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Advancing the Role of Community Health Workers: Engaging State Medicaid Offices to Develop State Plan Amendments Regarding the Preventive Services Rule Change

January 1, 2019

Community health workers (CHWs)1 provide services that address the social and environmental determinants of health, including preventive home- and communitybased health services (HCBS). Often as members of medical teams, CHWs are a vital part of the healthcare workforce in the vast majority of states, yet few state Medicaid programs reimburse even a portion of this work.2, 3, a Despite their rhetorical popularity, mostCHWs continue to rely upon unpredictable and often insufficient financial support.A new pathway of reimbursement for CHW services through Medicaid emerged in 2014. Before the Centers for Medicare and Medicaid Services (CMS) updated the regulatory definition of preventive services, preventive services could only be provided by physicians or other licensed practitioners (e.g., chiropractors or registered nurses). This "preventive services rule change" gave states the option to reimburse nonlicensed practitioners, including CHWs, for preventive services recommended by a licensed practitioner. In effect, the preventive services rule change enables states to include CHWs, as defined by the state's requirements for education, training, or credentialing, as qualified providers ofcertain preventive services under Medicaid.

Case Studies in Healthcare Financing of Healthy Homes Services

September 1, 2016

This report is part of a multiyear project to document and demystify the landscape and opportunities surrounding healthcare financing for healthy homes services.The findings described are the result of 34 interviews conducted with Medicaid agencies, public health departments, and other stakeholders in 11 states to distill lessons learned about pursuing healthcare financing for healthy homes services at the state level.

Building on the Affordable Care Act to Make the Health System Work for Young Gay Men: An Action Plan

April 10, 2014

The Affordable Care Act (ACA), the health reform law that was enacted in 2010, is expected to greatly expand access to stable and affordable insurance coverage for millions of Americans. Extensive research has documented that insurance matters; people with insurance coverage are less likely to report going without necessary care due to inability to pay and are more likely to report positive health outcomes than people who are uninsured.1 Young gay men, however, are a population with distinct needs that has rarely been the focus of attention for the health system. They may be among the least likely to automatically translate having insurance coverage into receiving consistent, high quality medical care. Therefore, focused efforts are needed to explain the importance of health coverage, facilitate enrollment in coverage, address structural barriers to care, and support their engagement with the health system once they obtain coverage. With the ACA developing new systems of care and new ways of paying for services, there is a fresh opportunity to examine key aspects of the healthcare delivery system to ensure that it is designed to facilitate good care and improved health outcomes for program beneficiaries and health plan enrollees. Indeed, the ACA includes several key provisions that create new protections and new opportunities to more proactively meet the needs of lesbian, gay, bisexual, and transgender (LGBT) individuals, including important protections against discrimination on the basis of sexual orientation and gender identity.