For decades, community health workers (CHWs) have improved access to health in underserved communities across the globe by helping to make health care, education, and prevention efforts more accessible and culturally relevant to their communities. CHWs have served U.S. communities for decades as well, and their distinctive role was officially recognized by the United States Department of Labor in 2010. CHWs are not new to the health care or public health systems, but growing recognition of their unique ability to help address social determinants of health—especially as health care insurers and providers become increasingly responsible for patient outcomes—has given rise to an influx of opportunity for CHWs. Many public health departments and community-based organizations also rely on community health workers to conduct outreach, assess community needs, provide culturally relevant health education, and connect individuals to needed services. Moreover, a mounting body of evidence demonstrates that community health workers play an important role not only in improving health outcomes, especially among vulnerable populations, but also in improving community-based public health research. Accompanying this professional growth is an evolving area of legislation and regulation as well as legal considerations for employers as they integrate CHWs into their workforce.
This issue brief explores legal issues relating to the regulation and employment of community health workers. It outlines the authority for states to regulate CHWs, describes types of state legislation and activity currently affecting CHWs, and provides considerations for employers utilizing the services of CHWs.