Community Health Worker (CHW)
CHWs can work under many different job titles, including promotores de salud/promatora, community health representative, community advisor, outreach worker, peer educator, patient navigator, and other related titles. In January 2010, the role of Community Health Worker was officially recognized by the Bureau of Labor Statistics of the Department of Labor as Standard Occupational Classification 21–1094.
According to the American Public Health Association, a Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison⁄link⁄intermediary between health⁄social services and the community to facilitate access to services and improve the quality and cultural competency of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.
The duties of a CHW include:
- Assisting individuals and communities to adopt healthy behaviors
- Conducting outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health
- Providing information on available resources
- Providing social support and informal counseling
- Advocating for individuals and community health needs
- Providing services such as first aid and blood pressure screening
- Collecting data to help identify community health needs
Education and training
According to a national HRSA health workforce survey there are three main trends in CHW workforce development:
- Certificates or degrees at the community college level, which provide career advancement opportunities
- On–the–job training, to improve standards of care, CHW income, and retention
- Certification at the state level, which recognizes the work of CHWs and facilitates Medicaid reimbursement for CHW services
Minnesota is the first state to create and offer a statewide CHW curriculum based in post–secondary education. The Minnesota standardized curriculum is a competency–based, 14–credit certificate program that creates a pathway for students interested in a wide range of health and social services careers.
The curriculum includes:
- (Note: the first 6 are core competencies.)
- Roles, Advocacy and Outreach: 2 credits
- Organization and Resources: 1 credit
- Teaching and Capacity Building: 2 credits
- Legal and Ethical Responsibilities: 1 credit
- Coordination and Documentation: 1 credit
- Communication and Cultural Competency: 2 credits
- Health Promotion Competencies: 3 credits
- Practice Competencies - Internship: 2 credits
The following seven schools offer the certificate program:
- Minneapolis Community and Technical College, Minneapolis
- Minnesota West Community and Technical College, Worthington (fall 2016)
- Normandale Community College, Bloomington
- Northwest Technical College, Bemidji (primarily online/meet in–person as needed)
- Rochester Community and Technical College, Rochester (as needed)
- St. Catherine University, St. Paul (hybrid: online/in–person)
In order to enter the program, a CHW student must have a high school diploma or GED. To date, over 650 CHWs have earned a certificate.
At this time, this foundational CHS training is voluntary. CHW on-the-job training content varies depending on the CHW employer and CHW job duties. However, in Minnesota, in order for Medicaid-eligible CHW employers to receive Medical Assistance reimbursement for authorized CHW services, the CHW must hold a CHW certificate from one of the above mentioned schools that offer the standardized curriculum. There are other reimbursement requirements that must be met as well, which are described later in this document under the Medical Assistance Billing and Reimbursement section. A certificate of completion issued by the schools to program graduates also helps assure providers that the CHW has the appropriate education and training needed to provide CHW services.
Similar to most states, Minnesota has not enacted occupational regulation of CHWs and does not define the CHW scope of practice in statute or rule. The Minnesota Department of Health uses the definition provided by APHA, described above.
The Minnesota Community Health Worker Alliance, a statewide nonprofit partnership committed to advancing health equity, provides the following description of CHW roles.
CHWs apply their training along with their unique understanding of the experience, language, and/or culture of the populations they serve in order to carry out one or more of the following:
- Providing culturally appropriate health education, information and outreach in community-based settings, such as homes, clinics, schools, shelters, local businesses,and community centers
- Bridging/culturally mediating between individuals, communities and health and human services, including actively building individual and community capacity
- Assuring that people access the coverage and services they need
- Providing direct services, such as informal counseling, social support, care coordination and health screenings
- Advocating for individual and community needs
Based on population needs, training and specific work setting, whether in a community or clinic environment, for example, a CHW´s job duties may vary.
Billing and reimbursement
According to Minnesota Statute 256B.0625, Subdivision 49, the state´s Medical Assistance (MA) program covers care coordination and patient education services provided by a CHW if the CHW has received a certificate from the Minnesota State Colleges and Universities System approved community health worker curriculum.
Minnesota´s Medicaid program, known as Minnesota Health Care Programs (including Medical Assistant and MinnesotaCare) has covered CHW services since 2009. At this time, covered services are defined as “diagnosis–related health education” as specified by the CHW´s authorized ordering provider. Many provider types may supervise CHWs, including physicians, dentists, public health nurses and mental health professionals among others.
The following is a link to the Minnesota Department of Human Services Provider Manual, which includes the most up-to-date information on enrollment and reimbursement for CHWs. For questions, contact the MHCP Enrolled Providers - Contact Information webpage.
Questions regarding coverage, payment and reimbursement for clients enrolled in a non-MHCP managed care organization or commercial insurance carrier should be directed to those specific organizations.
Relevant Minnesota Statutes and Rules:
- Community Health Workers: A Review of the Literature, 2016
- Community Health Workers: Existing Toolkit Report, 2015
- Community Health Workers: Environmental Scan, 2016
- Community Health Workers: Summary of Regulatory and Payment Processes, 2016
- Community Health Workers: Review and Analysis of Trends in Other States Report, 2016
- Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home, 2015
Minnesota CHW programs spotlights and resources
- Minnesota CHW Alliance
Examples of CHW training, networks and certification programs in other states
- American Public Health Association Community Health Workers
- Community Health Workers in Maine
- Massachusetts Association of Community Health Workers
- Community Health Worker Network of NYC
- Oregon Home Care Commission—Community Health Worker
- CDC: States Implementing Community Health Worker Strategies – Technical Assistance Guide, December 2014 (PDF)
- Program Sustainability Assessment Tool, Center for Public Health Systems Science, 2013
- Social return on investment: Community Health Workers in cancer outreach (PDF), a toolkit developed for the American Cancer Society – Midwest Division, Wilder Research, June 2012
- Community Health Worker Toolkit, Rural Assistance Center, last reviewed December 2014
- Community Health Workers in Rural Settings, Rural Assistance Center, last reviewed December 2014
- State Community Health Worker Models, National Academy for State Health Policy
- Policy Evidence Assessment Report: Community Health Worker Policy Components (PDF), CDC: National Center for Chronic Disease and Health Promotion, September 2014
- Support for CHWs to Increase Health Access and to Reduce Health Inequities, American Public Health Association, November 2009
- Community Health Workers in the Midwest: Understanding and developing the workforce (PDF), Wilder Research, American Cancer Society, June 2012
- Perspectives on the Community Health Worker Workforce