Community health workers, the new frontier of prevention and care: A model from New York City

Several sections of the Affordable Care Act (ACA) recognize community health workers'(CHWs) vital role in improving the delivery of preventive and primary care to America's diverse communities. By bridging individuals to the healthcare system, overcoming distrust, and enhancing adherence to care, multilingual and multicultural CHWs provide additional patient support, reinforcing the treatment they receive by health providers. With the ACA's emphasis on community-based preventive care, patient-centered medical homes, and health benefit exchange navigators, CHWs' sustainability is vital to the paradigm shift towards prevention-oriented community-based primary care. The context of immigration reform also provides opportunities and challenges for the CHW workforce, given their unique capacity to reach marginalized communities, such as undocumented immigrants. For instance, if immigration reform enables undocumented immigrants to utilize their income to purchase health insurance through the health insurance marketplace, or if a pathway to citizenship enables more immigrants to be eligible for public benefits, then the CHW workforce will have a critical role in helping these newly eligible individuals navigate these resources and assist with enrollment. In addition, 5 of the top 7 countries with the highest number of family-sponsored waiting list registrants are from Asian countries. CHWs already provide immense social support for individuals coping with stressors of family separation. An increase in workers visas would also result in CHWs continuing to serve as key resources for newly arrived immigrants to navigate health and social services. Changes in immigration reform policy will very likely increase the need for the CHW workforce to be expanded and supported in order to respond to the needs of these growing underserved immigrant populations. Examples from a CHW model utilized in the NYC Filipino community will demonstrate how CHWs serve, and advocate for, community members at individual and systemic levels, in order to improve health access and expand immigrant rights.