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HR10414119th CongressWALLET

Community Health Worker Access Act

Sponsored By: Representative Adams, Alma S. [D-NC-12]

Introduced

Summary

Expands Medicare and Medicaid coverage and funding for community health workers. The bill would create a new Medicare Part B benefit for "community health services" and give states an optional Medicaid pathway to pay community health workers for preventive and social-determinant services starting Jan. 1, 2027.

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  • Medicare beneficiaries: People on Medicare could receive community health services like preventive care, care coordination, and social needs interventions. These services would be paid at 100% of the lesser of the actual charge or a fee schedule amount and would not trigger the Medicare Part B deductible.
  • States and Medicaid enrollees: States could use a new "Community Health Workforce Support" Medicaid state plan pathway to pay community health workers, promotoras, and community health representatives for preventive and SDOH services. Approved state plans would get a 6 percentage point FMAP increase for those expenditures and that boost is excluded from territorial cap calculations.
  • Community health workforce and agencies: The bill sets standards for community health agencies and CHW networks, including wages aligned with the market, professional development, manageable caseloads, supervision, worker safety, evaluation, and worker leadership. The Secretary must issue guidance to help states recruit agencies and reimburse organizations that do not bill insurance.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

More Medicaid support for CHW services

If enacted, states would be able to add Medicaid coverage for preventive and social‑determinant services that community health workers, promotoras, or community health representatives provide. For services paid under an approved State plan amendment or Secretary guidance, the federal share (FMAP) would be 6 percentage points higher for calendar quarters beginning on or after January 1, 2027. The Secretary could waive statewideness and comparability rules to let states implement this option. The Secretary would also have to issue guidance requiring recruitment of community health agencies, coordination with CHW networks, emergency readiness, help to reduce participation barriers, and a way to reimburse community groups that do not bill insurance.

New Medicare community health services

If enacted, Medicare Part B would cover a new category called "community health services" starting January 1, 2027 when provided by a certified community health agency under a supervising provider. Medicare would pay 100% of the lesser of the provider's actual charge or the fee schedule amount set by the Secretary. The Part B deductible would not apply to these community health services. The Secretary would define agency and workforce standards, such as hiring workers with shared lived experience, paying market wages, and providing training and manageable caseloads.

Sponsors & CoSponsors

Sponsor

Adams, Alma S. [D-NC-12]

NC • D

Cosponsors

  • Rep. Ruiz, Raul [D-CA-25]

    CA • D

    Sponsored 9/16/2026

Roll Call Votes

No roll call votes available for this bill.

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