CHW positions and programs are supported through a variety of avenues, including:
- Medical Assistance (MA) and MinnesotaCare coverage
- Government grants and contracts
- Foundation grants
- General operating dollars for employing organizations
Minnesota Health Care Programs (MHCP) including Medical Assistance (Medicaid) and MinnesotaCare cover diagnostic-specific health education services provided face-to-face to individuals and groups by CHW certificate holders under the clinical supervision of authorized provider types. This includes both fee-for-service as well as enrollees of managed care plans.
For CHW services to qualify for coverage, CHW supervision may be provided by physicians, advance practice nurses, dentists, certified public health nurses working in a unit of government and mental health professionals who are enrolled as Minnesota Health Care Program providers.
State legislation was introduced and passed in 2007 and then subsequently amended to include additional provider types as authorized CHW supervisors. The Minnesota Department of Services successfully sought federal approval for MHCP payment for CHW services through its state plan.
Our state’s standardized CHW curriculum was a key factor in the success of this measure. Another was effective advocacy efforts by CHWs and allies. In addition, the legislation was determined to be budget neutral.
Looking ahead
Payment reform is already underway with the roll-out of accountable care organizations and patient-centered medical homes known as health care homes in Minnesota. In order to better align incentives, global payment approaches based on value and performance will replace the current volume-based methods. Aligning payment with outcomes will favor the integration of CHW strategies which are an integral part of the solution to the major challenges facing our health care system.
Another funding source for CHW services is community benefit programs. Nonprofit hospitals are required to provide benefits to the communities they serve in order to maintain their tax-exempt status. New community benefit requirements under the Patient Protection and Affordable Care Act include community health needs assessments and improvement plans.
Community benefits go beyond health to include building community capacity and engagement. Hospital community benefit support for upstream CHW strategies will build individual and community capacity for better health, leading to stronger, healthier communities.