State Community Health Worker Models
*Chart updated June 5, 2015
As states transform their health systems many are turning to Community Health Workers (CHWs) to tackle some of the most challenging aspects of health improvement, such as facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health. While state definitions vary, CHWs are typically frontline workers who are trusted members of and/or have a unique and intimate understanding of the communities they serve. This chart highlights state activity to integrate 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 chart includes enacted state CHW legislation[1] and provides links to state CHW associations and other leading organizations working on CHW issues in states. Click here for more details on how states are financing the work of CHWs. To view State Refor(u)m’s webinar on integrating CHW models into evolving state health care systems click here.
Like all State Refor(u)m research, this chart is a collaborative effort with you, the user. We are actively researching state CHW activity and will be updating this chart regularly. Know of something we should add to this compilation? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email jrosenthal@oldsite.nashp.org with your suggestions.
Like all State Refor(u)m research, this chart is a collaborative effort with you, the user. We are actively researching state CHW activity and will be updating this chart regularly. Know of something we should add to this compilation? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email jrosenthal@oldsite.nashp.org with your suggestions.
| State | Financing [2] | Education | Certification | State CHW Legislation | CHW Organizations | CHW Roles in State |
|---|
| State | Financing [2] | Education | Certification | State CHW Legislation | CHW Organizations | CHW Roles in State |
|---|---|---|---|---|---|---|
| Source of funding for CHW work | Training requirements and core competencies | Requirements for state CHW certification | Enacted state CHW legislation | State association or leading organization | State definition of a CHW and key roles | |
| AK | Community Health Aide Program (CHAP) funding support through Indian Health Service, the Denali Commission (a federal agency) or federal Community Health Center funding (p.12). | Board-certified 3-4 week intensive training course; completion of designated number of practice hours and patient encounters; post-session learning needs and practice checklists; 200 hours village clinical experience; preceptorship; 80% or higher on CHAP exam, and 100% on statewide math exam. Fourregional training centers. | Certification necessary to participate in the Community Health Aide/Practitioner program, and the Alaska Native Tribal Health Consortium. | HB 209 (enacted 1993): Community Health Aide Program (CHAP) provides grants for third parties to train community health aides as Community Health Practitioners with an exam at the end of training. | Alaska Community Health Aide Program | CHWs function as Community Health Aides and Practitioners, Dental Health Aides, and Behavioral Health Aides, each of whom is subject to specific standards of practice defined by Certification Board and in the CHAP manual. |
| AZ | Funding for CHWs through community health centers, universities, and health care plans. Pursuing Medicaid and health insurance funding streams.Funding from the HRSA Rural Network Development Planning Grant Programto develop a statewide network of stakeholders to support Arizona Community Health Outreach Workers Network in moving Arizona’s CHW agenda forward. | Arizona Community Health Outreach Workers Network offers annual trainings. Local Area Health Education Centers, Federally Qualified Health Centers, and the University of Arizona provide ongoing training on evidence based curricula on a number of health issues. | Three voluntary certification programs administered by Community Colleges. | The Arizona CHW Workforce Coalition is currently exploring legislation to be introduced in the 2016 legislative session. | Arizona Community Health Outreach Workers NetworkArizona Prevention Research Center and the Arizona Area Health Education Centers are also working on CHW issues. | The Arizona Department of Human Services has formed a CHW Leadership Council to define roles; the AZ CHW Workforce Coalition has accepted theAmerican Public Health Association’s (APHA) definition and defined competencies and scope of practice. |
| AR | Funding for CHWs in potential as care coordinators as defined in State Innovation Model Narrative. | Not currently. | Not currently. | Not currently. | Arkansas Community Health Worker Association | Potential role for CHWs in patient centered medical homes (PCMH); AR has nine CHWs employed by STAR Health Program, which promotes maternal and child health, oral health and chronic disease management in three counties. |
| CA | Funding for CHWs included in SIM plan as part of care team of health homes for complex patients (p.30), in the discussion of Community Transformation Grants (p.38-39), and in the discussion of workforce building (p. 40-45). | The SIM Workforce Group is specifically addressing CHW training and credentialing. | Section 6332 of the California Labor Code includes definition of a CHW. | Vision y CompromisoCalifornia Association of Community Health Workers. | As defined in Section 6332 of the California Labor Code: Community health care worker is an individual who provides health care or health care-related services to clients in home settings. | |
| CO | CHWs in SIM plan (p.145-6, 158); work group looking at core competencies, licensing requirements and certification, and sustainable funding. | Not currently. | Colorado Community Health Worker and Patient Navigator Work Group | |||
| CT | Funding through SIM proposal (p. 10) discusses integrating CHWs into community health teams, creating training, and certification standards for CHW. | Southwestern CT AHEC offers CHW training. | Not currently. | |||
| DC | Pursuing Medicaid State Plan Amendment. | Not currently. | CHW Professional Association of Washington, DC | |||
| FL | CHWs hired by community based organizations (CBOs), universities, FQHCs, and insurance payers who run managed care organizations. Hiring at CBOs and universities based on grant availability. | The Florida CHW Coalition (FCHWC) CHW Certification Implementation Team has developed 28 CHW tasks in five performance domains. The Florida AHEC network and community colleges around the state provide training. Many organizations working with CHWs have developed their own training program such as: MHP Salud, Rural Women’s Health Project, Healthstreet,ConnectFamilias. | FCHWC moving towards voluntary certification, administered by the Florida Certification Board. Written exam will be developed in 2015, with full credentialing in 2016. Grandfathering period for expereinced CHWs includes 500 hours of documented paid or volunteer experience providing CHW services; at least 30 hours of training in core competencies and two letters of reference. | Not currently. | Florida Community Health Worker Coalition | |
| GA | Not currently. | Georgia Community Health Advisor Network | ||||
| HI | Healthcare Innovation Plan includes CHW training (p.27). | Not currently. | ||||
| ID | Funding through SIM plan/proposal (p.11, 29-30, 32-34); CHWs as part of the workforce for PCMHs, especially in workforce shortage areas. | SIM plan/proposal intends to develop training program for CHWs and community emergency services personnel to increase opportunities for coordinated primary care in rural and underserved areas. | Not currently. | Not currently. | Not currently. | Not currently. |
| IL | The Community Health Worker Act creates minimum core competencies for CHWs; an Advisory Board can consider other competencies. | HB 5412 (enacted 2014) creates an Advisory Board in Department of Public Health. Board must develop core competencies for training and certification of CHWs. Prohibits CHWs from performing services requiring a professional license. | Chicago CHW Local Network | The Community Health Worker Advisory Board Act uses the APHA definitionof a CHW. | ||
| IN | Integrated Care Community Health Worker and Certified Recovery Specialist Training and Certification Program, approved by the Indiana Division of Mental Health and Addiction and the State Department of Health. | Individuals must be 18 years old, resident of Indiana and have at least a high school diploma or GED. Three-day training and final exam. Certified CHWs may serve in outpatient medical/behavioral settings, including hospitals, medical clinics, schools, churches, and community centers. | Not currently. | Indiana Community Health Workers Association | Follows APHA’s definition. | |
| KY | Funded through grants or organizations large enough to absorb the costs (i.e., hospitals, FQHCs). CHW workgroup involved in SIM Planning Grant for health care systems change. Pursuing Medicaid State Plan Amendment.Cabinet for Health and Family Services through Kentucky Department for Public Health supports CHW program through a contract with the University of Kentucky Center for Rural Health called Kentucky Homeplace. | State does not approve training programs. Kentucky Homeplace training program requires 40 hours of classroom and online instruction and internship. Montgomery County Health Department (MCHD) trains CHWs through HRSA grant. Curriculum based on HRSA CHW training, Stanford Chronic Disease Self-Management, Stanford Diabetes Self-Management, American Association of Diabetes Educators ABCs of Diabetes Education, Healthy Homes for CHWs, Mental Health, First Aid and other resources. | Kentucky CHW Workgroup developing recommendations and process for certification. | Not currently. | Not currently. Lead state agency is the Department for Public Health; four staff dedicate 20-30 hours/month (total) on CHW project. Developing new position to work 20 hours/week on CHW project. | Follows APHA’s definition. |
| LA | Not currently. | Louisiana Community Health Outreach Network | ||||
| ME | CHWs are explicitly listed (p.4) as potential members of Community Care Teams (CCT) in Maine’s Health Homes program. The CCTs are reimbursedthrough Medicaid Health Homes.SIM grant (p.17) includes four CHW pilot sites. | Maine Community Health Worker Initiative (MECHWI) has developed a core competency/skills/roles cross-walk to inform the development of training recommendations. Training provided by employers or tied to specific projects. | Not currently. | Maine Community Health Worker Initiative | Maine’s SIM narrative (p. 17) includes four CHW pilot sites to “Demonstrate the value of integrating CHWs into the health care team; Provide models for state-wide replication; Build a core group of experienced CHWs who can provide leadership for ongoing development of the system.”MECHW Initiative defines CHW roles and scope of practice. | |
| MD | Financed primarily through grant funding. CHWs are key element of SIM plan. | No state-sponsored infrastructure for CHW training; programs training CHWs develop their own competencies and curricula. | Workgroup on Workforce Development for Community Health Workersestablished by HB 856; workgroup is charged with developing recommendations on CHW training, credentialing, and financing. | Community Outreach Workers Association of MarylandMaryland CHW Association disbanded but is presently reforming and held an inaugural meeting in November 2014. | Scope of practice and roles are not mentioned in HB 856, the workgroup islooking at this issue as part of their overall efforts. | |
| MA | Primarily grant funding, but in some cases a combination of grants, core operating funds and other resources such as federal, state and local governments, private foundations, other nonprofit funding and some health plan funding. Medicaid supports a small amount of CHW services through an 1115 waiver for high-risk pediatric asthma and a demonstration project for dually eligible adults. Department of Public Health and other partners exploring Medicaid State Plan Amendment.CHWs were included in several aspects of the 2012 payment reform law. | Training offered by CBOs, AHEC, local health department, and a university school of public health. Training programs address ten core competencies. 80 hours of online and in-person training; no practicum required, but CHWs applying for certification must have 2,000 hours of relevant work experience. Graduates of training programs eligible to apply for state CHW certification. | Board of Certification of CHWs will begin certifying both paid and volunteer CHWs in 2015. Process will consist of a paper application, submission of three professional references, completion of an approved training program, and 2000 hours of relevant work experience. There will be a grandparenting period for the first 3 years of certification; CHWs with 4000 hours of relevant work experience will be eligible to apply without training. | Chapter 58, Acts of 2006 – Section 110; and Chapter 224, Acts of 2012.Chapter 322, Acts of 2010 (enacted 2010) to establish a board in the Department of Public Health to certify CHWs. A law in 2007 created a seat on the Public Health Council for a representative from the Massachusetts Association of Community Health Workers. |
Massachusetts Association of Community Health WorkersMA Office of Community Health Workers | Roles include outreach, health education, client advocacy and empowerment, as well as health system navigation; hired primarily for their special connection to and understanding of the populations and communities they serve, conduct outreach a significant portion of the time, and have experience providing services in community settings. |
| MI | Results of a 2014 program survey (p.27) conducted by the Michigan Community Health Worker Alliance (MiCHWA), show CHW funding sources.CHWs were included in Michigan’s SIM planning award report in 2014. | MiCHWA’s Education and Workforce working group develops training standards and core competencies with active participation from CHWs. 126-hour curriculum. Training is primarily employer-sponsored; CHWs return to positions when training is complete. Internship/practicum required for individuals not employed. | Not currently; curriculum MiCHWA is piloting may become the basis for certification. MiCHWA’s Steering Committee voted to support MiCHWA as a certifying body for statewide certification. | Not currently. | Michigan Community Health Worker Alliance (MiCHWA) | MiCHWA endorses seven roles for CHWs: case management and care coordination; community-cultural liaison; health promotion and health coaching; home-based support; outreach and community mobilization; participatory research; and system navigation. |
| MN | Federal approval in December 2007 for CHWs to participate in Medicaid program and receive payment for their services; CHW must enroll with Department of Human Services as the rendering provider in order for services to be reimbursed.MN’s SIM Grant (p.7) includes the use of emerging health professions, such as CHWs, as part of interdisciplinary teams in Accountable Care Organizations (ACOs). | State-wide standardized, competency-based educational program based in accredited post secondary school; overseen by MN State Colleges and Universities System. 14-credit program includes classroom and field-based learning for individuals with a high school diploma or GED, at a minimum. Department of Human Services requires a certificate (or at least 5 years supervised experience) for CHWs to receive Medical Assistance reimbursement for services provided to MN Health Care Program enrollees. Continuing education opportunities available. | Not currently. | HF 1078 Subd. 49 allows CHWs to participate in Medicaid program and receive payment for services. CHW must have certificate or at least 5 years supervised experienced with an enrolled clinician. CHWs must then work under the supervision of one of these clinicians. | MN CHW Peer NetworkMinnesota Community Health Worker Alliance | Roles for CHWs: bridge the gap between communities and the health and social service systems; navigate the health and human services system; advocate for individual and community needs; provide direct services; build individual and community capacity. |
| MS | In 2015, Medicaid in MS will begin to cover CHW services, however, it is under the auspice of “general education,” and not a specific billing code. Other funding is private and includes specific clinic or grant funding. | A past initiative to standardize the state definition of a CHW and to establish formal guidelines for CHW training and certificate programs failed due to legislative opposition. | Tougaloo College, Central Mississippi Area Health Education Center and state Department of Health joined together in 2012 to establish a CHW certification program. | Not currently. | Not currently. | The State Department of Health and other partners have formulated a definition, but the Board of Health has not had the opportunity to approve it for promotion across the state. CHWs provide services such as conducting home visits, helping navigate the health system, and connecting individuals to resources. |
| MO | Funded by health care entities or community organizations. | Metro Community College offers CHW certificate training program. Adapted Minnesota’s CHW curriculum; Department of Health and Senior Services to decide if the curriculum will become the state standard. Requirements: 160 hours and 60 service (practicum) hours. Core competencies include communication, organization and resources, life style choices, cultural beliefs and healthcare, legal and ethical considerations, and employability skills. Individuals or health systems pay for the training program. | Department of Health and Senior Services is establishing a pilot project in Kansas City area to certify CHWs and standardize curriculum; tuition reimbursement will be available for those enrolling in CHW Certificate program. CHWs who enroll and pass the curriculum receive certificates. | Not currently. | Not currently. Department of Health and Senior Services has a dedicated staff person assigned to the CHW pilot project who spends time networking, researching and implementing the project. | Department of Health and Senior Services definition includes the APHA definition and adds that CHWs are liaisons with resources in the communities they serve and play a vital role in improving Missourian’s health by providing a connection between health systems and community resources, as well as education on how to reduce behavioral health risk factors. |
| MT | Funding through Frontier Community Health Care Coordination Demonstration Grant (p.14). | Training developed by Montana Office of Rural Health and State AHEC office (p.15). | Not currently. | CHW care coordinators are non-clinical paraprofessionals focusing on chronic disease management and linking patients with services to achieve selected health outcomes and decrease hospitalizations and emergency room visits (p.15). | ||
| NE | Grants to local hospitals and Department of Health and Human Services (NDHHS) Division of Public Health. | NE CHW Coalition has assessed training program and developed recommendations for core competencies and scope of practice recommendations, number of hours of classroom/online instruction and practicum requirement, and consideration of grandfathering CHWs. NDHHS offers patient navigation training for CHWs which includes a full-day, face-to-face training; then 10 weeks of computer-based learning; a second full-day face-to-face training; plus a practicum. | Not currently. Indian Health Service certifies Community Health Representatives. The NE CHW Coalition Steering Committee Standards Workgroup developed certification recommendations. | Not currently. | In December 2014, the Public Health Association of Nebraska approved aCHW Section. This section will develop as a statewide association. | Follows the APHA definition. |
| NV | Leverages funds from sister programs at Nevada Division of Public and Behavioral Health (NDPBH), including Maternal and Children’s Health, Women, Infants, and Children (WIC), Chronic Diseases, and HIV. Medicaid does not reimburse for CHW services. | Nevada System of Higher Education developed training curriculum; currently offered at two colleges. Programs must address APHA’s core competencies; 56 hours of classroom instruction and no practicum required. CHW program also recommends Washington State’s training program. The NDPBH will recognize this curriculum for a CHW certificate of completion. | Not currently. | Bill Draft Request (BDR) places regulation and oversight to certify individual CHWs in Nevada within the Bureau of Health Care Quality and Compliance (HCQC, and also includes training standards according to CHW core competencies. | Efforts to establish CHW association underway to assist with promotion and understanding of CHW workforce and further help oversee standards, guidelines, and requirements. | Follows the APHA definition. |
| NH | Primarily funded through grants. | The Southern NH Area Health Education Center (AHEC) offers a CHW training program which includes a variety of topics. | Not currently. | Not currently; potential legislation in 2016. | Southern NH AHECNH CHW Coalition formed in January 2015. | No formal definition adopted; follows the APHA definition. |
| NM | Through a Medicaid 1115 Waiver, Centennial Care has leveraged contracts with Medicaid managed care organizations (MCOs) to support the use of CHWs in serving Medicaid enrollees. CHW salaries, training, and service costs are MCO administrative costs and embedded in capitated rates paid to Medicaid managed care organizations. | Certification is voluntary and through Department of Health. Applicants must complete a Department-approved training program and demonstrate proficiency in CHW core competencies. Specialist certification will be available. Background check required and certificates valid for two years. Continuing education required for recertification. Process to recognize and certify existing CHWs based on experience. | SB 58, Community Health Workers Act, creates a voluntary, statewide certification program for CHWs through the Department of Health. | New Mexico Community Health Worker AssociationNew Mexico Office Of Community Health Workers. | Office of Community Health Workers defined roles and scope of practice.Centennial Care contracts define CHWs as lay members of communities who work either for pay or as volunteers in association with the local health care system in Tribal, Urban, Frontier, and Rural areas and usually share ethnicity, language, socioeconomic status and life experiences with the Members they serve. CHWs include, among others, community health advisors, lay health advocates, promotoras, outreach educators, community health representatives, peer health promoters, and peer health educators. | |
| NY | CHWs can be optional team members of Health Home care teams. | Department of Health’s CHW Program trains CHWs to provide health education, referrals, and support for individuals navigating the health system. | Not currently. | Community Health Worker Network of New York City | CHW Program serves communities with high rates of infant mortality, out-or-wedlock births, late or no prenatal care, teen pregnancies and births, and births to low-income women. | |
| OH | Training program must be state approved; at least 100 hours of classroom instruction and 130 hours of clinical instruction, standard training exam. | Board of Nursing issues and renews certificates biennially; continuing education required. Individuals must be at least 18 years old, have a high school diploma, complete the CHW training program, and pass criminal background check. CHW must be supervised by a health professional and is restricted from performing services requiring a professional license. | HB 95 (enacted 2003) to require Board of Nursing to issue and renew CHW certificates. | Ohio Community Health Worker Association | ||
| OR | State Plan Amendment (SPA) created Patient-Centered Primary Care Homes (PCPCHs) explicitly includes CHWs in description of providers for four of the six core Health Home services. Only certified CHWs reimbursed.Oregon’s SIM grant (p. 2) designed to build on Community Care Organization (CCO) Model. CCOs must include “non-traditional healthcare workers” like CHWs on their care teams. A health professional must supervise a CHW in order for Medicaid to reimburse for services provided. No official reimbursement rate for CHWs; a few sites have negotiated reimbursement for targeted case management. Only CHWs certified by the Oregon Health Authority (OHA) and included on a registry,are eligible to be funded by Medicaid. | OR committed to training 300 new CHWs by 2015 (p. 8-9); 80 hours of training and 20 hours of continuing education required every 3 years. 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. | Only certified CHWs participate in Health Homes. CHWs can apply for certification after completing an OHA-approved training program. Must be at least 18 years old; criminal background check required. Grandfathering available to those who have worked over 3,000 hours in the past five years, and completed additional training. | HB 3650 (enacted 2011) mandated OHA to develop education and training requirements that also meet federal requirements to qualify for financial participation. Oregon Health Policy Board established the Non-Traditional Health Worker Subcommittee to create core competencies, education and training requirements.HB 3407 (2013) established the Traditional Health Worker Commission, which oversees CHWs, Peer Support and Peer Wellness Specialists, Personal Health Navigators, and Doulas. | Oregon Community Health Workers Association | CHW is an individual who: has expertise or experience in public health; works in an urban or rural community, in association with local health care system; may share ethnicity, language, socioeconomic status and life experiences with residents of the community; assists community to improve health and increases capacity of community to meet health care and wellness needs of residents; provides culturally appropriate health education and information; assists community residents in receiving care; provide peer counseling and guidance; provide direct services and screenings.The Traditional Health Worker Commission is defining a scope of practice for all of the Traditional Health Worker (THW) roles, including CHWs. |
| PA | Medicaid is the biggest source of payment for CHWs. PA provides Medicaid coverage for Peer Support Services (PSS) in the mental health field, and some PSSs are considered CHWs. | Academic institutions, health organizations and health systems offer CHW training as well as Area Health Education Centers (AHECs). PA Department of Health’s CHW Project Strategy includes recommending the eight core skills in the National CHW Workforce Study | Not currently. | Not currently. | A state-wide CHW symposium planned for May, 2015. PA Department of Health is the lead state agency for CHW issues. | No official definition of CHWs; discussing options and working on adopting a standard job title for CHWs to unify the workforce and educate partners.Common roles of CHWs: assuring people get the services they need; providing culturally appropriate accessible health education and information; providing informal counseling and social support; and advocating for individual and community needs. |
| RI | Grant funding (especially those working on disease-specific programs) or incorporated into the operating budgets of agencies. Some CHWs may bill services under a portion of their jobs (specific licensure or services approved for reimbursement). State is exploring Medicaid waivers for CHW billable services. | Training paid for by the trainees or their employers. Committee of CHW employers and supporters developed the curriculum, using standards approved by national CHW interest groups, as well as needs defined by RI stakeholders. Requires 30 hours of classroom learning and 80 hours of field experience in the field. | Certification is available for all CHWs (paid or volunteer), but is not mandatory. The Community Health Worker Association of Rhode Island (CHWARI) offers certification training for CHWs. The Rhode Island Department of Health endorses, promotes and supports certification. Participants must successfully complete the program classes, assignments and work experience to receive certification. There is no “grandfathering” process. | H 5633 (enacted 2011) established the Commission for Health Advocacy and Equity. Commission must make recommendations for increasing diversity of health care workforce, which may include recruitment, training and employment of CHWs. | Community Health Worker Association of Rhode Island | No formal definition. CHWARI promotes the APHA definition of CHWs. |
| SC | South Carolina Department of Health and Human Services (SCDHHS) CHW pilot program pays for primary care services provided by CHWs. Practices selected to participate in the SCDHHS CHW program received $6,000:. Two codes authorized for CHW service reimbursement; a group and individual encounter code. SCDHHS working with statewide partners to secure funding to expand CHW program. Plans to submit a Medicaid State Plan Amendment (SPA) to CMS; SCDHHS certification is necessary for Medicaid reimbursement. | Training curriculum developed by SCDHHS and Midlands Technical College includes 120 classroom hours and 120 practice hours; internship/mentorship requirement. Core competencies included in certification training program. | SCDHHS is the only body certifying CHWs for Medicaid reimbursement during pilot phase. For the pilot program, 14 primary care practices participated in the certification program; Grandfathering if CHW candidate has at least 3 years experience with community outreach; documentation from employer is required, and the CHW candidate must pass the CHW certification exam. | Not currently. | The first SC CHW Association meeting took place in December 2014 and was attended by community-based organizations and CHW leaders across SC. | SCDHHS has a draft policy in progress outlining the definition, scope of service and program guidelines for CHWs; an FAQ document outlines current role of CHWs in SC. |
| TX | Most paid CHW positions funded through grants or core budget funding. CHW positions not funded through state; contracts within Department of State Health Services (DSHS) Expanded Primary Health Care allow for reimbursement of CHW outreach services. Medicaid contracts with Managed Care Organizations (MCOs) and includes CHWs in administrative costs in order to receive reimbursement. CHW included in Medicaid 1115 waiverallows for reimbursement. | Community colleges, other academic institutions AHECs, Federally Qualified Health Centers (FQHCs), a CHW network, and community-based organizations train CHWs. 160 hours and eight standardized core competencies. Other activities may serve as proxies for demonstration of core competencies; eligibility based on experience is ongoing. | DSHS established and operates Promotor(a) or Community Health Worker Training and Certification Program for CHWs and instructors. Certification is for 2 years. DSHS reviews and approves all certification, training and continuing education. | Texas Health and Safety Code Chapter 48 provides authority to DSHS to establish and operate a certification program for CHWs.SB 1051 (enacted 1999) requires DSHS establish CHW training program- only mandatory for CHWs compensated for services. HB 2610 (enacted 2011) requires DSHS to establish statewide advisory committee to provide recommendations on CHW training, funding and employment. |
CHW Advisory Committee and regional organizations but no statewide CHW organization. | Definition included in Texas Health and Safety Code Chapter 48; CHWs are employed by a variety of organizations, including clinics, hospitals, health or social service nonprofits, area health education centers, schools or universities, local health departments, health plans, and others. |
| UT | Primarily grant funded; grants usually received by community based organizations. Molina Health Care hires CHWs to work with clients. | Developing a state standardized competencies training as well as topic specific modules (i.e. asthma, hypertension, etc.). Organizations using CHWs provide in-house and/or on-the-job training. | Not currently. | Not currently. | Utah Public Health Association has a CHW Special Interest Group to serve as state CHW association. | Uses APHA definition of CHWs. |
| VT | CHWs are part of Vermont’s Community Health Teams (CHTs); an integral part of the SIM narrative. CHTs paid out of Vermont’s Multi-Payer Advanced Primary Care Practice Demonstration pilot, which involves a monthly care management fee for beneficiaries receiving primary care from advanced primary care (APC) practices. Costs shared among Vermont’s major insurers, as well as Medicare and Medicaid. | Not currently. | As part of Community Health Teams, CHWs assist patients with insurance applications, following treatment plans, managing stress, and working toward personal wellness or disease-management goals. CHWs may accompany patients to appointments and help find transportation or childcare. | |||
| VA | CHWs included in VA SIM plan. Workforce Development workgroup looking at funding options. | Workforce Development work group looking at core competencies and training requirements. | Workforce Development work group looking at certification options. | Not currently. | Virginia CHW Advisory GroupVirginia CHW Association | |
| WA | Washington’s State Plan Amendment allows CHWs to participate in Health Homes and receive funding through Medicaid for each patient served. | Training through the Department of Health establishing core competencies for CHWs. 8-week program may be completed online or in-person, and training is conducted quarterly. CHW receives a certification of completion. | Not currently. | Washington Community Health Worker Network | CHW 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. | |
| WV | CHWs are optional members of Behavioral Health Health Home care teams (p. 5), which are financed by Medicaid through pre-set payments per member. | Not currently. | FutureWV participates in some state CHW activity. | Optional members of Behavioral Health Health Home care teams. |
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Notes:
[1] The Association of State and Territorial Health Officials (ASTHO) provides real-time legislative tracking on Community Health Workers on this page under “Licensure & Certification.”
[2] Click here for more details on how states are financing the work of CHWs.
Chart produced by Sara Kahn-Troster and Kaitlin Sheedy
[2] Click here for more details on how states are financing the work of CHWs.
Chart produced by Sara Kahn-Troster and Kaitlin Sheedy
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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. 
