Uptake of Medicaid Billing for Community Health Worker Services in Louisiana, 2022-2023.

Abstract

Background: In 2022, Louisiana Medicaid began offering reimbursement for some community health worker (CHW) services ordered and billed by a supervising clinician.

Objectives: We analyzed the extent to which CHW services were reimbursed by Louisiana Medicaid during 2022-2023, including number of encounters, demographics of Medicaid members served, number of encounters per member, geographic distribution of CHW encounters, primary diagnosis of members receiving CHW services, and provider type billing for CHW services.

Research design: Retrospective cohort study of Louisiana Medicaid members receiving CHW services reimbursed by Medicaid. We included paid fee-for-service claims and managed care encounters for CPT codes 98960, 98961, or 98962 with dates of service from 1/1/2022 through 12/31/23.

Results: A total of 10,726 unique individuals received 17,373 reimbursed CHW services, with an estimated total reimbursement of $314,905.52. Medicaid members ranged from 0 to 88 years, were majority female (56.8%), and received between 1 and 13 services; mean: 1.6 (SD: 1.1), median: 1 (IQR 1-2 encounters). The highest rate of CHW services per Medicaid member occurred in urban areas. Nearly all (99.97%) were individual services. A total of 41.9% of services were for screening without a specified diagnosis, and health-related social needs were more common than medical conditions. Over half (60.6%) of CHW services were billed by family practice or internal medicine providers.

Discussion: Health care practices may be asking CHWs primarily to conduct screenings, rather than provide the longitudinal services CHWs traditionally offer.

Conclusion: Uptake of billing for CHW services was limited. Providers may need education about CHW roles and technical assistance to support CHW integration and billing.