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.
For more information, visit our Medicaid Topics Page.
| State | Medicaid State Plan Amendment (SPA) | Coverage under Reimbursement under Medicaid SPA | Section 1115 Demonstration Waiver | Coverage under Section 1115 Demonstration Authority | Section 1115 Demonstration Waiver (2) | Coverage under Section 1115 Demonstration Authority (2) | Managed Care Arrangement Authority Title | Encouraged or Required Coverage under Medicaid Managed Care Arrangements | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALABAMA | Alabama Medicaid Agency - Multidisciplinary Care Team (MCT) | Alabama’s Coordinated Health Program requires multidisciplinary care teams, including health professionals and possibly community health workers, to provide coordinated, individualized care for patients with complex needs. | https://medicaid.alabama.gov/documents/2.0_Newsroom/2.4_Procurement/2.4_Active_Procurements/2.4_PL07_Multidisciplinary_Care_Team_12-29-23.pdf | |||||||||
| ALASKA | ||||||||||||
| ARIZONA | 2023 State Plan Amendment | Arizona'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 coaching. | https://www.medicaid.gov/sites/default/files/2023-02/AZ-22-0029.pdf | Arizona Health Care Cost Containment System (AHCSS) - As part of Secction 1115 Waiver | Certified CHWs are eligible to provide pre-tenancy housing services, as well as outreach and educational services under Arizona Health Care Cost Containment System's Housing and Health Opportunities program. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/az-hccc-dmnstrn-apprvl-12272024.pdf | ||||||
| ARKANSAS | HB 1258 (2025) | CHWs may be reimburse through Arkansas Medicaid or health plan. | https://arkleg.state.ar.us/Home/FTPDocument?path=%2FBills%2F2025R%2FPublic%2FHB1258.pdf | Arkansas Health Opportunity for Me (ARHOME) | Arkansas Health Opportunity for Me (ARHOME) - The Life360 HOME program supports CHW workforce development and provides intensive services for high-risk pregnant and new mothers, babies, rural Arkansas residents, and young adults at high risk for poor health outcomes. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ar-stcs-with-life360-home-evaluation-design01172025.pdf | ||||||
| CALIFORNIA | 2022 State Plan Amendment | Since July 1, 2022, Medi-Cal covers CHW services as a state plan benefit, with CHWs able to bill if they have lived experience and meet either training or experience pathway requirements. | https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-22-0001-Approval.pdf | CalAIM Section 1115 Demonstration Waiver | CHW services delivered by individuals with lived experience are reimbursable for qualified incarcerated individuals within 90 days before release. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ca-calaim-dmnstrn-appvl-thncl-crctn-atchmnt-c-aa-01172025.pdf | BH Connect 1115 Demonstration Waiver | Requires participating counties to provide CHW and peer support services with a forensic focus, and includes workforce initiatives such as loan repayment up to $120,000, training funding for evidence-based practices (including CHW services), and up to $10,000 per practitioner for training and education. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ca-bh-connect-01102025.pdf | WIC section 14132.36 | Medi-Cal managed care plans must educate members and providers about the CHW benefit, and under a 2024 amendment (SB 1385), must also create billing pathways for CHW services during ED visits and outpatient follow-ups. | https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=14132.36.&lawCode=WIC |
| COLORADO | State Plan Amendment CO-24-0025 | As of July 1, 2025 Medicaid will reimburse CHW services, but only for CHWs credentialed through the Colorado Depatrment of Public Health and Environment | https://www.medicaid.gov/medicaid/spa/downloads/CO-24-0025.pdf | SB 23-002 (5/1/2023) | Before July 1, 2025, Colorado’s Department of Health Care Policy and Financing (HCPF) will issue guidance on fee schedule reimbursement and RAE collaboration, with health navigation services funded through RAEs. For the first two years, CHW services in managed-care organizations will be reimbursed fee-for-service to track utilization, and HCPF does not expect MCOs to use administrative dollars for these services. | https://leg.colorado.gov/bills/sb23-002 | ||||||
| CONNECTICUT | ||||||||||||
| DELAWARE | ||||||||||||
| *DISTRICT OF COLUMBIA | ||||||||||||
| FLORIDA | Florida Statute § 409.973 | Requires managed care organizations to establish healthy behaviors programs, and contracts highlight examples such as CHWs providing medication therapy management support. | https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0409/Sections/0409.973.html | |||||||||
| GEORGIA | 2024 State Plan Amendment | Approval to recognize CHWs as certified practioners under the Medicaid Rehabilitation Option for Community Behavioral Health Rehabilitation services. Services are available to Medicaid members with mental illness or substance use disorders who are medically determined to need rehabilitative or prevention services. | https://www.medicaid.gov/medicaid/spa/downloads/GA-24-0008.pdf | Georgia Postpartum Extension Section 115 Demonstration Waiver | Allows Medicaid managed care organizations to use Resource Mothers, a specialized CHW model, funded through capitation as part of postpartum services. Programs must include supervision by a nurse case manager or similarly qualified staff. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ga-pathway-pa-04282025.pdf | ||||||
| HAWAII | ||||||||||||
| IDAHO | ||||||||||||
| ILLINOIS | HB 158 (2021-2022) | Medicaid to reimburse for certified CHW services (such as care coordination and diagnosis‑related education) subject to state funding, CHW certification, and supervision by an enrolled medical provider within Medicaid managed care contracts. Implementation is still underway and has not yet resulted in an approved SPA for CHW services. | https://www.ilga.gov/Legislation/BillStatus?DocNum=158&GAID=16&DocTypeID=HB&SessionID=110&GA=102 | |||||||||
| INDIANA | Indiana Health Coverage Programs | Indiana’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 services. | https://provider.indianamedicaid.com/ihcp/Bulletins/BT201826.pdf | |||||||||
| IOWA | ||||||||||||
| KANSAS | 2023 State Plan Amendment | As of July 1, 2023, Kansas's state Medicaid program reimburses for certified CHW services. | https://www.medicaid.gov/medicaid/spa/downloads/KS-23-0024.pdf | 2024 State Plan Amendment | As of January 1, 2025, Kansas managed care organizations must employ and promote certified CHWs/CHRs, define and support their roles with training, and evaluate their effectiveness in improving care, outcomes, and population health. | https://www.medicaid.gov/medicaid/spa/downloads/KS-24-0006.pdf | ||||||
| KENTUCKY | 2023 State Plan Amendment | Kentucky’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 training. | https://www.chfs.ky.gov/agencies/dms/spa/230002CHW.pdf | HB 525 (2022) - Relating to community health workers | MCOs may reimburse or directly hire CHWs, with payment set by provider contracts, but community-based organziations are not currently eligible for CHW service reimbursement. | https://apps.legislature.ky.gov/record/22rs/hb525.html | ||||||
| LOUISIANA | 2022 State Plan Amendment | Louisiana Medicaid reimburses CHW services as professional services billed “incident to” a supervising provider, with FQHCs, RHCs, and Indian clinics using specified HCPCS codes, and requiring an E&M visit within 30 days of CHW services. | https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0003.pdf | LA MCO Manual | MCOs 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 | ||||||
| MAINE | 2024 State Plan Amendment | MaineCare reimburses CHW services through its Primary Care Plus tiered payment model, Community Care Teams, and Opioid Health Homes, primarily using per-member per-month payments that support CHW positions and services. | https://www.medicaid.gov/medicaid/spa/downloads/ME-24-0022.pdf | |||||||||
| MARYLAND | HealthChoice Medicaid Section 1115(a) Demonstration Waiver | Medicaid reimburses CHWs for case management services during incarceration transitions and allows their inclusion in care teams under the Maternal Opioid Misuse Model Pilot. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/md-healthchoice-appvl-01132025.pdf | |||||||||
| MASSACHUSETTS | Mass. Section 1115 Demonstration Waiver | Funds CHW workforce development, includes CHWs in Behavioral Health Community Partners and Flexible Services programs, provides loan repayment opportunities, and supports a postpartum CHW pilot eligible for federal Medicaid matching. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ma-masshealth-appvl-01152025.pdf | MassHealth Capitated Primary Care Program (2023) | Incentivizes team-based care, specifically encouraging the inclusion of CHWs to support patient needs. Additionally, the One Care demonstration for dual-eligible adults ages 21–64 requires interprofessional care teams for care coordination, with CHWs included as key team members alongside other health professionals based on patient needs. | https://www.mass.gov/doc/community-health-centers-and-the-masshealth-aco-primary-care-sub-capitation-program-0/download | ||||||
| MICHIGAN | 2023 State Plan Amendment | Michigan’s Medicaid program reimburses for CHW services. Covered services include: (1) care coordination and system navigation and (2) health promotion and education. | https://www.medicaid.gov/sites/default/files/2023-10/MI-23-0020.pdf | Michigan Medicaid Policy (MMP) 23-74 | MCOs 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) coordination. | https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2023-Bulletins/Final-Bulletin-MMP-23-74-CHW.pdf?rev=1acdb5207cf4492da71c78c3cbc61035&hash=1CA483CD02E0F6AD1FCBB9A22C8F0F21 | ||||||
| MINNESOTA | Minnesota Provider Manual - Community Health Worker | Minnesota's Medicaid program reimburses for CHW services. Covered services include: (1) care coordination and (2) patient education. | https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_140357#ep | |||||||||
| MISSISSIPPI | ||||||||||||
| MISSOURI | ||||||||||||
| MONTANA | ||||||||||||
| NEBRASKA | ||||||||||||
| NEVADA | 2022 State Plan Amendment | Nevada's Medicaid program reimburses for CHW services. Covered services include: (1) health care guidance; (2) education; (3) health literacy promotion; and (4) care coordination. | https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2853_20220722.pdf | 2021 State Plan Amendment | Managed care entities must cover CHWs and include their services in medical capitation, while any CHW case management services are optional and funded through the administrative capitation portion. | https://www.medicaid.gov/medicaid/spa/downloads/NV-21-0013.pdf | ||||||
| NEW HAMPSHIRE | ||||||||||||
| NEW JERSEY | New Jersey FamilyCare Comprehensive Demonstration Section 1115(A) | New 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 services. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nj-1115-familcar-compr-demonstr-aprvl-09132023.pdf | NJ FamilyCare Comprehensive Demonstration | Encourage to explore community partnerships and engage in outreach to vulnerable populations; efforts may include CHWs. | |||||||
| NEW MEXICO | 2023 State Plan Amendment | New Mexico's Medicaid program reimburses for CHW services. Covered services include: (1) health education; (2) health navigation; and (3) clinical support. | https://www.medicaid.gov/medicaid/spa/downloads/NM-23-0011.pdf | New Mexico Turquoise Care Section 1115 Demonstration Waiver | CHWs can provide pre-release services to eligible incarcerated individuals within 90 days of their release. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nm-turquoise-care-dmnstrtn-aprvl-10162024.pdf | New Mexico Centennial Care | New Mexico mandates that all Medicaid MCOs provide CHW services to at least 3 percent of their members. | https://www.hca.nm.gov/public-information-and-communications/public_information_and_communications/centennial-care-2-0/ | |||
| NEW YORK | 2023 State Plan Amendment | New York's Medicaid program reimburses for CHW services. Covered services include: (1) health advocacy; (2) health education; and (3) health navigation. | https://www.health.ny.gov/regulations/state_plans/status/non-inst/original/docs/os_2023-03-31_spa_23-02.pdf | New York Medicaid Redesign Team Section 1115 Demonstration Waiver | CHWs are included in the Career Pathways Training Program, which funds Workforce Investment Organizations to provide training and education for healthcare career advancement. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ny-medicaid-rdsgn-team-appvl-01092024.pdf | ||||||
| NORTH CAROLINA | North Carolina Medicaid Reform Demonstration | The state’s Behavioral Health and LTSS Workforce Program offers training, certification support, and recruitment/retention bonuses to CHWs and other providers who commit to 3 years at organizations serving at least 30% Medicaid or uninsured patients. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nc-technical-correction-ltr-01162025.pdf | Health Opportunities Pilot | North 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://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots | ||||||
| NORTH DAKOTA | ||||||||||||
| OHIO | Ohio Administrative Code Rule Section 5167.173 | The 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 provider. | https://codes.ohio.gov/ohio-revised-code/section-5167.173 | |||||||||
| OKLAHOMA | 2024 State Plan Amendment | Reimburses CHWs if they meet training/experience requirements, work in a public health clinic, and provide services ordered by a licensed practitioner. | https://www.medicaid.gov/medicaid/spa/downloads/OK-24-0024.pdf | Oklahoma Medicaid Transformation and Quality Improvement Effort | Oklahoma’s Medicaid transformation includes partnering with entities such as CHWs to reduce health disparities, and some managed care plans, like Oklahoma Complete Health, use CHWs for value-added services such as home asthma visits. | https://oklahoma.gov/content/dam/ok/en/okhca/docs/about/soonerselect/_20230906-OHCA%20SoonerSelect%20QS%20Final.pdf | ||||||
| OREGON | 2017 State Plan Amendment | Oregon’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 interventions. | https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/OR/OR-17-0006.pdf | Oregon Health Plan Section 1115 Demonstration Waiver | CHWs can provide pre-release services within 90 days of incarceration release, receive HRSN infrastructure funding, and serve as connectors to link individuals with HRSN services. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/or-health-plan-dmnstrtn-aprvl-10162024.pdf | 2011 State Plan Amendment | CHWs 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 | |||
| PENNSYLVANIA | Keystone of Health Section 1115 Demonstration Waiver | CHWs eligible to receive infrastructure funding. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/pa-keystones-of-health-dmntn-aprvl-atchmnt-12302024.pdf | HealthChoices Agreement | Pennsylvania MCOs must work with CHWs as part of their Community Based Care Management programs. | https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/providers/providers/documents/managed-care-information/2024-HealthChoices-Agreement-Including-Exhibits-and-Non-financial-Appendices.pdf | ||||||
| *PUERTO RICO | ||||||||||||
| RHODE ISLAND | 2021 State Plan Amendment | Rhode 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 planning. | https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0012.pdf | |||||||||
| SOUTH CAROLINA | ||||||||||||
| SOUTH DAKOTA | 2019 State Plan Amendment | South 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 training. | https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/SD/SD-19-005.pdf | |||||||||
| TENNESSEE | ||||||||||||
| TEXAS | HB 113 (2023-2024) | Texas MCOs may recognize CHW services as a quality improvement cost | https://capitol.texas.gov/BillLookup/History.aspx?LegSess=88R&Bill=HB113 | |||||||||
| UTAH | Utah Medicaid Reform 1115 Demonstration Waiver | CHW services are reimbursable for pre-release services to qualified incarcerated individuals within 90 days prior to release. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ut-medicaid-reform-demo-aprvl-01082025.pdf | |||||||||
| VERMONT | ||||||||||||
| VIRGINIA | ||||||||||||
| WASHINGTON | 2024 State Plan Amendment | Washington reimburses for CHWs via the SPA | https://www.medicaid.gov/medicaid/spa/downloads/WA-24-0026.pdf | Washington Medicaid Transformation Project 2.0 Section 1115 Demonstration Waiver | Allows CHWs with lived experience to provide pre-release services within 90 days of incarceration release, support care coordination, and benefit from workforce investments such as CHW certification. | https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/wa-medicaid-transformation-dmnstrn-aprvl-01082025.pdf | ||||||
| WEST VIRGINIA | Drug Free Mom and Baby Program | WV Department of Health uses managed care to provide comprehensive support, including CHW services, for individuals with opiod use disorder during pregnancy and up to 1 year postpartum, with CHWs helping connect mothers and infants to care coordinators, transportation, MAT services, and home visitation programs. | https://dhhr.wv.gov/bms/Provider/Documents/Manuals/Appendixes/Policy_Chapter%20521B.pdf | |||||||||
| WISCONSIN | ||||||||||||
| WYOMING | ||||||||||||
| GUAM | ||||||||||||
| Last Updated: | 9/2025 |