Medicaid Coverage for Community Health Worker Services

This chart includes information about states that have laws to provide Medicaid coverage for services provided by Community Health Workers (CHWs). Check back often, as this chart is updated frequently.

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For more information, visit our Medicaid Topics Page. If you are looking for state laws about health insurance generally, return to the main state laws page.

StateCoverage under Reimbursement under Medicaid State Plan Amendment (SPA)Coverage under Section 1115 Demonstration AuthorityCoverage under Medicaid Managed Care Arrangements
ALABAMA
ALASKA
ARIZONAArizona's Medicaid program, AHCCCS, reimburses for CHW services and Community Health Representatives (CHRs) services. Covered services include: (1) health system navigation and resource coordination; (2) health education and training; and (3) health promotion and coachinghttps://www.azahcccs.gov/PlansProviders/OtherProviderProgramsAndInitiatives/CHW.html
ARKANSAS
CALIFORNIACalifornia's Medicaid program, Medi-Cal, reimburses for CHW services. Covered services include: (1) health education; (2) health navigation; (3) screening and assessment; and (4) individual support or advocacyhttps://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-22-0001-Approval.pdf
COLORADO
CONNECTICUT
DELAWARE
*DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANAIndiana’s Medicaid program reimburses for CHW services. Covered services include: (1) diagnosis-related patient education; (2) facilitation of cultural brokering; (3) health promotion education; and (4) direct preventive serviceshttps://provider.indianamedicaid.com/ihcp/Bulletins/BT201826.pdf
IOWA
KANSASKansas’s Medicaid program reimburses for CHW services. Covered services include: (1) screening and assessment; (2) health promotion and coaching; (3) health system navigation and resource coordination; (4) health education and training; and (5) care planninghttps://www.snco.us/HD/document/media%20releases/Public_Notices/PublicNotice-LHD-CommunityHealthWorkers.pdf
KENTUCKYKentucky’s Medicaid program reimburses for CHW services. Covered services include: (1) health system navigation and resource coordination; (2) health promotion and coaching; and (3) health education and traininghttps://www.chfs.ky.gov/agencies/dms/spa/230002CHW.pdfMCOs cover services by CHWs. Reimbursement is determined by the provider’s contract with the MCO.https://www.chfs.ky.gov/agencies/dms/Documents/CHW%20Medicaid%20FAQ.pdf
LOUISIANALouisiana’s Medicaid program reimburses for CHW services. Covered services include: (1) health promotion and coaching; (2) care planning; and (3) health system navigation and resource coordination services.https://www.lamedicaid.com/provweb1/Providermanuals/manuals/PS/PS.pdfMCOs cover services by CHWs. Covered services include: (1) health promotion and coaching; (2) care planning; and (3) health system navigation and resource coordination.https://ldh.la.gov/assets/medicaid/MCPP/MCO_Manual_CHW_2022-06-30.pdf
MAINEMaine’s Primary Care Plus payment model under the state's Medicaid program offers community-based community health worker services directly or through partnerships.https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/primary-careMaine allows the use of CHWs in their health home programs as part of a care team.https://www.maine.gov/sos/cec/rules/10/144/ch101/c2s089.docx
MARYLAND
MASSACHUSETTSAs part of the MassHealth Section 1115 demonstration, Massachusetts provides delivery system reform incentive payment (DSRIP) funding to accountable care organizations (ACOs) to hire CHWs and has funded CHW core competency trainings.https://www.medicaid.gov/sites/default/files/2022-11/ma-masshealth-ca-11072022.pdf
MICHIGANMichigan’s Medicaid program reimburses for CHW services. Covered services include: (1) care coordination and system navigation and (2) health promotion and educationhttps://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Inside-MDHHS/Budget-and-Finance/State-Plan-Amendments/10-03-23/SPA-23-0020_Submission.pdf?rev=217408bd453d4b6995f48b4ba650008e&hash=10D58DDF5064B5E4F8FD3A7655780C90MCOs must provide or arrange for CHWs to provide services related to behavioral health integration. Covered services include: (1) outreach; (2) engagement; (3) education; and (4) coordinationhttps://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder1/Folder101/contract_7696_7.pdf?rev=6b613a9a8ae04ede8b764176b3b9ab7e
MINNESOTAMinnesota's Medicaid program reimburses for CHW services. Covered services include: (1) care coordination and (2) patient educationhttps://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_140357
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADANevada's Medicaid program reimburses for CHW services. Covered services include: (1) health care guidance; (2) education; (3) health literacy promotion; and (4) care coordinationhttps://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSM/Medicaid_Services_Manual_Complete.pdf
NEW HAMPSHIRE
NEW JERSEYNew Jersey's Section 1115 renewal includes a Community Health Worker Pilot that will focus on overcoming health disparities within local communities by providing care coordination services and directly providing preventive or related serviceshttps://www.medicaid.gov/sites/default/files/2023-03/nj-1115-cms-exten-demnstr-aprvl-03302023.pdf
NEW MEXICONew Mexico's Medicaid program reimburses for CHW services. Covered services include: (1) health education; (2) health navigation; and (3) clinical supporthttps://www.hsd.state.nm.us/wp-content/uploads/23-0011-CHW-CHR-NEWSPAPER-NOTICE-Final.pdfNew Mexico mandates that all Medicaid MCOs provide CHW services to at least 3 percent of their members.https://www.macpac.gov/wp-content/uploads/2022/04/Medicaid-coverage-of-community-health-worker-services-1.pdf
NEW YORKNew York's Medicaid program reimburses for CHW services. Covered services include: (1) health advocacy; (2) health education; and (3) health navigationhttps://www.health.ny.gov/regulations/state_plans/status/non-inst/original/docs/os_2023-03-31_spa_23-02.pdf
NORTH CAROLINANorth Carolina incorporates CHWs as “care management extenders” within their “tailored plan” care management model, offering integrated services to enrollees with significant behavioral health needs and intellectual/developmental disabilities (I/DD).https://medicaid.ncdhhs.gov/use-care-manager-extenders-tailored-cm/download?attachment
NORTH DAKOTA
OHIOThe Ohio requires managed care organizations (MCOs) to provide CHW or public health nurse services to Medicaid enrollees who are pregnant or capable of becoming pregnant, reside in a community served by a qualified Community HUB, and was recommended to receive CHW or public health nurse services by a qualified health providerhttps://codes.ohio.gov/ohio-revised-code/section-5167.173
OKLAHOMA
OREGONOregon’s Medicaid program reimburses for CHW services. Covered services include: (1) self-care and self-management training; (2) counseling in prevention or risk factor reduction; (3) tobacco use cessation counseling, and (4) preventive medicine counseling and risk factor reduction interventionshttps://www.oregon.gov/oha/HSD/OHP/Tools/CHW_Billing%20Guide.pdfCHWs are included as authorized providers for four of the six health home services covered under Oregon’s health home/Patient-Centered Primary Care Homes (PCPCH) State Plan Amendment.https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/OR/OR-11-011-HHSPA.pdf
PENNSYLVANIAPennsylvania MCOs must work with CHWs as part of their Community Based Care Management programshttps://www.porh.psu.edu/new-pennsylvania-medicaid-provider-types-in-2024/
*PUERTO RICO
RHODE ISLANDRhode Island's Medicaid program reimburses for CHW services. Covered services include: (1) health promotion and coaching; (2) health education and training; (3) health system navigation and resource coordination; and (4) care planninghttps://www.medicaid.gov/sites/default/files/2022-05/RI-21-0012.pdf
SOUTH CAROLINA
SOUTH DAKOTASouth Dakota's Medicaid program reimburses for CHW services. Covered services include: (1) health system navigation and resource coordination; (2) health promotion and coaching; and (3) health education and traininghttps://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/SD/SD-19-005.pdf
TENNESSEE
TEXASTexas MCOs may recognize CHW services as a quality improvement costhttps://capitol.texas.gov/BillLookup/History.aspx?LegSess=88R&Bill=HB113
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
GUAM
Last Updated:3/24

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