The Minnesota Community Health Worker Alliance (MNCHWA) & Minnesota Department of Health Community Health Worker Initiatives (MDH) presented our research and workforce models on a national stage at the American Public Health Association Annual Meeting & Expo.
Community Health Workers (CHWs) are an evidence-based, health equity workforce that improve access, outcomes, and patient experience while reducing disparities and costs. Minnesota has been a national leader in CHW policy, becoming the first state to enact Medicaid reimbursement for CHW services almost 20 years ago. In 2024, Minnesota was the first state to adopt new Medicare Community Health Integration (CHI) codes into its Medicaid covered services. Despite this progress, financing and sustainability remain key barriers to workforce expansion. In response, Minnesota has advanced a coordinated approach to strengthen CHW infrastructure through a statewide Roadmap and Logic Model alongside targeted policy and financing strategies.
Methods:
The Minnesota Community Health Worker Alliance (MNCHWA) and Minnesota Department of Health (MDH) led a collaborative process including stakeholder engagement and landscape assessment which identified needs for diversified financing mechanisms and additional guidance to access CHW billing and reimbursement. To address this, the sustainable policy and financing workgroup engaged partners to identify billing barriers and develop policy recommendations, which were shared with the Department of Human Services (DHS), while also advancing strategies for non-billing financing and policy supports. CHW initiatives have also been embedded in emerging state financing mechanisms, including the Rural Health Transformation Program investments. Additionally, MDH supported development of a CHW billing toolkit, along with trainings, peer learning, and technical assistance to help employers navigate Medicaid, Medicare, and managed care financing.
Results:
The statewide Roadmap and Logic Model outline strategies across workforce development, financing and policy, care model integration, and evaluation. Efforts have expanded covered CHW services, increased awareness of billing pathways, and strengthened employer capacity through practical tools like the billing toolkit. The financing workgroup has informed policy discussions and system improvements through documented barriers and recommendations. However, gaps remain between workforce size and utilization of billable services, highlighting ongoing implementation challenges. Early efforts have strengthened cross-sector alignment and supported broader financing strategies beyond billing.
Conclusions:
Sustainable CHW infrastructure requires coordinated action across policy, financing, and practice. Minnesota’s approach demonstrates how a shared statewide framework, paired with practical tools, stakeholder-driven policy recommendations, and diversified financing strategies, can address real-world barriers to sustainability. Aligning billing and non-billing approaches is critical to expanding CHW workforce capacity and access.
