Lowering healthcare costs while also improving quality requires focus on disease prevention and early intervention. Shifting from reactive to proactive medicine saves lives, time, and money.
To further this goal, many areas are increasingly using community health workers (CHWs). These professionals address social and health issues in individuals before they become emergencies, providing resources and support geared toward the unique needs of their local population. Their services are less costly than those of typical healthcare workers, and they can complete necessary training quickly.
However, because they do not receive typical medical education or practice typical medicine, they have historically not been covered by state insurance or other tax funding. However, these traditional policies are rapidly changing in response to the preventive care trend, and states are coming up with varied ways to facilitate the shift.
1115 Waivers For Reentry Services
Medicaid Section 1115 waivers allow states to apply to the Department of Health and Human Services (HHS) for flexibility in using Medicaid coverage. For example, many states have successfully petitioned to have Medicaid cover reentry assistance for recently incarcerated individuals, and a CHW program can provide this aid.
By helping people transition successfully into housing, transportation, employment, and healthier lifestyles, a CHW helps lower the likelihood of homelessness, substance abuse, and other costly health outcomes for those adjusting to their new lives. Transition Clinics Network (TCN), a nonprofit community health organization with branches in 48 states, saw 51% fewer emergency room visits in former inmates who participated in their programs versus those who did not. TCN’s study found that $1.00 invested in this program saved $2.55 in Medicaid funds.
Furthermore, in places such as Topeka Women’s Correctional Facility, CHWs not only assist the outgoing inmates, they are the outgoing inmates. The facility provides training in the field for people who are still incarcerated, giving them the chance to both integrate and to help others in their position to do so.
Medicare Coverage Oversight
As of January 2024, Medicare covers some CHW services. Because states still determine qualifying rules for these workers, they are responsible for ensuring funds go to competent practitioners within their jurisdiction.
This discretion presents both a welcome opportunity and a vulnerability for individual states. Although some general guidelines are available, different regions thus far have taken vastly different approaches and should exercise caution in the rollout of their programs. In 12 states, the government runs certification boards, and eight more are currently developing their credentialing programs. In five other states, private organizations do the credentialing. Again, this rightful return to healthcare freedom has great potential for states, but it also requires insistence on local accountability.
Incentivized Programs
Although using taxes to fund community health programs can provide improvements in efficiency, perhaps the best way to take advantage of this healthcare model is through (preferably non-entitlement) incentives. These could include tax breaks, education credit for health-related schooling, and voluntary CHW service.
Historically, healthcare workers and their communities have often benefited from work-study programs. The workers are from the communities they serve, any tax money stays local, and the training can be tailored to unique area needs. CHW education should take higher precedence in this type of program.
Internships and apprenticeships are also making a welcome comeback, and CHWs have immense potential in this area. Employers already receive an average of a 44% return on investment in apprentices, but companies would be more likely to take advantage of this business model with better tax incentives, so states would serve both workers and community members by implementing these.
If undertaken correctly, the new CHW emphasis promises immense benefits to the overall healthcare system. An ounce of prevention is indeed worth a pound of cure, and states must ensure that the prevention money is properly used.