State Legislation Exploring the Use of Community Health Workers

August 10, 2017|3:07 p.m.| Crystal El-Khatib, Intern, State Health Policy

A community health worker (CHW) is a frontline public health worker who is trusted by a community and provides a link between the community and health services, as well as facilitates improved access and quality of health services. Through a variety of activities, such as providing health education and information, informal counseling and social support, as well as health screenings, CHWs work to improve the health of their community. 

ASTHO is currently tracking over 30 bills from 14 states and Washington, D.C. to address the role of CHWs. Bills have successfully passed legislatures in Connecticut (SB 126), Minnesota (SF 562), and Missouri (HB 11). In Delaware, lawmakers passed a concurrent resolution accepting a report prepared by the division of public health and the Delaware Center for Health Innovation that examines strategies to develop and deploy CHWs (SCR 37). 

  • Connecticut’s new law requires the director of the state innovation model initiative program to assess the feasibility of a CHW certification program, including the fiscal impact and administration of the program. The study must include recommendations for the minimum education and training of CHWs, ongoing training or continuing education requirements, as well as the identification of any training programs that meet the requirements for certification. 
  • In Minnesota, CHWs with one year of experience working for a qualifying agency may be reimbursed for early intensive development and behavioral intervention services provided to a person with autism spectrum disorder or a related condition. This legislation illustrates how states are exploring ways to expand the use of CHWs to a wide array of populations and issues.
  • Missouri included specific funding for a CHW initiative to provide casework services in the state’s Medicaid program. Lawmakers appropriated one million dollars from state general funds to support this work. The state funding is matched by federal Medicaid dollars as well. 
  • Delaware’s concurrent resolution signifies the submission of a report entitled the Development and Deployment of Community Health Workers in Delaware: Establishing and Certification Program and Reimbursement Mechanism. The report, which was submitted to the legislature, recommends developing a voluntary certification program for CHWs, establishing pathways to enter and grow in the profession, and financing strategies. Lawmakers stated, “With the implementation of these recommendations and legislation forthcoming, CHWs will better coordinate with our current healthcare system and work towards total integration while driving healthcare costs down.” 

Other bills addressing CHWs were introduced in 2017 but did not pass. In Minnesota, a bill included CHWs in the target audience for a mental health training program to increase the mental health workforce (SF 1880). In North Carolina, a bill to increase access and coordination for care for veterans included a provision to train veterans as CHWs (H 894). Finally, a bill in Oregon would have incorporated the use of CHWs and other traditional health workers into quality metrics to evaluate the state’s coordinated care organizations (HB 2014). ASTHO will continue to monitor and share these and other innovative ways states are leveraging CHWs to improve health and wellbeing.