The Michigan Department of Health and Human Services (MDHHS) estimates that the state’s plan to recognize community health worker (CHW) services as a Medicaid benefit will help at least 50,000 residents if it is approved.
The Michigan Medicaid Program is working to develop policy to incorporate CHW services as a fee-for-service benefit to Medicaid enrollees. MDHHS submitted a state plan amendment to the Centers for Medicare and Medicaid Services in July requesting the policy change, and is currently awaiting a response, Chelsea Wuth, MDHHS associate public information officer, told State of Reform.
“MDHHS has conducted [a lot] of research, community engagement, and consultation with other states to frame a state plan amendment, the process to add a new covered service to the package of benefits covered by Medicaid. Additionally, MDHHS published a corresponding draft policy that outlined the covered services and detailed provider qualification expectations related to the delivery and reimbursement services under Medicaid.”
— Wuth
Wuth said the public comment period for the amendment has closed, and MDHHS is evaluating submitted comments to support any final modifications to the policy.
“CHWs play a critical role in bridging systems of care [in] communities and delivering services in a manner consistent with how Medicaid members want to receive them, whether that be in observance with cultural practices, in specific spoken languages, or in a setting appropriate to the member’s needs,” Wuth said.
While these actions lead to improved clinical service utilization and illness prevention and management, it most importantly leads to greater access to equitable services and outcomes for the individuals that receive CHW services and supports.”
Michigan has a robust history of utilizing CHWs in its workforce, Wuth said.
“The Michigan Medicaid program has long recognized the role of a CHW as integral to improving [the] health and well-being of Medicaid members, as demonstrated through [their] inclusion in Health Home programs and contractual requirements of Medicaid health plans. These models have provided MDHHS with the opportunity to test models of CHW integration into the care team and assess accessibility of CHW services broadly to address physical and mental well-being, as well as health-related social needs.”
— Wuth
It is estimated that the availability of these services will impact at least 50,000 Michiganders following the initial implementation of the new benefit, Wuth said.
“In proposed policy, MDHHS identified Medicaid beneficiaries with chronic health conditions, social determinant of health needs, and pregnancy/postpartum as those that could benefit from Medicaid reimbursable CHW services,” she said. “MDHHS anticipates this is a conservative estimate, as the standard clinical documentation of health-related social needs is both limited and needs are fluid.”