State policymakers considering community health workers: Some lessons learned in multi-state meetings

More than thirty states have at least begun investigations into the establishment of a policy infrastructure to expand engagement of community health workers (CHWs) in public health and health care delivery.  CHWs are unique among health-related professions in important ways, relying more on community relationships, trust and shared life experience than on clinical training.  There is evidence that they contribute significantly in addressing social and behavioral determinants of health at community, family, and individual levels because of those same strengths.  The unique attributes and widely varied roles of CHWs can be challenging for state officials and other stakeholders to understand and support.  State legislators and executive branch officials must also deal with persistent concerns such as scope of practice boundaries with other professions, fiscal pressures favoring cost savings over “new spending,” and liability for actions of personnel with limited clinical training.  Some states have taken direct measures to study potential policy options around CHWs, often with legislative backing, others have implemented state funding for CHW pilot projects, and others have encouraged and supported multi-sector coalitions or working groups to develop and advocate for new policies.  State Medicaid offices have shown varying degrees of interest and support for these processes.  The authors have presented and facilitated discussion in various multi-state gatherings of policy-makers and legislators on these topics, as well as advised state officials and coalitions in individual states.  Authors will share their observations and recommendations for future regional/national activities to engage with policy-makers.