Barriers and Strategies to Operationalize Medicaid Reimbursement for CHW Services in the State of Minnesota: a Case Study

• Published in: Journal of general internal medicine : JGIM Vol. 38; no. Suppl 1; pp. 70 - 77
• Main Authors: Gunter, Kathryn E., Ellingson, Megan K., Nieto, Megan, Jankowski, Ron, Tanumihardjo, Jacob P.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2023; Springer Nature B.V
• Subjects: Community Health Services; Community Health Workers; Government programs; Health care; Humans; Internal Medicine; Lobbying; Medicaid; Medical personnel; Medicine; Medicine & Public Health; Minnesota; Organizations; Perspective; Reimbursement; United States; United States; Minnesota; United States > US
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-022-07925-3

Integrated medical and social care via community health worker (CHW) services is a growing area of interest, particularly among health care organizations that offer care for underserved populations. Establishing Medicaid reimbursement for CHW services is only one step to improve access to CHW services. Minnesota is one of 21 states that authorize Medicaid payment for CHW services. Despite available Medicaid reimbursement for CHW services since 2007, the actual experience of many Minnesota health care organizations in obtaining reimbursement for CHW services has been challenging due to barriers at multiple levels (e.g., clarifying and operationalizing regulation, navigating complexity of billing, building organizational capacity to reach key stakeholders at state agencies and health plans). This paper provides an overview of the barriers and strategies to operationalize Medicaid reimbursement for CHW services in the state of Minnesota, through the experience of a CHW service and technical assistance provider. Based on lessons learned in Minnesota, recommendations are made to other states, payers, and organizations as they navigate processes to operationalize Medicaid payment for CHW services.