Medicaid Reimbursement and Other Funding Strategies for Community Health Workers: Perspectives of Employer Organizations in Indiana.

Abstract

Objective: To investigate challenges and opportunities related to Medicaid reimbursement and other funding strategies for community health workers (CHW) among employers in Indiana.

Design: Qualitative study using in-depth interviews with organizational and program leaders in 2024. Analysis used a framework approach.

Setting: Indiana.

Participants: Leaders from 8 Indiana-based CHW employer organizations, including health systems, federally qualified health centers (FQHCs), local health department, and community-based organization, supplemented by leaders of 3 non-Indiana-based organizations engaged in CHW policy, research, or advocacy elsewhere in the United States.

Main outcome measure: Organizational perspectives on CHW workforce funding, specifically Medicaid reimbursement, and alternative funding approaches.

Results: We found that CHW employers relied on short-term grant funding but that there was diversity in funding approaches. Only 1 of 8 Indiana-based CHW employers billed Medicaid for CHW services, with barriers to Medicaid reimbursement related to low reimbursement rates, complex billing procedures, limited billable activities, and structural exclusion to Medicaid reimbursement for some providers like FQHCs. Alternative funding approaches identified by employers included reforms to the current Medicaid policy, moving towards value-based payment models, pursuing braided funding approaches, and advocating with organizational leadership based on return-on-investment from CHW activities. Non-Indiana-based stakeholders highlighted additional strategies that could be pursued in Indiana to enhance sustainability, including managed care incentives or requirements for employing CHWs and dedicated workforce development partner organizations that can support CHW employers in building and sustaining their CHW workforces.

Conclusions: Insights from this study revealed current structural and policy challenges that CHW employers face in Indiana and can inform reforms to build a more sustainable CHW workforce to serve diverse health and community settings.