Medicaid Funding for Community Health Workers: Lessons Learned from Families USA’s Health Action 2017 Conference

Last month, CHLPI attended Families USA’s annual health advocacy conference, Health Action 2017, in Washington D.C. Given the tumultuous path of health policy in today’s world, the conference’s goal was to prepare health care advocates as they seek to defend and bolster progress that has been made since the implementation of the Affordable Care Act. CHLPI brought along student Jacob Barrera to gain insight into the ideas and strategies that health advocates are using to protect access to affordable care. Jacob is pursuing his Masters of Public Health from the Harvard T.H. Chan School of Public Health. 

Image via @FamiliesUSA on twitter.

Community Health Workers (CHWs) are considered trusted members of their communities, bridging the gaps between the health care system, social services, and the community. Their jobs are multiple and not necessarily defined—health educators, community navigators, and enrollment specialists, just to name a few. At Families USA’s Health Action 2017 Conference in Washington, D.C., many of the panelists presenting at a workshop on funding and integrating CHWs echoed the same research findings on the effectiveness of CHWs—they can improve health care outcomes and reduce costs incurred by the health care system as a whole, particularly for those living with HIV and other chronic conditions. The goal of the panel on CHWs was to talk about ways to fund and integrate them through Medicaid as a billable service.

According to panelist Gail Hirsch, Co-Director of the Office of Community Health Workers for the Massachusetts Department of Public Health, there is a clear notion to recognize and strengthen the field of CHWs, but there is disagreement as to how this should happen. Gail, along with co-panelists Abby Charles, Senior Program Manager for the Institute for Public Health Innovation and Charlie Alfero, Executive Director of the Southwest Center for Health Innovation reached a consensus regarding standardization of the scope of practice and core competencies of CHWs. However, there were dissenting opinions in the audience, with one audience member claiming that the standardization and training of CHWs was not necessary according to the rules set forth by the Centers for Medicare and Medicaid Services.

In building an argument for standardization of scope and core competencies, there is an aim to build a consensus on the value of CHWs from the perspective of providers, payers, and policymakers. Charles explained that there is currently a return on investment of 3:1, on average, which is something that is leveraged in Medicaid Managed Care Organizations (MCOs) for internal investments in CHWs. This return on investment is due, in part, because CHWs reduce barriers such as education disparities, citizenship, and language barriers that hinder access to health care and other community resources.

Charles noted that despite this return on investment, the challenges to funding and integrating CHWs in Medicaid persist. One of the main challenges is simply getting buy-in from Medicaid. Other challenges that came up across the panel include the lack of understanding of the value and cost-effectiveness of CHWs, the concerns that individuals have about the fraud and abuse within the CHW field, the fact that CHWs are not the biggest priority for Medicaid agencies, and a national trend away from the fee-for-service model.

A model that has effectively funded and integrated the CHWs into their field of practice is through the MCOs run by the University of New Mexico, with Charlie Alfero at the helm. These MCOs have incorporated CHWs into different levels of care. Each service is billed through the university, which is then reimbursed by Medicaid. This is a means of trying to create a separate revenue stream that is not linked to physician revenue. According to Alfero, this creates important short-term profits for the health care center. This is the only model that seems to be getting any money from Medicaid for the work that is being provided by CHWs, and it may be a model for other organizations to design their own CHW program that is both adequately funded and sustainable.