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The COVID-19 pandemic has highlighted the many health disparities in our health care systems, including a shortage of primary care providers. In Kentucky, there is one primary care provider for every 1,000 people overall and, in some counties, only one for every 10,000 people. This creates a barrier for Kentuckians to access healthcare as they face months-long waiting lists for appointments and unaddressed, treatable health concerns. The disparate ratio also creates an over-burdened system for providers. Community partners’ recent push to pass HB525 now puts Kentucky in a position to address this disparity through Medicaid reimbursement of Community Health Workers (CHWs) services.
While Kentucky has a provider shortage, it also boasts some of the strongest regional concentration of CHWs in the country. They are frontline public health workers who help people navigate health care and social services. As trusted messengers, CHWs reflect the background of their community while serving as connectors to an often-inaccessible healthcare system. Their role positions them to bridge the gap created by the provider shortage as they increase health literacy, improve health outcomes, and direct patients to primary care earlier, avoiding expensive trips to emergency care when symptoms worsen.
Under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has allowed states to reimburse for preventive services by professionals that are outside of physicians or other licensed practitioners, including CHWs. Kentucky State Rep. Kimberly Moser introduced a bipartisan bill, HB525, this session to require the state’s Medicaid program to reimburse Certified Community Health Workers (CCHWs) and offer college credit to CCHWs for certain services. This reimbursement would apply to health care, substance use treatment, and mental health services while expanding and integrating the CHW network into patient care. The legislation also allows other Medicaid providers to be approved to bill for CCHW services.
Community organizations, like the Kentucky Primary Care Association, Advocacy Action Network, Kentucky Voices for Health, Homeless and Housing Coalition of Kentucky, and CHI Saint Joseph Health, collaborated to develop a campaign to pass the bill. Over the past few years, Kentucky Association of Community Health Workers (KYACHW) and Kentucky Homeplace have developed a structure to support the state’s CHW workforce in collaboration with the Office of CHWs within the Department of Public Health.
Advocates mobilized CHWs from across the state to testify at the State House in March and share their stories via online platforms. CHWs, like Tiffany Taul-Scruggs from Sterling Health Care, spoke about her experience supporting the overall wellbeing of clients “to assess for barriers they may face in reaching goals related to jobs, justice, education, health or housing.” Pamela Spradlin from Big Sandy Health Care explained the importance of the Medicaid reimbursement, “In order for the CHW model to remain viable in Kentucky, we must have a sustainable stream of revenue as well.” After the legislation passed committees in both the Kentucky House and Senate, Gov. Andy Beshear signed the bill into law on April 7. Now, local advocates are working with the Kentucky Department for Medicaid Services to ensure implementation supports a sustainable path to integrate CCHWs in communities.
This law is a win for Kentuckians and continues a movement across the country to pass similar legislation that fosters community-centered care. As of last year, 15 states reimbursed CHW services through their Medicaid program and 10 other states’ Managed Care Organizations reimbursed their services or hired CHWs. Local governments continue to look at legislation to support the CHW workforce as research shows that they save states money, increase health literacy, and improve patient outcomes. As we look for solutions to the health disparities that the pandemic brought to light, community-centered care initiatives, like the integration of CHWs into patient care, emerges to be a very effective, valuable, and equitable response.