Advocates, providers and funders urge Pennsylvania to reimburse community health workers as state plan amendment stalls

HARRISBURG — At a Pennsylvania House Health Committee hearing, advocates, clinicians and philanthropy leaders urged the state to finalize payment for community health worker services under Medicaid, saying delays in a Department of Human Services state plan amendment (SPA) have left programs at risk and could cost the state money in avoidable high-cost care.

"We are here to provide information on the CHW workforce...and to urge you to prioritize the inclusion of community health worker services as reimbursable under the Pennsylvania Medicaid program," said David Wiles, executive director of the Pennsylvania Community Health Worker Collaborative, in testimony detailing the workforce and pressing for a sustainable financing mechanism.

The request reflects testimony from three panels of speakers — practicing community health workers, provider organizations that employ them, and foundations that have funded the work. Speakers described routine examples of CHWs preventing emergency care, connecting patients to housing and benefits, and supporting chronic-disease management. George Garrow, chief executive officer of Primary Health Network, described a recent clinic case in which a patient prescribed insulin "reported that he doesn't have a refrigerator. In fact, he doesn't have a house. He lives under a bridge," and said a CHW helped the patient secure stable housing so he could store and use the medication. Tia Whitaker, a certified community health worker, recounted a client whose premiums and out-of-pocket costs were cut "by two thirds" after CHW assistance with enrollment; the client told her, "we now can talk about going to visit our grandchildren in Arizona." Michelle Nakaradi…