State Policies for Expanding Medicaid Coverage of CHW Services

States can take a variety of approaches to authorize payment for or encourage use of CHW services within Medicaid programs. State approaches to covering CHW services may be influenced by state specific factors including existing delivery systems and payment models and state policy and program goals.

Kaiser Family Foundation (KFF) is a respected source for coverage of Medicaid information. In their 22nd annual Medicaid budget survey (conducted in 2022), KFF asked states about CHW coverage policies in place as of July 1, 2022 (the beginning FY 2023 for most states) and planned for fiscal year 2023.

Some Key Findings

  • Medicaid payment for CHW services: As of July 1, 2022, over half of responding states (29 of 48) reported allowing Medicaid payment for services provided by CHWs.

  • CHW coverage changes planned for FY 2023: A number of states reported plans to implement Medicaid coverage/payment of CHW services under state plan authority or through other coverage pathways, including under Section 1115 authority. Notably, a few states reported planning to target CHW interventions to pregnant and postpartum populations.

  • Certification and training: Though the survey did not include questions about CHW certification and training programs, several states reported plans to introduce new certification and/or standardized training programs for CHWs in FY 2023.

  • Efforts to expand CHW workforce: States also reported working with stakeholders to identify best practices for expanding the number of CHWs and for supporting broader acceptance of CHWs by Medicaid providers, health plans, and enrollees.

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Consolidated Appropriations Act 2023 - Letter to State Health Officials

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Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained