Our Approach

 

CHW Financing

 The CHW Sustainable Financing Committee was formed in 2021. Since then, PACHW has taken a multi-tiered approach when advocating for sustainable financing of Pennsylvania CHWs, including building the capacity of our coalition and engaging with the PA Department of Human Services, members of the PA General Assembly, CHWs, and  stakeholders. CHW programs and positions end every month across the Commonwealth as grant funding expires. Over 50% of funding for CHW positions in Pennsylvania derives from short-term grants.

 

The step-by-step approach that Pennsylvania took to work toward sustainable financing:

CHWs Transform Medicaid & Medicare Financing

Medicare, 1/1/24

  • CHW services billable to Medicare for first time-ever
  • No cap on number of units billed; $79 (initiating visit/60 min) $49 (follow-up/30 min)
  • Focus on clinical integration with CBOs; billing must come from a billing practitioner
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HealthChoices,1/1/24

  • MCOs required to fund CHWs under the Community-Based Care Management program (CBCM) for the first time ever
  • MCOs can now employ their own CHWs. Need to request DHS approval if wishing to end CBO contracts.
Learn more

Medicaid, Q2 2025

  • CHWs must be certified
  • Defining scope of practice
  •    Health system navigation
        and resource
        coordination
  •     Health education
  •     Health promotion &
        coaching
  • Advocating to minimize barriers to bill, especially for CBOs
Learn more

HRSN 1115 Waiver, 1/25 - 1/20

  • Pending CMS approval
  • 5 year opportunity
  • MA beneficiary must have clinical and social needs
  • Re-entry supports
  • Housing supports
  • Food and nutrition supports
  • Continuous coverage for children under 6
Learn more

Statewide Coverage as of 3/1/24

 

Funding Sources

 CHWs have historically been employed by community-based organizations and social agencies, although they are increasingly being used in clinical settings, such as federally qualified health centers (FQHCs), health departments, and hospitals (Malcarney et al. 2017). There are 507 Certified CHWs in PA as of 3/24. 58% of PACHW employers rely on grants to fund CHW positions, making long-term planning and continuity of programming tenuous. Only 13% of CHW employers fund CHW positions through MCO contracts, with 28% funded for the cost to employ CHWs and smaller portions funded at least partially by fee-for-service (20%) and VBP (20%) contracts.

Advocacy & Sustainability

Certified CHWs in PA

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Employers Rely on Grants

%

PA Counties Served by CHWs