Medicaid Reimbursement for Community Health Worker Services

Centers for Medicare and Medicaid Services (CMS) is reviewing a proposal from RI Executive Office of Health and Human Services (EOHHS/Medicaid) to cover Community Health Worker (CHW) services as a Medicaid benefit. On March 21 and 24, EOHHS staff and its fiscal agent Gainwell Technologies presented information on the proposed CHW benefit. Under the proposal, CHWs could bill for health promotion and coaching; health education and training; health system navigation, and; care planning for eligible Medicaid members. CHW services would need to be recommended for a patient by a licensed healthcare professional and providers must enroll as a CHW provider in order to be eligible to bill. Providers could back bill CHW services to July 1, 2021, with appropriate documentation. This benefit would not be covered by Medicaid managed care contracts, but rather through Medicaid directly and would be billed directly via Gainwell Technologies. EOHHS expects benefit approval from CMS in May 2022.