Community health workers (CHWs) are known by many names. They can be called lay health workers, community health representatives, community health advisors, or a variety of other names. In Hispanic communities, they are also known as promotoras. Some states recognize them through laws that establish certification programs for CHWs.
At their core, community health workers are individuals who work or volunteer in communities where they share the language, socioeconomic status, and cultural experiences of the populations they serve. CHWs fill a vital role in increasing access to health care because they often work in areas with low health literacy. Their role is so vital that they were recognized in the Patient Protection and Affordable Care Act (ACA), alongside more traditional health care professionals (e.g., physicians, nurses, and dentists), under the definition of “health care workforce.” In their various roles, community health workers can help: 1) increase access to culturally appropriate care; 2) increase healthy behaviors, chronic disease detection and management; and 3) connect patients with acute care needs and prevent unnecessary hospitalization. The ACA also included grants to promote positive health behaviors in medically underserved areas through the use of CHWs.
A study conducted by the Centers for Disease Control and Prevention (CDC) utilized a Quality and Impact of Component (QuIC) Evidence Assessment to determine the impact of CHWs. A QuIC examines the evidence base for multiple policy components and categorizes them along a continuum of “emerging,” “promising impact,” “promising quality,” and “best.” Evidence suggested that CHWs provide chronic disease services and interventions that improve health related outcomes and reduce the cost of health care, specifically in diabetes and hypertension patients.
Researchers at the Fay W. Boozman College of Public Health found that Medicaid recipients in Arkansas who worked with CHWs experienced a 23.8 percent reduction in annual Medicaid spending. The net savings for the state equaled approximately $2.619 million. A University of New Mexico study also found that Medicaid consumers in the state working with CHWs had an overall cost saving of $2,044,465.
Currently only Oregon, New Mexico, Texas, Ohio and Massachusetts have enacted laws to establish certification programs for CHWs. Texas passed a CHW certification law in 2011. In Texas, in order to become a certified CHW an individual must: be at least 18 years of age, a resident of Texas, and complete the required competency based certification programing. Texas has established professional and ethical standards under which CHWs must operate. The statute further requires a promotora and CHW Advisory Committee be established to advise on matters of CHW funding and employment.
More recently, New Mexico passed a CHW certification law in 2014. The statute outlines a comprehensive procedure for certification, education, trainings, grandfathering CHWs, and the grounds for removing certification. Criminal background checks and fingerprinting procedures are standard in the certification process.
Certification is vital because it provides opportunities for the future of the profession, including reimbursement from private and public insurance companies for CHW services. The Centers for Medicare and Medicaid Services amended Medicaid reimbursement rules in 2013 to allow reimbursement for preventive health services provided by non-licensed professionals, thus opening the doors for CHW services to be reimbursable under Medicaid managed care plans.
Continued utilization of CHWs and expansion of laws promoting certification of CHWs can potentially strengthen health outcomes and improve the public’s health.
This blog post was prepared by Leila Barraza, J.D., M.P.H., Consultant, Network for Public Health Law – Western Region, Assistant Professor, Mel and Enid Zuckerman College of Public Health at the University of Arizona, and Andrea Logue J.D./M.P.H. Candidate (2017) from the University of Arizona, James E. Rogers College of Law and the Mel and Enid Zuckerman College of Public Health.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.