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MDHHS Incorporates Community Health Worker Services Into Medicaid On January 1

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10x25mm
(@10x25mm)
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Community Health Workers are health care bureaucracy navigators necessitated by the complexification of health care in Michigan.  Typical CHW position titles:

  • Certified Peer Support Specialist
  • Community Health Advocate
  • Community Outreach Worker
  • Community Neighborhood Navigator
  • Family Health Outreach Worker
  • Outreach and Enrollment Worker
  • Community Health Representative
  • Recovery Coach
  • Community Health Outreach Worker
  • Community Health Worker
  • Early Intervention Services (EIS) Worker
  • Maternal Child Health Worker
  • Promotor/a (Spanglish)

Will any of these myriad specialists provide a cost effective improvement in Medicaid-paid health care?

 
 
 

MDHHS expands Medicaid coverage starting January 1 to include community health worker services

Michigan Community Health Worker Alliance chosen to facilitate provider qualification assessment, certification and registry

LANSING, Mich. – To help promote preventive care and address health disparities, the Michigan Department of Health and Human Services (MDHHS) has expanded Medicaid coverage for Michigan beneficiaries to include community health worker (CHW) services. This new benefit goes into effect Jan. 1, 2024.

CHWs are trained public health professionals and trusted members of the community whose goal is to address social determinants of health and serve as links between residents and the health and social resources needed to improve well-being. CHW services focus on preventing disease, disability and other chronic health conditions or their progression, and promoting physical and mental health. The expanded Medicaid coverage includes health system navigation and resource coordination, health promotion and education and screening and assessment.

“This coverage is another step towards addressing health disparities, improving health outcomes and promoting preventive care within Michigan communities,” said Elizabeth Hertel, MDHHS director. “By integrating community health workers, MDHHS is working to enhance the overall well-being of Medicaid bneficiaries and promote a more holistic approach to health care.”

The new CHW services coverage is complementary to existing Medicaid strategies that already incorporate CHWs, including targeted case management, health homes models and Medicaid Health Plan contract requirements.

To support the implementation of this policy, MDHHS selected Michigan Community Health Worker Alliance through a competitive bid process to facilitate provider qualification assessment, certification and the development of a registry of certified providers. This registry will ensure Medicaid beneficiaries have access to qualified CHWs to deliver covered services.

For more information, about CHW coverage or other Medicaid policies, visit 2023 Medicaid Policy Bulletins (michigan.gov).


   
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Abigail Nobel
(@mhf)
Member Admin
Joined: 2 years ago
Posts: 414
 

Certainly not!

Whether they'll improve anyone's health is doubtful, too.

But program enrollment numbers will go up. And this will enhance the bureaucracy metrics and justify budget demands... almost as smoothly as though that were the original intent.


   
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Abigail Nobel
(@mhf)
Member Admin
Joined: 2 years ago
Posts: 414
 

This is one massive expansion of public health.

Bridge Michigan's Robin Erb fills in details. Audio available at the link.

https://www.bridgemi.com/michigan-health-watch/michigan-medicaid-expanded-cover-health-workers-you-may-not-have-heard

Michigan Medicaid expanded to cover health workers you may not have heard of

 
Michigan has expanded Medicaid coverage to cover community health worker services
  • These workers are trained to connect people with transportation and other services to break down barriers to care 
  • The expanded coverage recognizes that environmental factors such as poverty and geography can strongly impact health

DETROIT—A shift in Michigan Medicaid policy has bolstered funding for a category of health care worker that can have a bigger impact on a patient’s health than the wisest doctor or specialist.

Starting this month, Medicaid coverage is expanded to reimburse the state’s community health workers — frontline public health workers, trained to connect patients to housing, transportation, technology, services and even health information they can understand.

Specifically, Medicaid will reimburse organizations and clinics from $4.21 to $10.26 for every 15 minutes they provide education and training to patients. (Under the policy, community health workers who aren’t employed by others — but rather work on their own — could be directly reimbursed for such services.)

The shift stabilizes funding for workers who can be found throughout health care and social services. That, in turn, is expected to expand a workforce that for too long has been funded piecemeal through grants or out of the razor-thin budgets of small clinics and community organizations, said Tressa Liba, executive director of the Michigan Community Health Worker Alliance. The group was chosen by the state to develop a training and certification process for community health workers and a registry of providers.

The Michigan Department of Health and Human Services estimates the shift will extend their services to an estimated 50,000 or more Michiganders.

It’s unclear how many community health workers work in Michigan. The U.S. Bureau of Labor Statistics lists just 1,650. That’s likely a vast undercount, because these workers might go by different names — “community liaisons,” “navigators” “recovery coaches” or “maternal health workers,” for example, Liba said.

In health care, community health workers have expertise a doctor doesn’t typically have time to offer, said Dr. Felix Valbuena, chief executive officer at Community Health and Social Services (CHASS) in Detroit.

Medical care contributes 10 to 20 percent to a patient’s overall health, Valbuena said, referencing an often-reported statistic.

More crucial to a patient’s health is what they eat, where they live, their income, or the life stresses they face, he said. It’s a calculus known as the social determinants of health

“It's sometimes a little depressing after so many years in school to only be impacting 20 percent of the overall health and wellness of the patient in front of you as an M.D.,” Valbuena said.

Consider a patient who is teetering on the brink of diabetes.

Valbuena can warn about the disease, prescribe medicine and advise good diet and exercise in a 15-minute appointment.

But what then? What if the patient doesn’t know how to prepare healthy foods, lacks transportation to get a next medical appointment, or doesn’t have a reliable place to sleep, let alone to store medication?

Enter Teresa Anel-Morones, a community health worker at CHASS in southwest Detroit, who last week was writing informational slides about preventing diabetes, while her colleague, Teresa Plascencia, down the hallway was teaching a class on healthy foods to primarily Spanish-speaking patients.

Such workers — paid about $18 to $19 an hour at CHASS — can help patients find free cooking classes, support groups, and, for the uninsured, links to health coverage.

“We wear many hats,” Anel-Morones said.

It’s part of a larger, pro-active shift in health care to focus more on prevention and disease management and not waiting until people fall into a more expensive emergency room crisis.

In a 2021 study published in the American Journal of Public Health, University of Michigan researchers looked at the experiences of 284 Detroit-area patients contacted by a community health worker after multiple trips to the hospital.

Even with limited contact by community health workers, the small study group had a reduction in emergency hospital visits in the first year — 2.8 visits on average, compared to 3.1 visits for those who had no contact with a worker. The findings suggest that community health workers had helped walk back some care from crises.

“That's really what we want: more preventive care, more preventative screens, more being compliant with your treatment plan, like getting your labs … rather than people waiting until their illness advances to the point that they have to be admitted to a hospital or go to an emergency room,” said Julie Aronica, director of Plan Initiatives for Blue Cross Complete, which provides Medicaid plans throughout the state.

Through November of last year, the 46 community health workers in the Blue Cross plans had 143,056 telephone contacts, and 13,927 in-person visits with patients.

At MidMichigan Community Health Services, a community clinic in Houghton Lake in mid-northern Michigan, community health worker Tammy Frisbie has been trying to find housing for a woman living in a van, whose upper respiratory conditions are worsened by the winter cold. For others, Frisbee coordinates transportation since “it could be over 50 miles to get a patient just in to see their local doctor.”

“There's nobody designated out there who has all the control and the resources,” she said.


   
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