Community Health Worker Access Act
Sponsored By: Senator Blunt Rochester, Lisa [D-DE]
Introduced
Summary
This bill would create nationwide Medicare Part B coverage for community health services and would give States a new Medicaid option to fund community health workforce services, both effective January 1, 2027.
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- Families and beneficiaries would get covered access to preventive and social-determinant services delivered by community health workers, with the Medicare Part B deductible waived for these services and Medicare payments set at 100% of the lesser of actual charge or a fee schedule.
- Community health workers, promotoras, and community health representatives would be formally defined and supported. Community health agencies would face workforce standards like hiring workers with lived experience, paying market-based wages, offering professional development, keeping manageable caseloads, and including CHWs in leadership.
- States would be able to add these services to their Medicaid plans and receive an enhanced Federal medical assistance percentage. The bill would raise the FMAP by 6 percentage points for approved preventive and SDOH services starting January 1, 2027, with special territorial cap treatment.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Higher Medicaid match for community health workers
If enacted, the federal Medicaid match (FMAP) would increase by 6 percentage points for calendar quarters beginning January 1, 2027. The increase would apply to State spending on qualifying preventive and social-determinants services furnished by community health workers under an approved State plan amendment or federal guidance. For U.S. territories, the extra portion attributable to the increase would be excluded from certain territorial cap calculations. This would lower State net costs for these services.
Medicare coverage for community health services
If enacted, Medicare Part B would cover community health services furnished on or after January 1, 2027. Medicare would pay 100 percent of the lesser of the provider's actual charge or an amount on a Secretary-set fee schedule for these services. The Part B deductible would not apply to community health services. Services would have to be provided by a qualifying community health agency under an individual needs assessment and supervised by an applicable provider.
New standards for community health workers
If enacted, the bill would define community health services and set standards for community health agencies starting January 1, 2027. Community health services would include preventive services and services to address social determinants of health such as needs assessments, outreach, home visiting, case management, and referrals. The Secretary could require agencies to hire workers with community experience, pay market wages, provide training and professional development, keep manageable caseloads, ensure worker safety, supervise and evaluate staff, and include CHWs in leadership roles.
State Medicaid option for community health workers
If enacted, states would be able to add Medicaid coverage for preventive and social-determinants services provided by community health workers starting January 1, 2027. States would need to adopt a Medicaid State plan amendment and follow federal guidance to get approval. The Secretary would issue guidance on required elements like recruiting community health agencies, coverage design for preventive and SDOH services, CHW-led emergency response plans, and ways to reimburse organizations that do not bill insurance. The federal government could permit waivers of certain Title XIX rules to help states implement the option.
Sponsors & CoSponsors
Sponsor
Blunt Rochester, Lisa [D-DE]
DE • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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