State Community Health Worker Models

As states transform their health systems many are turning to Community Health Workers (CHWs) to tackle some of the most challenging aspects of health improvement, such as facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health. While state definitions vary, CHWs are typically frontline workers who are trusted members of and/or have a unique and intimate understanding of the communities they serve. 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.

Map
Green Click for more information. (40 states)
Light Blue No information at this time. (11 states)

Financing
AK

The Community Health Aide Program (CHAP) was initially federally funded, with formal training standards established, in 1968. Today, funding to support CHAP is generally through the Indian Health Service, the Denali Commission (a federal agency) or federal Community Health Center funding, (p.12)

AZ

Funding for CHWs through community health centers, universities, and health care plans. Pursuing Medicaid and health insurance funding streams. Funding from the HRSA Rural Network Development Planning Grant Program to develop a statewide network of stakeholders to support Arizona Community Health Outreach Workers Network in moving Arizona’s CHW agenda forward.

 

AR Community health workers (CHWs) could potentially fulfill the role of care coordinators as defined in Arkansas’s State Innovation Model (SIM) narrative (p.18, 29-31). However, a policy brief on CHWs from the Arkansas Center for Health Improvement does not consider CHWs to be care coordinators. Arkansas’s workforce strategic plan does include CHWs.
CA Funding for CHWs included in SIM plan as part of care team of health homes for complex patients (p.30), in the discussion of Community Transformation Grants (p.38-39), and in the discussion of workforce building (p. 40-45). According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services, CHWs are employed by a Managed Care Organization to provide in-home asthma services.
CO CHWs are discussed in the SIM plan’s Workforce section, which talks about CHWs (pp.145-6, 158) and mentions the work group is looking at core competencies, licensing requirements and certification, and sustainable funding.
CT  The SIM proposal from December 2013 discusses integrating CHWs into community health teams, as well as creating training and certification standards for CHWs (see p.10).
DC Washington, DC is pursuing a Medicaid State Plan Amendment to finance the work of CHWs. See the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services in the District of Columbia.
FL CHWs are hired by community-based organizations, universities (especially those conducting research on disparities and population-based approaches to dealing with health equity), FQHCs, and insurance payers who run managed care organizations. Hiring at community-based organizations and universities depends on grant availability. Florida is not pursuing a Medicaid State Plan Amendment in 2015.
GA  Not currently.
HI  Not currently.
ID CHWs are discussed in Idaho’s SIM plan/proposal (p.11, 29-30, 32-34) as part of the workforce for Patient Centered Medical Homes (PCMH), especially in workforce shortage areas. CHWs are also discussed in the section on workforce development (p.67), and as part of the Year One milestones (p.99).
IL  Not currently.
IN  Not currently.
KY

Funded through grants or organizations large enough to absorb the costs (i.e., hospitals, FQHCs). CHW workgroup involved in SIM Planning Grant for health care systems change. Kentucky is pursuing a Medicaid State Plan Amendment to finance the work of CHWs. Cabinet for Health and Family Services through Kentucky Department for Public Health supports CHW program through a contract with the University of Kentucky Center for Rural Health called Kentucky Homeplace.

LA  Not currently.
ME Practices involved in Maine’s Health Homes program must include a Community Care Team (CCT), and CHWs are explicitly listed (p.4) as potential team members. The CCTs are reimbursed through Medicaid Health Homes. Maine’s SIM grant (p.17) includes five CHW pilot sites.
MD CHWs are financed primarily through grant funding. While Medicaid does not reimburse for CHWs, Medicaid Health Maintenance Organizations (HMOs) are believed to employ CHWs. The Workgroup on Workforce Development for Community Health Workers is tasked with making recommendations to the Legislature on reimbursement and payment policies for Medicaid and private payers. CHWs are a key element of the recently submitted SIM plan.
MA The principal mechanisms for funding CHW positions in MA are through grants.  Less common is a combination of grants, core operating funds and other resources. Current sources include federal, state and local governments, private foundations, other nonprofit funding and some health plan funding. The state hopes that the future the shift to global payments will be able to financially support more CHW services. Medicaid supports a small amount of CHW services through an 1115 waiver for high-risk pediatric asthma and a demonstration project for dually eligible adults. The MA DPH and other partners are exploring a Medicaid State Plan Amendment to reimburse more broadly for CHW services under the new Medicaid rule.Community health workers were included in several aspects of the 2012 payment reform law (Chapter 224) in the following ways: 1) ACOs can pay for CHWs as part of multidisciplinary care teams in a global fee structure. 2) The Prevention and Wellness Trust fund established by the law and administered by the MA DPH ($60 million over a 4-year period) supports CHW services in all nine of its projects across the state and 3) The establishment in the law of the Health Care Workforce Transformation Fund, designed to support the training of emerging health care workforces.
MI The Michigan Community Health Worker Alliance (MiCHWA) has a work group focused on policy and finance issues. Current funding mechanisms for CHWs are included in the 2014 program survey report. Michigan’s upcoming SIM test award may impact CHWs though it is currently unknown how. CHWs were included in Michigan’s planning award report in in 2014.
MN In May 2007, the Legislature passed a provision allowing for reimbursement of registered Medicaid providers for services by CHWs as follows:

Services are provided under medical supervision (multiple types of professionals qualify to supervise)
The CHW has completed training following a standard curriculum
The CHW must register as a Medicaid provider but may not bill State directly
The CHW may be an employee or contractor of billing provider
MN’s SIM Grant (p.7) involves the state giving infrastructure support to ACOs, including the use of emerging health professions, such as CHWs (p.7), as part of interdisciplinary teams.
MS In 2015, Mississippi Medicaid plans to begin covering CHW services. However, it is under the auspice of “general education,” and not a specific billing code for reimbursement. The code must be submitted by another entity or organization. Private funding sources, through clinics or grants, also finance the work of CHWs.
MO Currently, health care entities or community organizations fund CHW positions in Missouri. Medicaid does not pay for CHW services, and state funding is not available. The Missouri Department of Social Services is not planning on submitting Medicaid State Plan Amendment at this time, and CHWs are not part of state-level health reform, although the Missouri HealthNet Division is piloting the use of CHWs in its Primary Care Health Home Program, according to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services.
MT Montana funds CHWs through a Frontier Community Health Care Coordination Demonstration Grant (HRSA-11-202). The model is a network approach consisting of eight frontier Community Access Hospital communities that are part of the Montana Care Coordination Network. (p.14).
NE CHWs are funded by: grants to local hospitals, and the Nebraska Department of Health and Human Services (NDHHS), Division of Public Health. NDHHS administers Minority Health Initiative funding to counties with 5% or greater minority population, and those projects may choose to include CHWs in their work plans and budgets. Of the 16 current projects, 10 include CHWs in some capacity. In addition, DHHS funds patient navigation training for CHWs. There is additional funding available from other offices and programs within DHHS, but it varies from year to year. It is also affected by a variety of other factors (e.g., readiness of the evolving CHW structure to take on additional projects and outcomes). There is no long-term funding for CHWs from within DHHS and Medicaid does not pay for CHW services. CHW activities are not part of payment reform in NE and there is no plan to submit a Medicaid State Plan Amendment.
NV Nevada’s CHW program leverages funds from sister programs at the Nevada Division of Public and Behavioral Health (NDPBH), including Maternal and Children’s Health, Women, Infants, and Children (WIC), Chronic Diseases, and HIV. Medicaid does not reimburse for CHW services.
NH New Hampshire does not have a state financing mechanism for CHWs. They are primarily grant-funded.
NM Through a Medicaid 1115 Waiver, Centennial Care has leveraged contracts with Medicaid managed care organizations (MCOs) to support the use of CHWs in serving Medicaid enrollees. CHW salaries, training, and service costs are MCO administrative costs and embedded in capitated rates paid to Medicaid managed care organizations.
NY CHWs can be optional team members of Health Home care teams, although the language used in the state plan amendment is “outreach workers including peer specialists” (p.8). According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services, New York has proposed to use CHWs to deliver home-based asthma care in many of its pending Delivery System Reform
Incentive Payment (DSRIP) initiatives.
OH  Not currently.
OR State Plan Amendment (SPA) created Patient-Centered Primary Care Homes (PCPCHs) explicitly includes CHWs in description of providers for four of the six core Health Home services: Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services. Only certified CHWs will be reimbursed. Oregon’s SIM grant is designed to build on its Community Care Organization (CCO) Model (p.2). CCOs currently provide care within Medicaid, but are being expanded to dual eligibles, state employees, and people who have bought insurance through the state Marketplace through the SIM grant. CCOs are required to include “non-traditional healthcare workers” like CHWs on their care teams. A health professional must supervise a CHW in order for Medicaid to reimburse for services provided.
PA Medicaid is the largest source of funding for CHWs in Pennsylvania, followed by Federal Grant Categorical Funding. CHW programs at mental health organizations are funded primarily through Medicaid. Pennsylvania provides Medicaid coverage for Peer Support Services (PSS) in the mental health field, and some PSS providers are considered CHWs. The Department of Human Resources oversees PSS.
RI The majority of CHW positions are either grant-funded (especially those working on disease-specific programs) or incorporated into the operating budgets of agencies. Some CHWs may bill services under a portion of their jobs (specific licensure or services approved for reimbursement). Rhode Island is exploring Medicaid waivers for CHW billable services. According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Lead Follow-up Services, CHWs may provide lead poisoning follow-up services.
SC The South Carolina Department of Health and Human Services (SCDHHS) CHW pilot program pays for primary care services provided by CHWs. Practices selected to participate in the SCDHHS CHW program received $6,000: $3,500 for training costs and $2,500 for CHW integration into the practice and community (i.e. laptop, “hotspot”, cell phone). There are two codes authorized for CHW service reimbursement; a group encounter code and an individual encounter code.The SCDHHS is working with statewide partners to secure funding to continue and expand the CHW program. The SCDHHS plans to submit a Medicaid State Plan Amendment to CMS and is also investigating the new Medicaid rule allowing reimbursement for preventive services delivered by non-licensed providers, upon recommendation from a licensed Medicaid provider. SCDHHS certification is necessary for Medicaid reimbursement. According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services, there are ongoing efforts to better incorporate CHWs into the healthcare system.
TX CHW positions are not funded through the state; contracts within the Department of State Health Services (DSHS) Expanded Primary Health Care where CHW outreach related services may be reimbursed. Most paid CHW positions are funded through grants or core budget funding. The Health and Human Services Commission (Medicaid agency) contracts with MCOs and allows CHW costs to be included in administrative costs in order to receive reimbursement. A Medicaid 1115 waiver incentivizes hospitals and other providers to do health care improvements and CHWs are involved in a small number of the more than 1,300 projects and are reimbursed through this mechanism. Contract language for Medicaid/CHIP managed care health plans was amended to include a definition of CHWs and to clarify that CHW costs could be included in administrative costs.
UT Primarily grant funded; grants usually received by community based organizations. Molina Health Care hires CHWs to work with clients.
VT CHWs are a standard part of Vermont’s Community Health Teams (CHTs), which are an integral part of their SIM narrative. The CHTs are paid for by Vermont’s Multi-Payer Advanced Primary Care Practice Demonstration pilot, which involves a monthly care management fee for beneficiaries receiving primary care from advanced primary care (APC) practices. Costs are shared among Vermont’s major insurers, as well as Medicare and Medicaid. According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services, CHWs provide environmental assessments to identify ways to reduce asthma triggers.
VA CHWs included in VA SIM plan. Workforce Development workgroup looking at funding options.
WA CHWs and other “allied health care staff” can be part of Washington’s Health Homes, which allows them to receive funding under Medicaid, for each patient served. According to the National Center for Healthy Housing’s case study on Medicaid Reimbursement for Home-Based Asthma Services, CHWs provide environmental home assessments through a program supported by the Environmental Protection Agency.
WI Primarily grant funding, but in some cases a combination of grants, core operating funds and other resources such as federal, state and local governments, private foundations, other nonprofit funding and some health plan funding. Wisconsin Medicaid funds Prenatal Care Coordination and Peer Support Specialists, some of whom are Community Health Workers. Wisconsin stakeholders have written the Business Case for Coordinated Team-Based Care, which includes CHW’s.
WV CHWs are listed as optional members of Behavioral Health Health Home care teams (p. 5), which are financed by Medicaid through pre-set payments per member, not Fee for Service.
Education
AK Board-certified 3-4 week intensive training course; completion of designated number of practice hours and patient encounters; post-session learning needs and practice checklists; 200 hours village clinical experience; preceptorship; 80% or higher on CHAP exam, and 100% on statewide math exam. Four regional training centers.
AZ Arizona Community Health Outreach Workers Network offers annual trainings. Local Area Health Education Centers, Federally Qualified Health Centers, and the University of Arizona provide ongoing training on evidence based curricula on a number of health issues.
AR Not currently.
CA Not currently.
CO  Not currently.
CT Southwestern CT AHEC offers CHW training.
DC  Not currently.
FL The Florida CHW Coalition (FCHWC) CHW Certification Implementation Team has developed 28 CHW tasks in five performance domains. The Florida AHEC network and community colleges around the state provide training. Many organizations working with CHWs have developed their own training program such as: MHP Salud, Rural Women’s Health Project, Healthstreet, ConnectFamilias.
GA  Not currently.
HI Healthcare Innovation Plan includes CHW training (p.27).
ID SIM plan/proposal intends to develop training program for CHWs and community emergency services personnel to increase opportunities for coordinated primary care in rural and underserved areas.
IL The Community Health Worker Act creates minimum core competencies for CHWs; an Advisory Board can consider other competencies.
IN Integrated Care Community Health Worker and Certified Recovery Specialist Training and Certification Program, approved by the Indiana Division of Mental Health and Addiction and the State Department of Health.
KY  State does not approve training programs. Kentucky Homeplace training program requires 40 hours of classroom and online instruction and internship. Montgomery County Health Department (MCHD) trains CHWs through HRSA grant. Curriculum based on HRSA CHW training, Stanford Chronic Disease Self-Management, Stanford Diabetes Self-Management, American Association of Diabetes Educators ABCs of Diabetes Education, Healthy Homes for CHWs, Mental Health, First Aid and other resources.
LA  Not currently.
ME Maine Community Health Worker Initiative (MECHWI) has developed a core competency/skills/roles cross-walk to inform the development of training recommendations. Training provided by employers or tied to specific projects.
MD No state-sponsored infrastructure for CHW training; programs training CHWs develop their own competencies and curricula.
MA Training offered by CBOs, AHEC, local health department, and a university school of  public health. Training programs address ten core competencies. 80 hours of online and in-person training; no practicum required, but CHWs applying for certification must have 2,000 hours of relevant work experience.  Graduates of training programs eligible to apply for state CHW certification.
MI MiCHWA’s Education and Workforce working group develops training standards with active participation from CHWs. Training is primarily employer-sponsored; CHWs return to positions when training is complete. Internship/practicum required for individuals not employed.
MN State-wide standardized, competency-based educational program based in accredited post secondary school; overseen by MN State Colleges and Universities System. 14-credit program includes classroom and field-based learning for individuals with a high school diploma or GED, at a minimum. Department of Human Services requires a certificate (or at least 5 years supervised experience) for CHWs to receive Medical Assistance reimbursement for services provided to MN Health Care Program enrollees. Continuing education opportunities available.
MS A past initiative to standardize the state definition of a CHW and to establish formal guidelines for CHW training and certificate programs failed due to legislative opposition.
MO Metro Community College offers CHW certificate training program. Adapted Minnesota’s CHW curriculum; Department of Health and Senior Services to decide if the curriculum will become the state standard. Requirements: 160 hours and 60 service (practicum) hours. Core competencies include communication, organization and resources, life style choices, cultural beliefs and healthcare, legal and ethical considerations, and employability skills. Individuals or health systems pay for the training program.
MT Training developed by Montana Office of Rural Health and State AHEC office.
NE NE CHW Coalition has assessed training program and developed recommendations for core competencies and scope of practice recommendations, number of hours of classroom/online instruction and practicum requirement, and consideration of grandfathering CHWs. NDHHS offers patient navigation training for CHWs which includes a full-day, face-to-face training; then 10 weeks of computer-based learning; a second full-day face-to-face training; plus a practicum.
NV Nevada System of Higher Education developed training curriculum; currently offered at two colleges. Programs must address APHA’s core competencies; 56 hours of classroom instruction and no practicum required. CHW program also recommends Washington State’s training program. The NDPBH will recognize this curriculum for a CHW certificate of completion.
NH The Southern NH Area Health Education Center (AHEC) offers a CHW training program which includes a variety of topics.
NM Not currently.
NY Department of Health’s CHW Program trains CHWs to provide health education, referrals, and support for individuals navigating the health system.
OH Training program must be state approved; at least 100 hours of classroom instruction and 130 hours of clinical instruction, standard training exam.
OR OR committed to training 300 new CHWs by 2015 (p. 8-9); 80 hours of training and 20 hours of continuing education required every 3 years. Training centers are certified through the Traditional Health Worker Commission. Core competencies include outreach and mobilization; community liaising; care management, care coordination, and system navigation; and health promotion and coaching.
PA Academic institutions, health organizations and health systems offer CHW training as well as Area Health Education Centers (AHECs). PA Department of Health’s CHW Project Strategy includes recommending the eight core skills in the National CHW Workforce Study.
RI Training paid for by the trainees or their employers. Committee of CHW employers and supporters developed the certification curriculum, using standards approved by national CHW interest groups, as well as needs defined by RI stakeholders. Requires 30 hours of classroom learning and 80 hours of field experience in the field.
SC Training curriculum developed by SCDHHS and Midlands Technical College includes 120 classroom hours and 120 practice hours; internship/mentorship requirement. Core competencies included in certification training program.
TX Community colleges, other academic institutions AHECs, Federally Qualified Health Centers (FQHCs), a CHW network, and community-based organizations train CHWs. 160 hours and eight standardized core competencies. Other activities may serve as proxies for demonstration of core competencies; eligibility based on experience is ongoing.
UT Developing a state standardized competencies training as well as topic specific modules (i.e. asthma, hypertension, etc.). Organizations using CHWs provide in-house and/or on-the-job training.
VT Not currently.
VA Workforce Development work group looking at core competencies and training requirements.
WA Training through the Department of Health establishing core competencies for CHWs. 8-week program may be completed online or in-person, and training is conducted quarterly. CHW receives a certification of completion.
WI Wisconsin has 2 recognized training programs:
•CHW Registered Apprenticeship Department of Workforce Development
•Milwaukee AHEC
WV Not currently.
Certification
AK Certification necessary to participate in the Community Health Aide/Practitioner program, and the Alaska Native Tribal Health Consortium.
AZ Three voluntary certification programs administered by Community Colleges.
AR Not currently.
CA The SIM Workforce Group is specifically addressing CHW training and credentialing.
CO Not currently.
CT Not currently.
DC Not currently.
FL FCHWC moving towards voluntary certification, administered by the Florida Certification Board. Written exam will be developed in 2015, with full credentialing in 2016. Grandfathering period for expereinced CHWs includes 500 hours of documented paid or volunteer experience providing CHW services; at least 30 hours of training in core competencies and two letters of reference.
GA Not currently.
HI Not currently.
ID Not currently.
IL Not currently.
IN Individuals must be 18 years old, resident of Indiana and have at least a high school diploma or GED. Three-day training and final exam. Certified CHWs may serve in outpatient medical/behavioral settings, including hospitals, medical clinics, schools, churches, and community centers.
KY Kentucky CHW Workgroup developing recommendations and process for certification.
LA Not currently.
ME Not currently.
MD Not currently.
MA Board of Certification of CHWs will begin certifying both paid and volunteer CHWs in 2015. Process will consist of a paper application, submission of three professional references, completion of an approved training program, and 2000 hours of relevant work experience. There will be a grandparenting period for the first 3 years of certification; CHWs with 4000 hours of relevant work experience will be eligible to apply without training.
MI Not currently; curriculum MiCHWA is piloting may become the basis for certification. MiCHWA’s Steering Committee voted to support MiCHWA as a certifying body for statewide certification.
MN Not currently.
MS Tougaloo College, Central Mississippi Area Health Education Center and state Department of Health joined together in 2012 to establish a CHW certification program.
MO Department of Health and Senior Services is establishing a pilot project in Kansas City area to certify CHWs and standardize curriculum; tuition reimbursement will be available for those enrolling in CHW Certificate program. CHWs who enroll and pass the curriculum receive certificates.
MT Not currently.
NE Not currently. Indian Health Service certifies Community Health Representatives. The NE CHW Coalition Steering Committee Standards Workgroup developed certification recommendations.
NV Not currently.
NH Not currently.
NM Certification is voluntary and through Department of Health. Applicants must complete a Department-approved training program and demonstrate proficiency in CHW core competencies. Specialist certification will be available. Background check required and certificates valid for two years. Continuing education required for recertification. Process to recognize and certify existing CHWs based on experience.
NY Not currently.
OH Board of Nursing issues and renews certificates biennially; continuing education required. Individuals must be at least 18 years old, have a high school diploma, complete the CHW training program, and pass criminal background check. CHW must be supervised by a health professional and is restricted from performing services requiring a professional license.
OR Only certified CHWs participate in Health Homes. CHWs can apply for certification after completing an OHA-approved training program. Must be at least 18 years old; criminal background check required. Grandfathering available to those who have worked over 3,000 hours in the past five years, and completed additional training.
PA Not currently.
RI Certification is available for all CHWs (paid or volunteer), but is not mandatory. The Community Health Worker Association of Rhode Island (CHWARI) offers certification training for CHWs. The Rhode Island Department of Health endorses, promotes and supports certification. Participants must successfully complete the program classes, assignments and work experience to receive certification. There is no grandfathering process.
SC SCDHHS is the only body certifying CHWs for Medicaid reimbursement during pilot phase. For the pilot program, 14 primary care practices participated in the certification program; Grandfathering if CHW candidate has at least 3 years experience with community outreach; documentation from employer is required, and the CHW candidate must pass the CHW certification exam.
TX DSHS established and operates Promotor(a) or Community Health Worker Training and Certification Program for CHWs and instructors. Certification is for 2 years. DSHS reviews and approves all certification, training and continuing education.
UT Not currently.
VT Not currently.
VA Workforce Development work group looking at certification options.
WA Not currently.
WI Not currently.
WV Not currently.
State CHW Legislation
AK HB 209 (enacted 1993): Community Health Aide Program (CHAP) provides grants for third parties to train community health aides as Community Health Practitioners with an exam at the end of training.
AZ The Arizona CHW Workforce Coalition is currently exploring legislation to be introduced in the 2016 legislative session.
AR Not currently.
CA Section 6332 of the California Labor Code includes definition of a CHW.
CO Not currently.
CT Not currently.
DC Not currently.
FL Not currently.
GA Not currently.
HI Not currently.
ID Not currently.
IL HB 5412 (enacted 2014) creates an Advisory Board in Department of Public Health. Board must develop core competencies for training and certification of CHWs. Prohibits CHWs from performing services requiring a professional license.
IN Not currently.
KY Not currently.
LA Not currently.
ME Not currently.
MD Workgroup on Workforce Development for Community Health Workers established by HB 856; workgroup is charged with developing recommendations on CHW training, credentialing, and financing.
MA Chapter 58, Acts of 2006 Section 110; and Chapter 224, Acts of 2012.  Chapter 322, Acts of 2010 (enacted 2010) to establish a board in the Department of Public Health to certify CHWs.   A law in 2007 created a seat on the Public Health Council for a representative from the Massachusetts Association of Community Health Workers.
MI Not currently.
MN HF 1078 Subd. 49 allows CHWs to participate in Medicaid program and receive payment for services. CHW must have certificate or at least 5 years supervised experienced with an enrolled clinician. CHWs must then work under the supervision of one of these clinicians.
MS Not currently.
MO Not currently.
MT Not currently.
NE Not currently.
NV Bill Draft Request (BDR) places regulation and oversight to certify individual CHWs in Nevada within the Bureau of Health Care Quality and Compliance (HCQC, and also includes training standards according to CHW core competencies.
NH Not currently; potential legislation in 2016.
NM SB 58, Community Health Workers Act, creates a voluntary, statewide certification program for CHWs through the Department of Health.
NY Not currently.
OH HB 95 (enacted 2003) to require Board of Nursing to issue and renew CHW certificates.
OR HB 3650 (enacted 2011) mandated OHA to develop education and training requirements that also meet federal requirements to qualify for financial participation. Oregon Health Policy Board established the Non-Traditional Health Worker Subcommittee to create core competencies, education and training requirements. HB 3407 (2013) established the Traditional Health Worker Commission, which oversees CHWs, Peer Support and Peer Wellness Specialists, Personal Health Navigators, and Doulas.
PA Not currently.
RI H 5633 (enacted 2011) established the Commission for Health Advocacy and Equity. Commission must make recommendations for increasing diversity of health care workforce, which may include recruitment, training and employment of CHWs.
SC Not currently.
TX Texas Health and Safety Code Chapter 48 provides authority to DSHS to establish and operate a certification program for CHWs. SB 1051 (enacted 1999) requires DSHS establish CHW training program- only mandatory for CHWs compensated for services. HB 2610 (enacted 2011) requires DSHS to establish statewide advisory committee to provide recommendations on CHW training, funding and employment.
UT Not currently.
VT Not currently.
VA Not currently.
WA Not currently.
WI Not currently.
WV Not currently.
CHW Organizations
AK Alaska Community Health Aide Program
AZ Arizona Community Health Outreach Workers NetworkArizona Prevention Research Center and Arizona Area Health Education Centers are also working on CHW issues.
AR Arkansas Community Health Worker Association
CA Vision y CompromisoCalifornia Association of Community Health Workers.
CO Colorado Community Health Worker and Patient Navigator Work Group
CT  Not currently.
DC CHW Professional Association of Washington, DC
FL Florida Community Health Worker Coalition
GA Georgia Community Health Advisor Network
HI  Not currently.
ID Not currently.
IL Chicago CHW Local Network
IN Indiana Community Health Workers Association
KY Not currently. Lead state agency is the Department for Public Health; four staff dedicate 20-30 hours/month (total) on CHW project. Developing new position to work 20 hours/week on CHW project.
LA Louisiana Community Health Outreach Network
ME Maine Community Health Worker Initiative
MD Community Outreach Workers Association of Maryland
Maryland CHW Association disbanded but is presently reforming and held an inaugural meeting in November 2014.
MA Massachusetts Association of Community Health WorkersMA Office of Community Health Workers
MI Michigan Community Health Worker Alliance (MiCHWA)
MN MN CHW Peer NetworkMinnesota Community Health Worker Alliance
MS Not currently.
MO Not currently. Department of Health and Senior Services has a dedicated staff person assigned to the CHW pilot project who spends time networking, researching and implementing the project.
MT Not currently.
NE In December 2014, the Public Health Association of Nebraska approved a CHW Section. This section will develop as a statewide association.
NV Efforts to establish CHW association underway to assist with promotion and understanding of CHW workforce and further help oversee standards, guidelines, and requirements.
NH Southern NH AHEC, NH CHW Coalition formed in January 2015.
NM New Mexico Community Health Worker AssociationNew Mexico Office Of Community Health Workers.
NY Community Health Worker Network of New York City
OH Ohio Community Health Worker Association
OR Oregon Community Health Workers Association
PA A Statewide Summit in May 2015 led to the development of four task forces: the Steering Group, Policy Group, Employer Group, and Training Group. These groups had their first meeting in the fall of 2015. PA Department of Health is the lead state agency for CHW issues.
RI Community Health Worker Association of Rhode Island
SC The first SC CHW Association meeting took place in December 2014 and was attended by community-based organizations and CHW leaders across SC.
TX CHW Advisory Committee and regional organizations but no statewide CHW organization.
UT Utah Public Health Association has a CHW Special Interest Group to serve as state CHW association.
VT  Not currently.
VA Virginia CHW Advisory Group, Virginia CHW Association
WA Washington Community Health Worker Network
WI Wisconsin CHW Alliance
United Voices
WV FutureWV participates in some state CHW activity.
CHW Roles in State
AK CHWs function as Community Health Aides and Practitioners, Dental Health Aides, and Behavioral Health Aides, each of whom is subject to specific standards of practice defined by Certification Board and in the CHAP manual.
AZ The Arizona Department of Human Services has formed a CHW Leadership Council to define roles; the AZ CHW Workforce Coalition has accepted the American Public Health Association’s (APHA) definition and defined competencies and scope of practice.
AR Potential role for CHWs in patient centered medical homes (PCMH); AR has nine CHWs employed by STAR Health Program, which promotes maternal and child health, oral health and chronic disease management in three counties.
CA As defined in Section 6332 of the California Labor Code: Community health care worker is an individual who provides health care or health care-related services to clients in home settings.
CO Not currently.
CT Not currently.
DC Not currently.
FL Not currently.
GA Not currently.
HI Not currently.
ID Not currently.
IL The Community Health Worker Advisory Board Act uses the APHA definition of a CHW.
IN Follows APHA’s definition.
KY Follows APHA’s definition.
LA  Not currently.
ME Maine’s SIM narrative (p. 17) includes four CHW pilot sites to “Demonstrate the value of integrating CHWs into the health care team; Provide models for state-wide replication; Build a core group of experienced CHWs who can provide leadership for ongoing development of the system.” MECHW Initiative defines CHW roles and scope of practice.
MD Scope of practice and roles are not mentioned in HB 856, the workgroup is looking at this issue as part of their overall efforts.
MA Roles include outreach, health education, client advocacy and empowerment, as well as health system navigation; hired primarily for their special connection to and understanding of the populations and communities they serve, conduct outreach a significant portion of the time, and have experience providing services in community settings.
MI MiCHWA endorses seven roles for CHWs: case management and care coordination; community-cultural liaison; health promotion and health coaching; home-based support; outreach and community mobilization; participatory research; and system navigation.
MN Roles for CHWs: bridge the gap between communities and the health and social service systems; navigate the health and human services system; advocate for individual and community needs; provide direct services; build individual and community capacity.
MS The State Department of Health and other partners have formulated a definition, but the Board of Health has not had the opportunity to approve it for promotion across the state. CHWs provide services such as conducting home visits, helping navigate the health system, and connecting individuals to resources.
MO Department of Health and Senior Services definition includes the APHA definition and adds that CHWs are liaisons with resources in the communities they serve and play a vital role in improving Missourian‰Ûªs health by providing a connection between health systems and community resources, as well as education on how to reduce behavioral health risk factors.
MT CHW care coordinators are non-clinical paraprofessionals focusing on chronic disease management and linking patients with services to achieve selected health outcomes and decrease hospitalizations and emergency room visits (p.15).
NE Follows the APHA definition.
NV Follows the APHA definition.
NH No formal definition adopted; follows the APHA definition.
NM Office of Community Health Workers defined roles and scope of practice. Centennial Care contracts define CHWs as lay members of communities who work either for pay or as volunteers in association with the local health care system in Tribal, Urban, Frontier, and Rural areas and usually share ethnicity, language, socioeconomic status and life experiences with the Members they serve. CHWs include, among others, community health advisors, lay health advocates, promotoras, outreach educators, community health representatives, peer health promoters, and peer health educators.
NY CHW Program serves communities with high rates of infant mortality, out-or-wedlock births, late or no prenatal care, teen pregnancies and births, and births to low-income women.
OH  Not currently.
OR CHW is an individual who: has expertise or experience in public health; works in an urban or rural community, in association with local health care system; may share ethnicity, language, socioeconomic status and life experiences with residents of the community; assists community to improve health and increases capacity of community to meet health care and wellness needs of residents; provides culturally appropriate health education and information; assists community residents in receiving care; provide peer counseling and guidance; provide direct services and screenings.The Traditional Health Worker Commission is defining a scope of practice for all of the Traditional Health Worker (THW) roles, including CHWs.
PA No official definition of CHWs; discussing options and working on adopting a standard job title for CHWs to unify the workforce and educate partners. Common roles of CHWs: assuring people get the services they need; providing culturally appropriate accessible health education and information; providing informal counseling and social support; and advocating for individual and community needs.
RI No formal definition. CHWARI promotes the APHA definition of CHWs.
SC SCDHHS has a draft policy in progress outlining the definition, scope of service and program guidelines for CHWs; an FAQ document outlines current role of CHWs in SC.
TX Definition included in Texas Health and Safety Code Chapter 48; CHWs are employed by a variety of organizations, including clinics, hospitals, health or social service nonprofits, area health education centers, schools or universities, local health departments, health plans, and others.
UT Uses APHA definition of CHWs.
VT As part of Community Health Teams, CHWs assist patients with insurance applications, following treatment plans, managing stress, and working toward personal wellness or disease-management goals. CHWs may accompany patients to appointments and help find transportation or childcare.
VA Not currently.
WA CHW participating in Health Homes provide administrative support for the Health Home Care Coordinator, such as mailing health promotion material, arranging for beneficiary transportation to appointments, and calling the beneficiary to facilitate face-to-face Health Home visits with the Care Coordinator.
WI Follows the seven roles for CHWs: case management and care coordination; community-cultural liaison; health promotion and health coaching; home-based support; outreach and community mobilization; participatory research; and system navigation.
WV Optional members of Behavioral Health Health Home care teams.
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