State Strategies for Sustaining Community Health Workers: Virtual Convening of Milbank State Leadership Network Recap

Event date: September 11, 2025

Legislative Movement Across States

Cara Osborne, ScD, Senior Fellow for Health and Wellness, Heartland Forward

Cara Osborne described the Heartland Health Caucus, which convenes governor’s offices, departments of health and health and human services, Medicaid, and mental health directors and health care payors in eight states (AR, IN, KS, KY, LA, MO, OK, TN) on maternal health, mental health, and workforce priorities. The caucus develops template legislation and best practices for implementing legislation through state plan amendments, agency rulemaking, and partnering with health care service and delivery partners. Osborne described recent bipartisan legislative activity from the Caucus related to community health workers.

Legislation on CHW Certification and Reimbursement from Heartland Health Caucus States

She emphasized the importance of rate setting for CHWs, pointing out that inadequate reimbursement for these services leads to CHW burnout and undermines the sustainability of the workforce. Finally, she highlighted the work of the Maternal & Child Health Center for Policy and Practice in Arkansas focused on expanding team-based care offered by county health departments to CHWs, doulas, and midwives as part of a broader maternal and child health strategy. The center is developing policies that define the scope of practice for these workers and working with hospitals to change bylaws to transition to team-based care models.

I think relationships are the most powerful intervention that we can offer each other. And having an ongoing relationship positions the community health worker so well to be able to anticipate needs and head off things like calling 911. Talk about a lovely case for offsetting costs. Two ambulance rides is an annual salary for a community health worker. – Cara Osborne, ScD, Senior Fellow for Health and Wellness, Heartland Forward

Public Health and Health Care Partnerships

Chelsea Cipriano, MPH, Common Health Coalition

Cipriano explained the need to create partnerships between public health and health care to support CHW and improve population health. During COVID-19 pandemic, CHWs demonstrated their ability to connect patients with both medical care and community services across public health and health care systems. As emergency pandemic funding ended abruptly in March and amid ongoing cuts to public health funding and infrastructure, the challenge is embedding CHW models into routine practice, not just crisis response.

The Common Health Coalition includes 300+ member organizations consisting of health systems, payers, and public health agencies working to bridge silos. Cipriano promoted their 2025 Common Health Challenge that spotlights CHWs as trusted professionals who build bridges among health care, public health, and community organizations to facilitate access to services and improve health. The challenge includes:

• Catalyst Awards: Awards that distributed $400,000 to 11 pioneering CHW programs.
• Community of Practice: A forum for 60–70 organizations to share lessons and resources. This is an open group for CHW-supporting organizations.

She emphasized the importance of creating collaborative systems that support CHWs by reducing redundancy, improving continuity, and enabling shared financing and sustainability for CHWs. 

Opportunities for Sustainability

Annie Cloke, MPA, IMPaCT Care

IMPaCT is the most widely implemented CHW model in the country and is used by over 70 organizations across 20 states. It is also a recipient of the Common Health Coalition Catalyst Award. Drawing on State Strategies for Engaging Community Health Workers Amid Federal Policy Shifts, Cloke reviewed opportunities for state Medicaid and public health leaders to integrate CHWs into health care delivery. Cloke explained that proven CHW programs can help achieve state spending and population health goals. Evidence-based CHW programs can reduce spending and deliver a $2.47 return on investment for every Medicaid dollar spent while improving health outcomes for individuals by reducing avoidable emergency department use, shortening hospital stays, and increasing patient engagement.

Opportunities for Medicaid

Cloke explained that despite tighter budgets, state Medicaid leaders can support access to CHW services through innovative approaches that are cost neutral or low-cost, including:

• Medicaid Managed Care Contracts: Require MCOs to integrate CHWs into care teams
• Value-Based Care Models: Embed CHWs into primary care medical homes and accountable care organizations
• 1115 Waivers: Fund reentry programs and CHW infrastructure (e.g., IL, OR, NC)
• State Plan Amendments (SPAs): Authorize Medicaid reimbursement for CHW services (Resource: Model State Plan Amendment & Other Guidance).

Other Opportunities

• Rural Health Transformation Program (RHTP): A new funding opportunity created by the federal “One Big Beautiful Bill Act” (HR1), allocates $50 billion for state rural health initiatives that improve outcomes and access. CHWs can play a central role in states’ RHTP applications, due November 5, 2025 (Resource: Model Language for Integrating Proven Community Health Worker Programs into RHTP Applications).

Cloke also highlighted critical elements that should be included in state strategies to advance CHW policies and programs:

• Partnerships with CHW associations: Include CHWs in policy and program development to ensure the workforce is supported 
• Evidence-based infrastructure: Implement evidence-based CHW program design, training, and workflows
• Program standards: Create CHW accreditation to certify the quality of CHW programs and support the CHW workforce
• Financial sustainability: Provide sufficient payment rates and appropriate reimbursement infrastructures (i.e., allow community-based organizations and CHWs to bill Medicaid; align Medicaid and Medicare CHW codes)

Key Themes from the Discussion

All panelists reiterated a common motto, “nothing about us, without us.” CHWs need to be included in the policy and program development process. States should ensure sustainability of the CHW workforce through fair reimbursement rates, career ladders, program accreditation standards, and support networks. In addition, panelists highlighted the need for hyper-localized recruitment and training to align the workforce to local needs and pointed to successful high school internship programs to cultivate community-based workers. There was also discussion about alignment of CHWs with behavioral health peer support specialists, who have distinct but complementary roles. States like California are testing joint models with CHWs and peer support specialists (Resource: Integrating CHW and peer support specialists), and panelists said that creating specific CHW roles and titles can help distinguish these roles (Resource: Professional Roles and Titles for CHWs).

In closing, the panelists discussed the strong evidence base supporting CHWs and the availability of resources that can be used across states and organizations to support this workforce. Pairing this evidence base with storytelling that personalizes the CHW impact is crucial to growing support among policymakers, health care leaders, and others.      .

Conclusion

CHWs are proven, cost-effective professionals who strengthen community engagement, improve outcomes, and help states achieve population health goals even in tight fiscal environments. Sustaining this workforce requires cross-sector collaboration, innovative financing, and intentional policy design with CHWs and their organizations. State leaders were encouraged to leverage upcoming federal opportunities, particularly the Rural Health Transformation Program, and to prioritize CHW involvement in shaping the future of care.

Resources

CHW resources

• Medicaid Reimbursement for Community Health Worker Services: Model SPA & Guidance: (Milbank Memorial Fund) 
• State Strategies for Engaging Community Health Workers Amid Federal Policy Shifts (Milbank Memorial Fund) 
• Special Report on Public Health Cuts (June 2025) Common Health Coalition 
• NASHP State CHW Policies Tracker
• Kentucky HB 525; Arkansas HB 1258; Oklahoma HB 1831
• Washington State DOH – CHW Training Program
• Minnesota Medicaid note: covers G0019 and G0022 (Community Health Integration) 
• California DHCS – Enhanced CHW Services (BH CONNECT):  

Roles, standards & frameworks

• C3 Council – Standards for CHW Roles and Skills:  
• NACHW – Professional Roles and Titles (PDF)

CHW Integration & behavioral health

• AMA – Designing Workflow for Behavioral Health Integration
• Camden Coalition – Integrating CHWs & Peer Support Specialists

CHW support organizations

• Envision CHWs
• Common Health Coalition – Challenge