The Blueprint for Health is in Vermont state statute and uses multi-payer model (Medicaid/Medicare and commercial payers) to support patient-centered medical homes through funding, training, and support. These funds are distributed to administrative entities and allow the community to hire a variety of staff based on needs identified through community health needs assessments and other community partnerships. The community may choose to hire CHWs to support these goals.
Vermont is currently in the beginning process of identifying additional sustainable funding models that can support CHWs in a variety of settings. The Vermont Department of Health and the CHW Steering Committee are leading this work.
Authorized by SB 184, California will be implementing an APM with a subset of its federally qualified health centers (FQHCs) starting in 2024. Currently, both managed care plans and FQHCs pay for CHW services. CHWs play a critical role in implementation of the California’s Advancing and Innovating Medi-Cal initiative, a statewide effort to strengthen the state’s Medicaid program by offering Californians a more equitable, coordinated, culturally competent, and person-centered health care services. The APM will provide FQHCs with greater flexibility in care delivery approaches that meet this objective by moving away from a volume-based reimbursement.
North Carolina plans to incorporate CHWs as “care management extenders” within the state’s Medicaid managed care prepaid health plan care management models. Care management extender roles will fit into the existing PMPM capitation payment model.
In addition to existing “Standard Plans,” the state will launch “Tailored Plans” on April 1, 2023. These plans will offer integrated services to enrollees with significant behavioral health needs and intellectual/developmental disabilities.
Care management extenders can support care managers and help meet member contact requirements. CHWs who have completed the North Carolina CHW Standardized Core Competency Training will meet the extender qualification requirements.
The state is also exploring an additional PMPM capitation payment structure via its contract authority with Standard Plans that would establish a CHW staffing requirement ratio. The goal of this ratio would be to expand the number of CHWs deployed throughout its Medicaid managed care system. The state is also considering how health plan-level requirements filter down to providers with local care management responsibilities and how to encourage community-based organization partnership and deployment of CHWs. Current guidance was provided in July 2022. Additional guidance is expected in July 2023.
NASHP will continue to track these approaches as they emerge and develop.