Community health worker (CHW) programs have historically been funded through private contracts, grants, or time-limited pilot programs. Recently, however, Medicare and many state Medicaid agencies have introduced funding options to support this workforce and expand access to CHW services. In New York, this includes funding under a Medicaid state plan amendment and Section 1115 waiver.

This fact sheet highlights what New York-based providers and other organizations delivering CHW services need to know about funding these services through Medicare and Medicaid. The fact sheet summarizes each funding mechanism, including covered services, provider and member eligibility, CHW requirements, and key considerations. While developed for the New York context, this resource can inform efforts in other states to launch or expand CHW programs.

This fact sheet is a product of the New York Community Health Worker Reimbursement and Sustainability Learning Collaborative, an initiative led by the Center for Health Care Strategies and supported by the New York Health Foundation that is working with New York-based organizations to strengthen their capacity to access and braid state and federal funding to support CHW service delivery.