Community Health Workers
Community health workers (CHWs) have been practicing since the 1950s and states continue to examine the role these professionals can play in rural and underserved areas. CHWs often serve in areas where health care services may not be readily available or easily accessible. CHWs help people navigate a complex health care system by connecting them to preventive and other health care services in culturally and linguistically relevant ways.
CHWs traditionally work in the communities where they live and understand the community they serve. They often work in community health facilities providing case management, client education and follow-up care. Others may be employed by government agencies and nonprofit groups to assist with community organizing, health education, Medicaid enrollment and preventive care services. Building relationships with both patients and providers allow CHWs to effectively function as a liaison between providers and patients. CHWs also help connect patients with additional support, such as reducing social isolation, outside of a specific health care practice.
The Bureau of Labor Statistics (BLS) estimates that as of May 2019, more than 117,000 community health workers and health educators were employed across almost all states. The estimated size of the CHW workforce tends to vary, as BLS and other groups (e.g., community health worker coalitions) define this workforce and its roles and responsibilities differently.
What Services do Community Health Workers Provide?
Community health worker services often include:
- Creating connections between vulnerable populations and health care systems.
- Providing health education on topics related to chronic disease prevention, physical activity and nutrition.
- Performing health screenings, informal counseling and referrals.
- Facilitating health care and social service system navigation.
Training and Certification
Occupational regulation, which involves certification, licensing or other credentials for community health workers, falls under the purview of state legislatures. States may consider occupational regulation to create standards for the CHW profession, which has typically been very broadly defined. Credentialing requirements can include training, skills, competencies and a standardized scope of practice, which would delineate CHWs’ practice abilities and limitations.
As of 2019, at least nine states have laws or regulations for CHW certification. In addition, Illinois and North Carolina passed laws to establish a work group or task force charged with determining requirements. Many states have established, or are working toward, establishing certification processes through state agencies (e.g. departments of health) or other nonlegislative directives (e.g., third-party organizations).
Training requirements for CHWs vary widely, ranging from formal educational institutions to on-the-job learning. Requirements commonly focus on skills and competencies rather than achieving specific education levels. Almost half of the states have training programs, some of which are connected to certifications and were established by state agencies.
Many community health workers traditionally served as volunteers but are increasingly being employed by hospitals and health systems. CHWs can be deployed to reach Medicaid beneficiaries, especially as state programs increasingly move toward a comprehensive approach that addresses patients’ barriers and needs (e.g., transportation, health literacy, social stigma, etc.) and emphasizes preventive and coordinated care.
In 2007, Minnesota passed legislation to become the first state to reimburse for CHW services under Medicaid. The Centers for Medicare and Medicaid Services (CMS) issued a regulation in 2014 that expanded reimbursement for preventive services and helped facilitate reimbursement for CHW services through state Medicaid programs.
Medicaid is not the only mechanism for financing CHWs. CHWs are also funded through a variety of federal, state, local and private dollars. These include funds from federal, state and private grants, state and local health departments, hospitals and clinics, private insurers, community-based organizations, and university and college research projects.