Coalition. The Louisiana CHW Workforce Coalition is co-led by the state CHW association (the Louisiana Community Health Outreach Network, LACHON) and the Louisiana CHW Institute at the LSU Center for Healthcare Value and Equity. Additional members include the Louisiana Office of Public Health, the Louisiana Managed Medicaid Associations, community-based organizations, the Louisiana Primary Care Association, and health systems. There is an effort to ensure that half of members are CHWs in keeping with APHA and NACHW policy.
Louisiana Medicaid is also working closely with the Louisiana CHW Workforce Coalition, the Louisiana CHW Institute and LACHON to develop a sustainable Medicaid financing strategy for some CHWs services. Medicaid is hosting a series of discussions and focus groups with CHWs and other stakeholders to gather input about their perspectives. |
| ME | The Maine Community Health Worker Initiative is a multisector, statewide coalition that is dedicated to advancing the community health workforce by delivering training, fostering CHW leadership, and promoting systemic change. The activities of the coalition are coordinated by the Maine Mobile Health Program and MCD Public Health with funding from Maine Center for Disease Control and Prevention.
The Minority Health Program Stakeholder Alignment Project is coordinated by the City of Portland and represents a broad cross-section of communities, individuals and organizations working together towards population health goals in a collaborative environment. CHWs are integrated into many of the strategies that this project pursues. Strengthen ME is a coalition of organizations and agencies working together to provide stress management, outreach, resource linkage and resiliency resources to anyone in Maine experiencing stress reactions from the COVID-19 Pandemic. The initiative is coordinated by the Maine Office of Behavioral Health and offers peer support and training to partners that work with CHWs. |
| MD | The Maryland State CHW Advisory Committee (established in Health-General Article, Title 13, Subtitle 37 – Maryland Community Health Worker Act) advises the Maryland Department of Health on various issues relating to the certification and training of community health workers in the state as well as the accreditation of community health worker training programs.
The CHW Program within the Maryland Department of Health, Office of Population Health Improvement, coordinates a regional CHW collaborative team that meets regularly throughout the year to discuss CHW workforce issues and ways states can collaborate to expand opportunities for the CHW workforce. Partners engaged in this collaborative process are government, community-based organizations, and other agencies invested in advancing the CHW workforce. Maryland has a very active CHW Association led and attended by Maryland CHWs that meets regularly to discuss, support, and advocate for the CHW workforce. |
| MA | Key relationships of the Office of CHWs at the Department of Public Health include partnership with the Statewide Investments team at MassHealth, collaborations with other sister state agencies including the Executive Office of Labor and Workforce Development and with the diverse CHW training programs in the states, with Commonwealth Corporation on a variety of CHW workforce development initiatives, with the Massachusetts Association of CHWs and with the Massachusetts Public Health Association. |
| MI | The Michigan CHW alliance, Michigan’s FQHC state association, local health departments, Medicaid health plans. There is also collaboration within the Medicaid agency (across FFS/policy and managed care) in the development of the current CHW approach in Medicaid, and with colleagues in behavioral health administration and public health administration. |
| MN | Minnesota CHW Peer Network, Minnesota Community Health Worker Alliance |
| MS | Key partnerships include CHCAMS (Community Health Center Association of Mississippi), the development of state association, NACHW, Southeast CHW network, Mississippi State Department of Health. |
| MO | Missouri Department of Health and Senior Services works most closely with CHWs. Within the Bureau of Cancer and Chronic Disease Control, there is one Public Health Program Specialist that handles CHW work. |
| MT | |
| NE | Certification is not currently required but is under consideration. A Cross-Sector Workgroup that was convened from September 2019 to April 2020 on Nebraska community health workers financing and sustainability models indicated a need for development and implementation of a certification process for Nebraska CHW’s. |
| NV | Nevada Community Health Worker Association |
| NH | Area Health Education Centers (AHECs) and the New Hampshire CHW Coalition |
| NJ | In thinking about long-term support for CHWs and the training program, the NJDOH partnered with Medicaid and began having regular “sustainability meetings.” |
| NM | |
| NY | |
| NC | |
| ND | |
| OH | |
| OK | |
| OR | |
| PA | The Jewish Healthcare Foundation, in collaboration with the Pennsylvania Department of Health, worked with the Pennsylvania Certification Board to establish a certification program for CHWs.
The Pennsylvania Department of Health supports stakeholder initiatives to provide education opportunities to CHWs. In September 2020, Temple University organized a CHW Conference to celebrate and provide training for CHWs. The Secretary of the Pennsylvania Department of Health participated in the conference and provided remarks to CHWs attending the event. |
| RI | The Department of Health (RIDOH) convenes the “CHW Strategy Team” for monthly meetings, which brings together governmental and non-governmental organizations to advance community health worker initiatives throughout the state.
Rhode Island is also home to the Community Health Worker Association of Rhode Island (CHWARI), which supports community health workers in professional development, mentorship, advocacy and networking. The CHWARI also administers the CORE CHW certification training and specialty certification in chronic disease management and healthy aging. |
| SC | |
| SD | The Community Health Worker Collaborative of South Dakota, in partnership with the Department of Health, are creating guidance to support a CHW workforce. |
| TN | |
| TX | The Texas Association of Promotores and Community Health Workers (TAPCHW) was established in 2019. This association is comprised of representatives from numerous regional CHW associations in Texas. The TAPCHW collaborates with community organizations and the Texas Promotora/Community Health Worker Training and Certification Advisory Committee (supported by Texas Department of State Health Services) to support CHW work and opportunities in Texas. |
| UT | The Utah Department of Health’s Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program coordinates the CHW Core Skills training, participates in the Utah Broad Based Community Health Worker Coalition, and supports the Utah Public Health Association’s CHW Section. At the Utah Department of Health under the Office of Health Disparities (OHD), there are also CHW efforts that are currently underway. Through OHD, they have led the COVID Community Partnership that connects CHWs with clients who experienced COVID-19 with resources and information. |
| VT | State Agencies (Vermont Department of Health and Department of Vermont Health Access) and Accountable Care Organization (OneCare Vermont), as well as other community-based organizations. |
| VA | Virginia Department of Health staff and other key partners are finalizing draft regulatory text to present to the State Board of Health with the intent of codifying requirements for CHWs to practice as certified community health workers. |
| WA | |
| WV | |
| WI | Wisconsin Department of Health Services (DHS) Chronic Disease Prevention Program (e.g., 1815, 1817, Coverdell), Wisconsin DHS Division of Medicaid Services, Wisconsin DHS Asthma Program, National Common Indicators Project, Regional and Statewide CHW Networks, Wisconsin Public Health Association CHW Section, UW-Madison MATCH Just Recovery for Racial Equity Initiative and COVID Response Corps. |
| WY |
| State | Certification and Training |
| AL | |
| AK | CHWs function as Community Health Aides and Practitioners (CHAPs), Dental Health Aides, and Behavioral Health Aides in Alaska, each of whom is subject to specific standards of practice defined by the Certification Board and in the CHAP manual. The Community Health Aide Program Certification Board certifies CHAPs at all levels of practice. Certification is necessary for Medicaid reimbursement pursuant to the state plan amendment. |
| AZ | The Arizona Department of Health Services is in the rule making process to develop a voluntary certification for CHWs. |
| AR | The Community Health Worker Stakeholder Advisory Committee created the CHW Certification Commission. The Commission will make decisions on the creation of a voluntary certification program, establish a registry of certified CHWs and programs and oversee recertification. The Commission began certifying programs in late Fall 2021. |
| CA | The Department of Health Care Services (DHCS) is working with interested stakeholders to help inform development of policies and qualifications for CHWs under Medi-Cal, the state’s Medicaid program. |
| CO | Credentialing is voluntary. |
| CT | Connecticut started a certification program in 2020. Certification is required by the state. |
| DE | The state is considering a voluntary certification program. |
| DC | Certification is not required by the district. |
| FL | Certification is recommended, but not required. This varies from payer to payer, and certification is voluntary in Florida. The state currently has no policy on supervision. Florida is examining stackable credentials that will allow CHWs to progress on a career path and to enhance the prospect of sustainability and provide them with opportunities for livable wages. |
| GA | In order to be eligible for Medicaid reimbursement, Resource Mothers are required to successfully complete a Resource Mother training module and participate in ongoing in-service training as provided. Training topics are outlined in the waiver application. |
| HI | University of Hawaii offers training (degrees) and certification, but it is not required by the state.
Hawaii Department of Health submitted testimony to the legislature requesting Hawaii Department of Human Services create a task force to plan certification and training programs for CHWs. |
| ID | Certification is not required by the state. There is no state approval process for educational programs or curricula. Idaho State University offers a CHW training course. |
| IL | The new legislation signed by Governor Pritzker in April 2021 creates a board within the Department of Public Health to develop and oversee CHW certification. Certification is required to submit claims to Medicaid FFS or MCOs but is not required when services are paid through MCO administrative dollars. |
| IN | Indiana Health Coverage Program (IHCP) will recognize any CHW certification program that demonstrates the core competencies of a CHW. This includes CHW certification programs, employer-based training, or at least an associate’s degree in a healthcare-related field. IHCP enrolled billing provider must maintain documentation of CHW qualification for the individual providing CHW services. Indiana’s Division of Mental Health and Addiction (DMHA) also utilizes a continuum of peer services, including CHWs. Certification to provide CHW services through the DMHA programs must be obtained through Peer Network Indiana. |
| IA | Iowa Chronic Care Consortium (ICCC) has a CHW training program, though the program is not state sanctioned. Some organizations in Iowa are providing CHW training to current non licensed or certified employees, such as front desk and housekeeping staff, to allow the staff to advance in their career.
ICCC offers a certificate of completion once the program has been completed and the Iowa Department of Labor has approved Apprenticeship Program for CHWs, though the Apprenticeship Program is not state sanctioned. |
| KS | |
| KY | The Kentucky Department for Public Health (KDPH) launched the statewide competency-based certification process in 2019. The process is currently optional, but most organizations who employ CHWs request that they become certified. KDPH CHW Program plans to launch the official curriculum approval process for foundational level “Tier 1” training programs in 2021 and will collaborate with partners to develop specialized “Tier 2” CHW training. KDPH CHW Program performs annual assessments of CHW training needs to ensure that trainings are tailored to CHW needs. Current training efforts include Asthma/Healthy Homes, Diabetes Basics, Tobacco Cessation 101, and Healthy Living for persons with Disabilities, and Immunization following the “Vaccinate with Confidence” framework. KDPH CHW Program collaborates with external partners to provide or approve additional trainings.
The KDPH CHW Program aims to elevate and promote the CHW profession within Kentucky through professional development, workforce development, workforce promotion, and technical assistance and networking. In addition to providing the official statewide certification, the KDPH CHW Program reviews and approves Continuing Education Units (CEUs) for CCHWs. CCHWs are required to earn 10 CEUs per year, 5 of which must come from KDPH-approved programming. CCHWs recertify every October. In 2021 KDPH CHW Program launched the first edition of the CHW Stories of Success report and anticipates the launch of the official CHW curriculum review and approval process. KDPH CHW Program supports the Kentucky Association of Community Health Workers through approval of CEUs at quarterly meetings and the annual conference as well as assistance with planning of annual conference. |
| LA | In 2019, the Louisiana legislature created a CHW workforce study committee (requiring that at least half the members be CHWs) to make recommendations about how best to support the CHW workforce. The study recommendations included opting not to develop certification, but rather standardized training for CHWs.
The CHW Workforce Study Committee has evolved into the Louisiana CHW Workforce Coalition, which is now creating criteria and a review process for CHW training programs in the state. |
| ME | Currently there is no certification program, but Maine Community Health Worker Initiative (MECHWI) is considering steps to create a professional registry for CHWs. Since 2016, the Maine Mobile Health Program has delivered a 45-hour core skills training using a curriculum designed by the Institute for Public Health Innovation to 100 CHWs across the state. MCD Public Health has created its own CHW eLearning Program with a focus on chronic disease management, COVID-19, and starting in 2021, a 40-hour core skills training. One hospital system in Maine has also contracted with the Penn Center for Community Health Workers to implement the IMPaCT model, which includes a more extensive core competency training. |
| MD | The Maryland 2018 Community Health Worker Act (Health-General §§ 13-3701 – 3709) established the State Community Health Worker Advisory Committee which established processes for certification and accreditation of community health workers.
The Maryland Department of Health, Office of Population Health Improvement houses Maryland’s Community Health Worker Program. The Code of Maryland Regulations (COMAR) 10.68.01 set the requirements for an individual to be certified by the Maryland Department of Health as a Certified Community Health Worker as well as the requirements for entities to become accredited by the Maryland Department of Health to offer CHW certification training programs. The Maryland Department of Health, CHW Program aims to engage broad stakeholders in all decision-making processes, this includes including 50% CHW representation on committees and workgroups. Maryland is currently working with stakeholders to explore the opportunity to offer specialty certification to Maryland CCHWs in focused topic areas. |
| MA | The Board of Certification of CHWs is located within the Massachusetts Department of Public Health in the Bureau of Health Professions Licensure (which regulates a number of health-related occupations). The Board has the authority to grant voluntary certification to individual CHWs and to approve CHW Core Competency Training Programs, the successful completion of which will be a component of individual CHWs’ applications to be certified through the “Training and Work Experience” pathway (which is anticipated to open later this year). Certification regulations also require approved training programs to include a CHW co-trainer or trainer in at least 40% of instructional hours, which provides an advancement opportunity for CHWs. |
| MI | Medicaid does not engage with this aspect of workforce development and Medicaid does not require certification or a specific curriculum. The state does not require specific categories of knowledge be included in any training a CHW participates in when being utilized by a Medicaid health plan (MHP). |
| MN | Certification is not required for employment but required for Medical Assistance reimbursement for services provided to MN Health Care Program enrollees. Providers must have a valid certificate from the Minnesota State Colleges and Universities (MnSCU) demonstrating that the applicant has completed an approved community health worker curriculum. CHW providers must enroll and be screened following the MHCP provider screening requirements at the time of enrollment and once within every five years to maintain their enrollment. Minnesota Medicaid recognizes the state-wide standardized, competency-based educational program based in accredited post-secondary school; overseen by MN State Colleges and Universities System. |
| MS | A certification program in Mississippi is under development |
| MO | Certification is not required for credentialing, but it is highly recommended. CHWs must complete a CHW Certification program at a certified curriculum provider or be eligible for the legacy option. |
| MT | |
| NE | |
| NV | For grants to community organizations, Nevada has a statute which requires licensure, regulated through the Nevada Division of Public and Behavioral Health (NRS 449.0028).
The Nevada CHW Association in conjunction with the Nevada Certification Board provides a certificate of completion when students complete an approved course or approved course with CEUs, work experience, etc. In order to enroll into Nevada Medicaid as a CHW for fee for service reimbursement, CHWs will be required to show proof of their CHW certification. It will be up to each Managed Care Entity (MCE) on how they want to enroll CHWs. |
| NH | Certification program is under development. |
| NJ | The New Jersey Department of Health (NJDOH) has established the Colette Lamothe-Galette (CLG) Community Health Worker Institute through a New Jersey Department of Labor Apprenticeship program. The goal of the Institute is to create a standardized community health worker training and certification program with core competencies. The New Jersey Department of Labor and Workforce Development also recognizes the Rutgers Health Care Talent Network’s CHW training program. |
| NM | The NM Department of Health approves some CHW training and continuing education programs. |
| NY | New York State currently does not have certification for CHWs, but there are training programs available which provide a certificate of completion. Many employers require this training certificate before or during the initial 6 months of employment. |
| NC | |
| ND | There is an interim legislative study that will identify the feasibility and desirability of implementing a community health worker program in the state. The study was assigned to the Health Care committee in summer 2021 and will be discussed over the following year and a half. |
| OH | The Ohio Board of Nursing issues and renews CHW certificates biennially. In order to be certified, individuals must be at least 18 years old, have a high school diploma, complete the CHW training program, and pass criminal background check. CHWs must be supervised by a health professional and are restricted from performing services requiring a professional license. Per Ohio Administrative Code Rule 4723-26-05, all Ohio Board of Nursing certified CHWs are required to renew their certification in March of every odd year. A certified CHW’s first renewal only requires the CHW to confirm during the renewal process that it is their first renewal. Afterwards, certified CHWs are required to obtain 15 contact hours through educational activities that meet the continuing education requirements. |
| OK | |
| OR | Certification is encouraged but not required for employment. Only certified CHWs may participate in Health Homes/ the Patient-Centered Primary Care Home program. CHWs can apply for certification after completing a state-approved training program. Training centers are certified through the Traditional Health Worker Commission. Core competencies include outreach and mobilization; community liaising; care management, care coordination, and system navigation; and health promotion and coaching. CHWs are trained in lead prevention and asthma trigger reduction. |
| PA | |
| RI | Rhode Island has a state-operated certification program. |
| SC | Certification is voluntary. Interested CHWs take an approved core competency course and the state exam (which costs $50). If all are passed, they are granted certification. |
| SD | The Community Health Worker Collaborative of South Dakota, in partnership with the Department of Health, are creating guidance to support a CHW workforce. |
| TN | |
| TX | Certification is required for any CHW employed in Texas, per Texas Health and Safety Code, Chapter 48. The Department of State Health Services (DSHS) continues to support the Promotora/Community Health Worker Training and Certification Program, which certifies CHWs, CHW Instructors, CHW Training Programs and CHW Training Curricula (initial certification trainings and CEUs). |
| UT | Currently, Utah does not approve any educational programs or curricula for CHWs. The state is currently working with the Utah CHW Coalition to develop accreditation standards for CHW training programs. The Utah CHW Broad-Based Coalition (CHWC) Advisory Board approved a statewide curriculum covering the core competencies for CHWs in July 2017. The core competencies mirror the Community Health Worker Core Consensus Project (C3) recommendations for CHW role definitions and core skill requirements. |
| VT | Vermont does not currently have a certification program for CHWs and certification for CHW is not required for reimbursement by Medicaid.
Vermont Community Colleges of Vermont (CCV) is launching a statewide Community Health Certificate program in Fall 2021. This certificate prepares students for a variety of frontline positions in public health. Students gain foundational skills and knowledge in public health, case management, communication, and complete a capstone course aligned with the core competencies of the community health worker role in Vermont. |
| VA | |
| WA | |
| WV | |
| WI | Wisconsin has several policies and structures in place to support CHW services including the CHW Core Competency Training (based on C3 Core Consensus Project) recommended for CHW workforce.
Wisconsin does not have a CHW certification. However, certification is still a topic of discussion among CHW organizations in Wisconsin. As part of the Wisconsin CHW Network, there are six CHW-led committees including 1) Advocacy, 2) Community-Clinical Linkages, 3) Curriculum & Training, 4) Legislation & Sustainability, 5) Research & Evaluation, and 6) Conference Planning. Although still new, the Curriculum & Training along with Legislation & Sustainability have had early discussions of what CHW certification could look like in Wisconsin and whether it would be beneficial to the current and future CHW workforce. |
| WY |
| State | State CHW Legislation |
| AL | |
| AK | HB 209 (enacted 1993): Community Health Aide Program (CHAP) provided grants for third parties to train community health aides as Community Health Practitioners with an exam at the end of training. |
| AZ | |
| AR | |
| CA | |
| CO | |
| CT | Public Act 19-117 became law in 2019 and requires CHWs to be certified by the state. |
| DE | |
| DC | |
| FL | |
| GA | |
| HI | |
| ID | |
| IL | Public Act 102-0004 (HB0158) was signed by the Governor on April 27, 2021. This Public Act creates a board within the Department of Public Health to develop and oversee Community Health Worker (CHW) certification and directs the state to add CHW services as a covered benefit under the state’s Medicaid program. The state is in the process of implementing this new law. When implemented, CHW services will be reimbursed both through the Medicaid state plan. |
| IN | |
| IA | |
| KS | |
| KY | |
| LA | |
| ME | |
| MD | The Maryland 2018 Community Health Worker Act (Health-General §§ 13-3701 – 3709) established the State Community Health Worker Advisory Committee which established processes for certification and accreditation of community health workers. The Code of Maryland Regulations (COMAR) 10.68.01 set the requirements for an individual to be certified by the Maryland Department of Health as a Certified Community Health Worker as well as the requirements for entities to become accredited by the Maryland Department of Health to offer CHW certification training programs. |
| MA | Multiple pieces of legislation (including 2006 health reform law and 2010 certification law), regulations for certification, contract language for Department of Public Health-funded community-based vendors that employ CHWs, and significant funding from multiple sources to support state CHW infrastructure (Office of CHWs, supported by CDC chronic disease funding and the Massachusetts Board of Certification of CHWs, which is supported by general Department of Public Health operating funds). |
| MI | |
| MN | Minnesota Statute 256B.0625, Subdivision 49, provides that the state’s Medical Assistance (MA) program cover care coordination and patient education services provided by a CHW if the CHW has received a certificate from the Minnesota State Colleges and Universities System approved community health worker curriculum. |
| MS | |
| MO | |
| MT | |
| NE | |
| NV | During the 2021 Legislative Session, the legislature passed Assembly Bill 191 and Senate Bill 420 to allow Nevada Medicaid to reimburse for Community Health Worker services effective January 1, 2022. |
| NH | |
| NJ | |
| NM | SB 58, Community Health Workers Act, creates a voluntary, statewide certification program for CHWs through the Department of Health. |
| NY | |
| NC | North Carolina Administrative Code 10A 48B.0803 states that the local health department shall assure that program planning and implementation involve community health advocates that represent populations being served in the local health department. |
| ND | |
| OH | HB 95 (enacted 2003) requires the Ohio Board of Nursing to issue and renew CHW certificates. |
| OK | |
| OR | HB 3650 mandated the Oregon Health Authority (OHA) to develop education and training requirements and authorized Coordinated Care Organizations to provide members with access to Traditional Health Workers.
HB 3407 established the Traditional Health Worker Commission, which oversees CHWs, Peer Support and Peer Wellness Specialists, Personal Health Navigators, and Doulas. HB 2024 requires OHA to adopt rules and procedures for the training and certification of health workers to provide oral disease prevention services. |
| PA | |
| RI | |
| SC | |
| SD | |
| TN | |
| TX | |
| UT | |
| VT | |
| VA | |
| WA | |
| WV | |
| WI | |
| WY |
| State | Advancing Equity Through COVID-19 Response |
| AL | |
| AK | During the pandemic, tribal networks in Alaska relied on CHAs to educate, deliver vaccines, and vaccinate local tribal members. CHAs also brought vaccinations to ship workers. |
| AZ | CHWs in the state have been working to advance equity. Specific to Medicaid, Arizona Health Care Cost Containment System (AHCCCS) has researched potential scope of practice and codes that CHW/CHRs may be able to provide upon completion of the Arizona Department of Health Services (ADHS) rulemaking process, which are expected to advance equity. AHCCCS has also established a Health Equity Committee for using data to research disparities in care. |
| AR | |
| CA | During the COVID-19 pandemic, CHWs working in the Whole Person Care Program have been a tremendous driver on the front lines of the emergency response to care for the highest risk and vulnerable beneficiaries. The CHWs connected beneficiaries to critical health and social services, such as essential food deliveries, coordinating services at shelter-in-place sites, and/or using telehealth to improve care transitions. |
| CO | |
| CT | |
| DE | In May 2020, Gov. John Carney announced a partnership with Healthy Communities Delaware — a collaboration between the Delaware Division of Public Health, the Delaware Community Foundation, and the University of Delaware. The partnership’s goal is to provide linkages between those who test positive for COVID-19 and CHWs, who can help coordinate basic needs like grocery delivery and housing during a period of quarantine. Healthy Communities Delaware is coordinating the effort in partnership with community-based organizations. |
| DC | |
| FL | |
| GA | |
| HI | |
| ID | |
| IL | The Department of Health and Family Services (HFS) funded a Pandemic Health Worker (PHW) program, in partnership with hospital systems in northern, central, and southern Illinois, for individuals to safeguard hospitals from being overwhelmed with COVID-19 patients, limit the spread of the virus, and digitally support those needing care. PHWs virtually visited recipients daily, delivered wellness kits that include essential tools to monitor their health, and followed-up over a 14-day period to ensure no further assistance is needed. Wellness kits include thermometers, pulse oximeters, blood pressure cuffs, and alcohol wipes.
Additionally, to advance equity during and beyond the COVID-19 pandemic, HFS recently awarded grant funding to Healthcare Transformation Collaboratives across the state. Grant funding will support the work of CHWs in many of these collaboratives. |
| IN | |
| IA | |
| KS | CHWs employed by managed care organizations (MCOs) have been addressing MCO members’ COVID-19 concerns (e.g., housing, rent, testing, vaccination coordination, etc.). Other CHWs have also been involved in serving clients’ needs through the COVID-19 pandemic. Some examples of their service include, but are not limited to: coordinating assistance with rent, coordinating food distribution, connection to medical appointments, recommendation of vaccines, etc. |
| KY | |
| LA | The Louisiana Office of Public Health has hired several dozen new CHWs to support contact tracing, resource coordination, and vaccine outreach. The Louisiana State University (LSU) Center for Healthcare Value and Equity (supported by Louisiana Medicaid), along with the Louisiana Community Health Outreach Network (LACHON), has provided training for CHWs and technical assistance for program development. |
| ME | |
| MD | |
| MA | The Massachusetts Department of Public Health has supported the engagement of CHWs to advance equity during the pandemic in several areas, including contact tracing, vaccine outreach and community resilience efforts. Additionally, the state has received CDC health disparity funding that will support CHWs in further vaccination efforts and applied for significant funding from CDC through CHW CARES Act funding. The Office of CHWs developed a policy brief for CHW employers on engaging CHWs during the pandemic and hosted a series of webinars for CHWs, CHW employers and CHW allies throughout the pandemic. MassHealth established a temporary billing flexibility allowing community health centers to utilize certain paraprofessionals, including CHWs, to provide telephonic assessment and management services, under supervision and within their level of experience and scope of practice. This enabled community health centers to ensure greater access to services. |
| MI | Medicaid has enhanced the prioritization of health equity during the COVID-19 pandemic in all facets, dedicating significant attention and policy leverage to addressing inequities in all realms of care. While there was no mandate for Medicaid health plans (MHPs) to utilize CHWs to address inequities specifically, there is anecdotal evidence that MHPs rely heavily on their CHW workforce to find, engage, and support their members who are experiencing social resource issues and discrimination. |
| MN | |
| MS | |
| MO | |
| MT | |
| NE | |
| NV | |
| NH | CHWs have been deployed by their hiring organizations to address the pandemic. |
| NJ | |
| NM | |
| NY | |
| NC | The North Carolina Department of Health and Human Services (NCDHHS) selected seven vendors to hire and manage over 400 Community Health Workers, who were deployed in 55 targeted counties to connect North Carolinians affected by COVID-19 with needed services and support. |
| ND | |
| OH | |
| OK | |
| OR | |
| PA | |
| RI | CHWs have been engaged in several ways during the pandemic, supporting community members who have needed to quarantine or isolate following exposure or sickness, and helping to coordinate provision of resources so that individuals and families could comply with quarantine/isolation requirements. CHWs have disseminated health information to community members, including ongoing updates as circumstances and our scientific understanding have changed. CHWs are supporting efforts to get vaccines to vulnerable communities, including assisting with logistics and health messaging. These efforts have been realized through federal funding made available to the Rhode Island Department of Health, which has since been awarded to the Health Equity Zones. Many of the Health Equity Zones hired CHWs to carry out the services above. |
| SC | |
| SD | |
| TN | |
| TX | |
| UT | |
| VT | The state of Vermont utilized Coronavirus Relief Funding (CRF) to address health disparities and advance health equity during the COVID-19 pandemic. Funds supported cultural broker programs for Refugees and New Americans, migrant farm worker outreach positions, and other groups to address racial and social justice and to meet the essential needs of vulnerable populations during this pandemic. No new Medicaid reimbursement was established during this time. |
| VA | Community Health Workers in Virginia have been increasingly engaged to advance equity, provide accurate information related to chronic disease self-management, the importance of testing, vaccine preparedness, access to primary care, and needed social supports during the COVID-19 pandemic.
The Virginia Department of Health (VDH), the Institute for Public Health Innovation, and the Virginia Department of Medical Assistance Services collaborated on submitting a proposal for CDC funding to use CHWs to address inequities around the COVID-19 pandemic. |
| WA | |
| WV | |
| WI | The COVID-19 Workforce Safety policy proposal included CHWs as essential health care workers. CHWs have been engaged in all aspects of the COVID-19 response from contact tracing, safe isolation and quarantine, vaccination outreach and community resilience. Resources include: https://uwphi.pophealth.wisc.edu/crrtf/ and https://uwphi.pophealth.wisc.edu/covid-19-a-fair-and-just-recovery/#uwphi-insights |
| WY |
| State | State Resources |
| AL | |
| AK | |
| AZ | Arizona Department of Health Services–Community Health Workers |
| AR | |
| CA | |
| CO | Health Navigator workforce development |
| CT | |
| DE | |
| DC | |
| FL | Division of Community Health Promotion and Division of Disease Control in Florida Department of Health |
| GA | Georgia Medicaid, Planning for Healthy Babies |
| HI | |
| ID | |
| IL | Illinois Department of Public Health–Community Health Workers |
| IN | |
| IA | |
| KS | |
| KY | |
| LA | |
| ME | |
| MD | Maryland Department of Health–Community Health Workers |
| MA | |
| MI | |
| MN | |
| MS | Mississippi State Department of Health–Community Health Workers |
| MO | |
| MT | |
| NE | |
| NV | |
| NH | |
| NJ | |
| NM | |
| NY | |
| NC | North Carolina Community Health Worker Initiative |
| ND | |
| OH | |
| OK | |
| OR | |
| PA | |
| RI | |
| SC | |
| SD | |
| TN | |
| TX | |
| UT | |
| VT | |
| VA | |
| WA | |
| WV | |
| WI | |
| WY |
If a state official or CHW association representative did not respond to the survey, NASHP used a combination of publicly available information and information from the previous map update, from 2015. If you have an update to share from your state, please email Elinor Higgins.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
