Bill would let Medicaid pay for certified community health workers | News

A bill requiring Medicaid reimbursement for certain services provided by certified community health workers and streamlining their certification process awaits a plenary vote.

CHWs are not medically trained, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social, and environmental services, improve health literacy, and provide disease prevention and self-management education.

Representative Kim Moser speaking at a news event on February 17
conference on HB 525. (Photo from the press release)

“What makes community health workers unique is not that they are necessarily clinical professionals, but rather that they are the lead in helping individuals understand what resources are available,” said Kim Moser, R- Taylor Mill, noted during a press conference on the bill in a video from the Kentucky Primary Care Association.

The federal Bureau of Labor Statistics said Kentucky had 1,350 CHWs as of May 2020, with an average annual salary of $37,320.

House Bill 525sponsored by Moser, would require the Department of Medicaid Services seek federal government approval for a state plan amendment, waiver, or alternative payment model, including public-private partnerships, for services provided by certified CHWs.

Teresa Cooper, director of government affairs at KPCA, said in an email that CHWs are hired as staff by a facility, but their services cannot be billed to Medicaid or private insurance. “This legislation would allow the clinic to charge for its services and receive reimbursement or count them towards its operating costs,” she said.

The bill would also require CHWs to be employed and supervised by a Medicaid-participating provider and states that as of January 1, 2023, “no one shall hold themselves out as a community health worker unless they are certified as such” in accordance with the provisions of the law.

The bill was passed by the House Health and Family Services Committee, chaired by Moser, on February 24. She pointed out a Kentucky House study that found that between July 2001 and June 2021, community health workers realized a return on investment of $11.32 saved for every dollar invested in their services.

“The cost-benefit analysis showed this to be a very productive use of our taxpayers’ money,” she said, adding that because Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act In 2014, the program serves 1.6 million Kentuckians, about one of every three.

“We know it’s time, because of this Medicaid expansion, to really focus our Medicaid dollars more and work on programs that work,” Moser said.

Emily Beauregard, director of Kentucky Voices for Healthsaid Moser’s bill, if passed, could be a game-changer by providing a sustainable source of funding for community health workers in Kentucky.

“House Bill 525 creates a very, very important pathway to expand our current network of community health workers,” Beauregard said.

Pamela L. Spradling, CSA with Big Sandy Health Carea federally qualified health center in Prestonsburg that covers five counties said its CHWs are currently paid as staff or through grants.

When asked what it would mean for them to be able to bill Medicaid, she replied, “It would be huge for us because it would mean the sustainability of our program…we wouldn’t have to constantly worry about where to go. where to come from to pay our community health workers.” She added that the challenge with grant funding is that when the grant money runs out, so does the CHW program.

Spradling also spoke about the value of CSAs in changing health outcomes, noting that 62% of their 150 diabetic patients who have CSAs saw a 2.5-point reduction in their A1C, and some of them with even higher discounts. An A1C is a blood test for diabetes that measures your average blood sugar over the past three months. A normal A1C level is below 5.7%.

Tiffany Taul Scruggs, Certified CHW and Patient Services Coordinator for sterling health carea federally licensed health center based in Mount Sterling, said CHWs at its facility were either on staff or paid through grants.

“If we could bill Medicaid, we could probably hire more community health workers just because we have such a large population in our coverage area,” she said. “It would be wonderful if we could invoice.”

Scruggs noted several services their CHWs provide, including helping their patients obtain medical equipment, medicine, and food, helping patients navigate the health care system, and providing health education. She added that one of their biggest needs is transportation to and from medical appointments.

“I am proud to say that our transportation service provided just under 1,300 rides to our most vulnerable population in 2021,” she said in a statement prepared for the House committee. “The team consists of a full-time driver, a recently hired part-time driver, two outreach and registration specialists and three community health workers ready to assist our patients in case of need.”

Tammy Collett, Cumberland River Regional Manager for Mountain Comprehensive Health Corp. in Whitesburg, said in an email that funding for their CHWs is provided by a grant from Marshall University, The University of Chicago and the Merck Foundation. She said the goal of this grant program is to demonstrate the effectiveness of using CHWs to improve health outcomes and quality of life.

“We hope payers will recognize the benefits of CHWs and consider coverage for their services,” Collett said.

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