Health Systems Transformation

Community Health Workers

This webpage contains resources for state health agencies on the use of non-licensed providers such as Community Health Workers (CHWs), including resources related to financing, certification and licensure, and examples of work in states to support CHWs.

CHW Call Series

Certification and Licensure
March 3, 2016

This interactive call provided an overview of state legislative activity related to certification and training of CHWs, described the Community Health Worker Core Consensus (C3) Project, and discussed the pros and cons to certification through a facilitated panel discussion with three CHW experts.

Financing and Reimbursement

CMS Releases Final Rule on Medicaid Home and Community-Based Services
On Jan. 10, 2014 the Centers for Medicare and Medicaid Services (CMS) released regulations that aim to enhance the quality of home and community-based services and provide additional protections to individuals that receive these services. More information on the final rule, including an informational bulletin, fact sheets and scheduled webinars, is available at

Medicaid Reimbursement for Community-Based Prevention (Nemours and TFAH)
This document provides an overview of the new Medicaid rule change that allows Medicaid reimbursement for preventive services. It addresses opportunities and barriers for states, and includes a questionnaire designed to prepare organizations to engage in a dialogue with their State Medicaid officials about pursuing this new option.

Q&A Document for Medicaid Rule Change
This document provides answers to commonly asked questions regarding the Medicaid rule change allowing reimbursement for preventive services delivered by non-licensed providers. 

Webinar: Leveraging Managed Care to Support Community Health Workers and Promote Population Health
Trust for America’s Health and ASTHO hosted a webinar on September 9th, 2015 that discussed how managed care organizations (MCOs) can integrate Community Health Workers (CHWs) into the healthcare workforce and impact population health. Two MCO models were highlighted from speakers Dodie Grovet, Clinical Program Training Manager at Molina Healthcare Inc., and Sue Moran, Senior Deputy Director at the Michigan Department of Health. Participants learned the importance of effective Medicaid partnerships, how states can use MCO contracts as a policy and financing lever, and effective models incorporating MCOs. Click here to view the webinar recording and slides

ASTHO Issue Brief on Expanding Access for Preventive Services: Key Issues for State Public Health Agencies
This issue brief gives a broad overview of financing strategies to expand preventive services, and opportunities for state public health departments to influence and lead such efforts in their states.

Pathways to Reimbursement: Understanding and Expanding Medicaid Services in Your State 
This technical brief from the National Center for Healthy Housing provides and overview of options for financing healthy homes services through your state's Medicaid program, including waivers, managed care contracts, state plan amendments, and more.

Including Community Health Workers into the Public Health and Health Care Systems- Payment Structure and Discussion
This PowerPoint presents information on including CHWs in the healthcare and public health system through payment structure. Anne De Biasi, MSN, Director of Policy Development, Trust for America's Health (TFAH) discusses Medicaid support for community prevention, while Cherylee Sherry, MPH, Community Health Systems Coordinator for the Minnesota Department of Health, presents on payment legislation for CHWs in Minnesota. 

Medicaid Funding of Community-Based Prevention: Myths, State Success Overcoming Barriers, and the Promise of Integrated Payment Models
This paper from Nemours describes key myths about Medicaid financing of prevention, highlights successful efforts by states to fund prevention initiatives through Medicaid, discusses the potential for integrated payment reforms to support prevention, and offers conclusions and recommendations for policymakers to encourage the use of Medicaid financing of a broad range of prevention initiatives.

Healthcare Financing of Healthy Homes Resource Library
With all of the emerging opportunities to finance healthy homes services through the healthcare system, it can be overwhelming to know where to start. This resource library provides an overview of key financing strategies, examples of home-based lead and asthma programs that are currently being financed through nonprofit hospitals and public or private insurance, and links to resources that are available to help state and local agencies, or other stakeholders, explore options for healthcare financing of healthy homes in their own communities.

The Reimbursement Landscape: Healthcare Financing of Healthy Homes Services 
This PowerPoint presentation describes results from the National Center for Healthy Housing research on Medicaid reimbursement policies in states for home-based asthma services and lead poisoning follow-up services.

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions
Medicaid health home is an optional benefit for high-need, high-cost beneficiaries with chronic physical conditions or serious mental illness, authorized in Section 2703 of the Affordable Care Act. The Urban Institute is conducting the five-year evaluation for the Department of Health and Human Services Assistance Secretary of Planning and Evaluation of the Medicaid health home option, focusing on providers' experiences with the new model of care. Read annual reports from base year, year two, and year three.

State Community Health Worker Programs

ASTHO Legislative Tracking of Community Health Workers
ASTHO's State Health Policy team tracks and analyzes legislation across the states to identify trends and emerging issues impacting public health and state health agencies. Real-time state legislative tracking on Community Health Workers is available on this web page under "Licensure and Certification".

ASTHO State Community Health Worker Certification Standards Map
This map includes the current status of state CHW certification standards, a chart illustrating what states have which program requirements/elements in their CHW law, and chart outlining the summaries of each state’s CHW certification bill as of March 2016.

NASHP State Community Health Worker Models
This map 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 map includes enacted state CHW legislation and provides links to state CHW associations and other leading organizations working on CHW issues in states.

NASHP State Reforum Discussion and Resources
The State Reforum is an online network for health reform implementation. This page is a place to discuss community health workers and state implementation of health reform where questions, comments, ideas, and resources are posted.





Community Health Worker Program Resources

IOM Report: Bringing Community Health Workers into the Mainstream of U.S. Healthcare
This report from the Institute of Medicine highlights benefits that CHWs can offer when integrated into team-based primary care, describes challenges to broader use of CHWs, and provides specific recommendations for the future. Recommendations detailed include implementing statewide infrastructure for scope of practice, training, and certification; building the analytic capacity to document ROI; promoting sustainable financing mechanisms; and establishing an information clearinghouse for CHWs.

NASHP Issue Brief: Community Health Workers In the Wake of Healthcare Reform
This brief captures key themes that emerged during an October 2015 meeting of state and federal leaders convened by the National Academy for State Health Policy (NASHP) to identify areas in which state and federal policy can align around the use of CHWs in transforming health systems to achieve better care, lower costs, and improved population health.

Rural Health Information Hub Community Health Worker Toolkit
This toolkit from the Rural Health Information Hub includes eight modules focused on the following topics: an introduction to CHWs, different CHW program models, training approaches, program implementation, planning for sustainability, disseminating best practices, and examples of and contacts for successful CHW programs.  

CDC Division for Heart Disease and Stroke Prevention Community Health Worker Toolkit 
This informational toolkit compiled of evidence-based research that supports the effectiveness of community health workers

Community Guide Fact Sheet: Interventions Engaging Community Health Workers
This informational handout summarizes The Community Guide review on interventions that engage community health workers to prevent cardiovascular disease.

Community Health Worker National Workforce Study
This bibliography published by the Health Resources and Services Administration covers articles and published and unpublished research reports to provide a better understanding of the CHW workforce and its contributions to the National health care delivery system.

Best Practice Guidelines for Implementing and Evaluating CHW Programs in Healthcare Settings
This guidelines by the Sinai Urban Health Institute (SUHI) in Chicago aim to address the gaps in knowledge about how to effectively implement the CHW model. The guidelines include information on approaches to CHW hiring, training, and performance evaluation; supervision challenges and strategies for success; facilitating CHW integration; elements of program design; and program evaluation, including standardized CHW process and outcome measures.

Community Health Worker National Education Collaborative (CHW-NEC) Website
The University of Arizona developed this national community of practice website to provide information and connections to assist in development of CHW educational resources, services, curricula, and promising practice delivery strategies which are particularly responsive to community health service members of the nation's health and human services delivery team.

How State Health Agencies Can Support Patient Navigators and Community Health Workers Address Cancer Prevention and Control
This issue brief, produced by ASTHO's Chronic Disease Project, highlights the growing importance of patient navigators and community health workers in the healthcare workforce and showcases successful developments to establish the role of these vocations in various states, territories and regions.

CDC Community Health Worker's Sourcebook
CDC developed this training manual for preventing heart disease and stroke. The manual is a user-friendly curriculum that community health workers can use in their training and also as a resource. The sourcebook offers basic information and activities to increase skills in preventing heart disease and stroke.

Integrating Community Health Workers into a Reformed Healthcare System
This paper by the Urban Institute highlights the roles played by CHW's, assesses evidence of their achievements, describes the increasing opportunities for them under healthcare reform, and considers productive next steps for training and growing the CHW workforce. 

ROI: Making the Case

Integrating Community Health Workers into Care Teams
This issue from the Commonwealth Fund reports on health care organizations that have integrated community health workers into multidisciplinary teams, which appears to be a factor in their success.

Global Evidence for Peer Support: Humanizing Health Care
This report by Peers for Progress makes the case for peer support and provides an excellent strategy to address present and future health challenges, including engaging those whom health care and prevention too often fail to reach, addressing mental health and its intersections with other health problems, reducing unnecessary and costly care, and improving the health of populations.