Learn more about the Knowledge Center Service

Advancing the Role of Community Health Workers: Engaging State Medicaid Offices to Develop State Plan Amendments Regarding the Preventive Services Rule Change

by Anya Vanecek; Katie Horton; Naomi K. Sieler

Jan 1, 2019

Community health workers (CHWs)1 provide services that address the social and environmental determinants of health, including preventive home- and communitybased health services (HCBS). Often as members of medical teams, CHWs are a vital part of the healthcare workforce in the vast majority of states, yet few state Medicaid programs reimburse even a portion of this work.2, 3, a Despite their rhetorical popularity, mostCHWs continue to rely upon unpredictable and often insufficient financial support.A new pathway of reimbursement for CHW services through Medicaid emerged in 2014. Before the Centers for Medicare and Medicaid Services (CMS) updated the regulatory definition of preventive services, preventive services could only be provided by physicians or other licensed practitioners (e.g., chiropractors or registered nurses). This "preventive services rule change" gave states the option to reimburse nonlicensed practitioners, including CHWs, for preventive services recommended by a licensed practitioner. In effect, the preventive services rule change enables states to include CHWs, as defined by the state's requirements for education, training, or credentialing, as qualified providers ofcertain preventive services under Medicaid.