Indiana Medicaid Reimbursement for CHWs
Community Health Workers bring value to the communities they serve-they link individuals to healthcare services, provide culturally and linguistically tailored support, and educate on a variety of health topics. Unfortunately, there are many challenges to establishing the CHW profession in healthcare delivery systems. Funding sources for CHWs often do not provide job opportunities that are secure, long-term options; CHW programs often rely on temporary grant funding and are rarely fully integrated with clinical services.
One way that CHW programs can become sustainably funded is through insurance reimbursement for CHW services. Funding from large public programs like Medicaid, Medicare, and the Children’s Health Insurance Program would provide new opportunities for CHW programs to be integrated onto clinical care teams. Not only can this type of funding support the financial sustainability of CHW programs but utilizing CHWs can help these programs to contain costs, improve outcomes, and reach underserved populations. There have been numerous studies that CHW-delivered care is cost-effective and can provide an opportunity for a return on investment (ROI) for the organizations that utilize them. In fact, recent analyses on MHP Salud’s CHW programs reported a ROI of between $1.09 and $3.16 for every $1 spent.
An Additional Funding Opportunity for CHW Programs
An exciting new insurance reimbursement opportunity in Indiana has recently been announced; this new development will create new funding opportunities for CHW programs in the state. The Indiana Health Coverage Program (IHCP), which includes all programs covered under Indiana Medicaid, added coverage for CHWs on July 1st, 2018. This means that CHWs that work for providers such as Physicians, Physician Assistants, or Chiropractors that accept patients using Indiana Medicaid, and are supervised by those providers, can be reimbursed for the following services:
- Patient education for managing physical or mental health (in conjunction with a healthcare team)
- Cultural Facilitation between a patient and their healthcare provider when language or socioeconomic status is a barrier to communication
- Health promotion education to prevent chronic disease
- Direct Preventative services like medication management or nutrition counseling, to slow or prevent chronic disease
In order to be eligible for reimbursement, the CHWs must have certification in the state of Indiana that demonstrates they have mastered core competencies of:
- Relationship building skills
- Service coordination and navigation skills
- Capacity building skills
- Advocacy skills
- Education and facilitation skills
- Individual and community assessment skills
- Outreach skills
- Professional skills and conduct
- Evaluation and research skills
- Knowledge base
There are some limitations to the new coverage options in Indiana. The following services are not covered:
- Insurance enrollment and navigator assistance
- Case management and care coordination
- Transportation aid
- Direct patient care outside of CHW training
CHWs also must provide these services in-person for it to be covered. CHWs are also limited to 2 hours per day, and 12 hours per month for each patient.
Looking to the Future
This new legislation provides an amazing opportunity for CHWs and their employers. It helps to create sustainable funding mechanisms that will further establish the CHW model as an effective way to reach underserved communities in a variety of settings. The integration of CHWs into clinical settings reflects the growing national interest in healthcare that is patient-centered, where prevention is valued, and the whole person is treated by a coordinated team of providers.
MHP Salud believes that the Community Health Worker (CHW) model is the most effective way to reach underserved, hard-to-reach populations, in order to improve health outcomes and reduce disparities. Our organization advocates for this model nationally in the programs that we implement, and the training/technical assistance that we provide to organizations that are interested in working with Community Health Workers.
About MHP Salud
MHP Salud has over thirty years of experience implementing CHW programs and training organizations looking to start and/or strengthen their own CHW programs. For more information about MHP Salud, our services, and how we can help you, please email us at firstname.lastname@example.org