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 Chapkis of Women for a Healthy Environment described healthy-home assessments that identified mold, pests and lead risks and the practical items CHWs leave behind, such as HEPA vacuums and air purifiers.

Why it matters: Witnesses said CHWs reduce use of high-cost services by addressing social drivers of health — housing, food, transportation, benefits enrollment and care navigation — and cited evidence of improved chronic-disease management and cost savings from CHW interventions. Phil Koch, vice president for policy and community impact at the Pittsburgh Foundation, and other funders told the committee that recent federal pandemic-era grants that supported many CHW positions have ended, leaving programs dependent on short-term philanthropic or grant funding.

What is delayed: David Wiles testified that since April 2023 the Department of Human Services and stakeholders worked on a Medicaid state plan amendment to authorize payment for CHW services. The SPA had an initially anticipated start date of Jan. 1, 2025, was later pushed to July 1, 2025, and — Wiles said — was delayed again in August 2024 with no new start date. Wiles said DHS convened listening sessions and working groups facilitated by an outside contractor (Deloitte), and that a document intended to inform DHS was "due to be submitted this [March]," but he said communication with DHS has been limited since the August delay.

Who would bill: Panelists said CHWs are employed by a mix of employers — federally qualified health centers (FQHCs), community-based organizations (CBOs), health systems and health plans — and that more than half of CHWs in Pennsylvania work for community-based organizations and FQHCs. Witnesses told the committee that some proposals circulating at DHS would route CHW payments through existing PA HealthChoices or managed-care contract structures rather than a SPA that allows direct Medicaid reimbursement, and that CBOs are currently not uniformly able to bill under the community-based care management program. Philanthropy and CBO witnesses urged any payment design to permit nonclinical community-based employers to participate, because those employers are primary CHW organizers and reach populations that clinical settings do not.

Workforce and training: Witnesses described CHW certification and workforce details. Wiles said Pennsylvania offers a voluntary CHW certification through the Pennsylvania Certification Board. Requirements he cited include a minimum of 75 hours of education through an accredited training provider, one year of full-time volunteer or paid CHW experience (or 2,000 hours equivalent), 60 hours of on-the-job supervision tied to training domains, a two-year certification period and a 30-hour continuing-education requirement for recertification. Primary Health Network's Garrow said his FQHC employs 12 CHWs and serves about 75,000 patients across 16 counties and that CHWs participate in care-team huddles and follow-up support.

Evidence and scale: Witnesses cited national and local examples: Wiles referenced a CDC program that integrated CHWs into organizations from 2021–2024 and reached many people with services, and he noted research finding returns on investment for some CHW interventions. Foundations described multi-year grants that seeded CHW deployment and training but characterized that funding as bridge support rather than long-term sustainability.

Concerns and constraints: Committee members pressed presenters on cost estimates, availability across rural and urban counties and differences between CHWs and licensed social workers or birth workers. Witnesses acknowledged gaps in available statewide cost modeling; several said they had asked DHS for fiscal plans and data but had not received detailed cost estimates. Witnesses and members also noted implementation barriers such as billing system readiness, HIPAA and electronic-record requirements for smaller CBOs, and workforce shortages. Carol Thornton of the Partnership for Better Health and other local funders said foundations have paid training costs and flexible funds to support CHW deployment but cannot scale the workforce statewide without Medicaid reimbursement.

Committee response and next steps: Representative Torczyk and other committee members asked for clarity from DHS about the SPA timeline and whether CBOs will be included in any reimbursement model. Wiles urged the committee to hold DHS accountable for progress; no formal action or vote was taken at the hearing. Several members said they would press the department for clearer timelines and consider the administrative path that would most quickly and equitably allow CHWs to bill Medicaid or be funded through managed-care arrangements.

Ending: Witnesses emphasized that CHW services are nonclinical, community-embedded supports that "meet people where they are," and asked the committee to press DHS to adopt a financing approach that preserves community-based employers and the relationships CHWs build. The committee did not set a date for follow-up but members said they expected to continue engagement with DHS and stakeholders.