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Integration subgroup urges stronger community health worker reimbursement and new Medicaid billing codes
Summary
The behavioral health integration subgroup is developing two recommendations: better reimbursement for community health workers (a prior pilot faltered due to low rates) and adoption of dyadic or non‑diagnosis billing codes to allow early childhood supports without pathologizing children.
Kristen, co‑lead of the behavioral health integration subgroup, told the work group the subgroup is advancing two recommendations. The first would stabilize and expand reimbursement for community health workers after a pilot faltered when reimbursement rates were insufficient and commercial payers were inconsistent. "The program has faltered because the reimbursement wasn't enough," Kristen said, adding that community health workers help families navigate services and let clinicians operate at the top of their license.
The second recommendation seeks adoption of billing codes that permit dyadic treatment (treating a parent‑child dyad) and codes that allow services without a formal diagnosis for a limited number of sessions, an approach used in some other states to provide early supports. Kristen argued these measures could prevent escalation of needs by enabling earlier interventions in pediatric and primary care settings.
Members discussed the potential cost and the need to build the economic case, with proponents noting prevention investments can reduce later system costs. The subgroup plans outreach to carriers and other stakeholders to craft a viable reimbursement and coding proposal.
