Despite being one of the last States to develop a Community Health Worker (CHW) workforce, South Dakota was one of the first states to receive approval for Medicaid reimbursement for CHW services as a fee-for-service reimbursement. Many lessons have been learned throughout the implementation of the CHW reimbursement in South Dakota while also simultaneously developing a CHW workforce and incorporating the tribal Community Health Representatives into the developing statewide efforts. Beginning in 2020, the Community Health Worker Collaborative of South Dakota (CHWSD) led the development of a CHW workforce and also worked closely with South Dakota Medicaid to understand Medicaid reimbursement for the profession.

Since its inception in 2020, CHWSD worked closely with CHW and CHR Programs, as well as SD Medicaid to enact policy changes to ensure that equitable reimbursement was available for all types of CHW programs. Since the first claim was submitted in March of 2023, various organization types have began to be reimbursement for CHW services, including: Medical/Clinical programs, Community-based CHW Programs and Cross-trained CHW programs (i.e., EMS and Dental Programs). Additionally, in early 2024, South Dakota saw the first CHR program in the country successfully bill for CHR services to South Dakota Medicaid.

The CHWSD and South Dakota are excited to share with other States and organizations the not-so-secret steps to successfully implementing CHW reimbursement through Medicaid to further solidify CHW sustainability for years to come!

Community Health Workers (CHWs) play a pivotal role in bridging healthcare gaps and addressing social
determinants of health, but CHW programs often must rely on unstainable funding sources. Since 2011,
the Michigan Community Health Worker Alliance (MiCHWA) has collaborated with stakeholders to
identify and advocate for sustainable payment mechanisms, including advocating for recognition of
CHWs as eligible Medicaid providers.

This advocacy journey involved strategic collaboration with CHWs, state health agencies, health systems,
policymakers, community organizations and other allies in a series of workgroups that engaged in
literature reviews, compelling storytelling, connections with experienced advocates and policy-makers,
and development of evidence-based arguments to influence state policy development through intensive
outreach to policy makers. The effort gained momentum when a workgroup developed budget
boilerplate language for the Michigan State Legislature and engaged key sponsors. After an initial
introduction for the FY22 State Budget, a stronger version passed in the FY23 State Budget, mandating
the Michigan Department of Health and Human Services (MDHHS) to seek federal authority to formally
enroll and recognize CHWs as Medicaid providers by September 30th, 2023. MiCHWA and its partners
provided feedback to MDHHS throughout all stages of the policy development process.

CHWs provided active leadership throughout the process, including on MiCHWA’s Board of Directors,
staff and workgroups. CHWs raised their voices and provided policy direction during MiCHWA's monthly
Policy Workgroup meetings, organizing and meeting with state legislators at MiCHWA’s Annual CHW
Advocacy Days, and participating in MDHHS forums by providing feedback to MDHHS on draft policy
language. Multiple CHWs were involved in drafting and revising this abstract.

These advocacy efforts resulted in Michigan officially recognizing CHWs as eligible Medicaid providers
following approval of its State Plan Amendment by CMS. Michigan Medicaid Policy 23-74 – Medicaid
Coverage of Community Health Worker (CHW)/Community Health Representative (CHR) Services – took
effect on January 1st, 2024. It includes CHW provider eligibility criteria and established the MI Medicaid
CHW Registry.

This presentation will detail strategies employed by MiCHWA and its partners and discuss challenges
faced, successful tactics, and the collaborative spirit that fueled this transformative change. The
integration of CHWs as Medicaid providers in Michigan stands as a testament to the power of
community-driven partnership for successful advocacy. We hope that CHWs, CHW alliances, advocates,
policymakers, and public health enthusiasts join us in reflecting on this success, understanding the
lessons learned, and exploring opportunities to replicate this model to advance health equity.

The Pennsylvania CHW Collaborative (PACHW) has engaged over 300 CHWs and allies across PA over the past 2 years to implement a CHW-driven, grassroots campaign for sustainable financing to support PA CHWs. PACHW has found success in its advocacy efforts due to the recent transformative changes implemented or in process for PA Medicaid (MA), including: 1) Medicaid Managed Care Organizations (MCOs) are now required to fund CHWs as part of the 2024 PA HealthChoices contract for the first time ever and 2) PA Department of Human Services (DHS) will submit a state plan amendment (SPA) to CMS this fall to authorize payment for CHW services. To achieve these goals, PACHW has utilized an integrated advocacy approach that includes coalition capacity building, building CHW awareness, legislative outreach, and authentic engagement with state officials.

Over 150 PA CHWs and allies voiced their support for sustainable financing of CHWs at PACHW’s first-ever CHW Rally Day at the State Capitol on October 17, 2023. Rally speakers consisted of 10 PA CHWs; Dr. Debra Bogen, Acting Secretary of Health; and Stephen Kinsey, Majority Chairman of the PA House Human Services Committee. For the past 11 months, PA DHS has been working with PACHW to develop a SPA, and it is anticipated to be submitted to CMS in early fall. CHWs are unlike any other profession currently in the state plan; therefore, the billing and policy procedures require a unique approach. According to the 2023 PA CHW Employer Survey (n=100), community-based organizations (CBOs) are the leading CHW employer in PA (39%). PACHW wishes to ensure equitable access to billing and successful engagement from all CHW employers; however, notable barriers exist, especially for CBOs. The process PACHW underwent to advocate for low-barrier access to billing in comparison to the language included in the SPA submitted to CMS will be discussed, along with lessons learned. The financial impact of the 2024 policy change that requires MCOs to fund CHWs as part of the HealthChoices contract will also be discussed. T.A. related to establishing a CHW coalition and advocating for low-barrier state policy change at a grassroots level will be provided.

A CHW and ally who are both an active part of PACHW and driving these efforts developed this abstract and will present together, if allowable. We would be interested in an oral, poster, or roundtable session. The session will be highly interactive with live polls and discussions.