Funds on horizon for community health workers
By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
New federal funding for the use of community health workers (CHWs), authorized by the health care reform legislation enacted in March, has the potential to help family planning programs expand their efforts to reach and serve disadvantaged populations.
Public health programs, including those focusing on family planning, have a decades-long history of using CHWs, dating back to the nation's antipoverty programs in the 1960s, according to Rachel Benson Gold, MPA, director of policy analysis and Washington office operations in the Guttmacher Institute's Public Policy Division.1 These workers, who traditionally are lay members of the local community, have a range of job descriptions and titles, including outreach workers (or promotoras in Latino communities), health educators, and patient navigators. Their close ties to the communities they serve help them to establish trust, especially important for programs serving immigrant communities and others with widespread fear or mistrust of government and medical authorities and addressing sensitive topics, such as sexuality and reproductive health. A recent, national workforce study on CHWs found that more than four in 10 programs employing these workers tasked them with addressing women's health, pregnancy-related care or HIV/AIDS, and for more than three in 10, sexual behavior or family planning.2
Many programs use CHWs to improve their visibility in the community and help make residents comfortable seeking care. This visibility might mean outreach at schools and community colleges, major local employers, community events and gathering places, and migrant camps and day-laborer sites. In other cases, CHWs help expand programs' capacity to provide patient counseling and care by running group sessions, providing extensive one-on-one counseling, conducting pregnancy and rapid HIV tests, or providing off-site education. All of these activities can free up clinicians' limited time. CHWs also might help a program's clients navigate the health care system, such as by helping clients to complete their Medicaid applications and connecting them with broader health and social services to address the full range of their risks and problems.
Check states' approaches
As use of CHWs grows, some states and programs have looked to improve their effectiveness and acceptance through training and credentialing. In Texas, for example, CHWs can attend programs run at community colleges that provide 160 hours of skills training and education, and then they receive no-cost certification from the state. A Massachusetts-based Title X grantee, Action for Boston Community Development/Boston Family Planning, requires its CHWs to complete a seven-day course covering communication and counseling skills and a range of reproductive health-related topics. The program then requires them to pass a take-home exam and be observed on-site.
An additional, potential benefit of credentialing is that it might help convince insurers and policymakers that the services CHWs provide are worthy of reimbursement or funding. One model for this is being tested in Minnesota, which in 2007 became the first state to provide Medicaid reimbursement to state-certified CHWs. A second model is being followed in Massachusetts, where a health department advisory group instead recommended that the agency continue to provide grants to fund CHW programs. The group cited concerns that insurance reimbursement to individual workers for specific services could end up curtailing one of their key strengths: their flexibility.
The 2010 federal health reform legislation explicitly designates CHWs as health care professionals and places them in the law's broader efforts to expand the nation's health care workforce and address persistent disparities. Most notably, it also authorizes a new federal grant program, to be run by the Centers for Disease Control and Prevention, to support CHW activities to promote positive health behaviors and outcomes in medically underserved communities.3 One potential limitation of this grant-based approach, however, is that its funding is less secure than would be Medicaid-based financing. Medicaid is an "entitlement" program that bypasses the annual congressional appropriations process. Instead, the CHW grant program will be pitted each year against a vast host of other, also-worthy programs and against budgetary and political demands to restrain federal spending. The program's prospects for the coming year are still uncertain. At press time, the relevant appropriations bill was a work in progress and likely will not be passed until after the November elections. However, in a promising development, the Senate Appropriations Committee included $30 million for the program in the version it approved in July.4
References
- Gold RB. 'I am who I serve' community health workers in family planning. Guttmacher Policy Rev 2010, 13(3):8-12, 17.
- Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. Community Health Worker National Workforce Study, March 2007. Accessed 9/10/2010 at ftp://ftp.hrsa.gov/bhpr/workforce/chw307.pdf.
- Patient Protection and Affordable Care Act, Public Law 111–148, Sec. 5313.
- Senate Appropriations Committee. Senate Report 111-243, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Bill, 2011(S. 3686). Aug. 2, 2010.
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