Community health workers (CHWs) are essential to bridge the gap between health and social care and expanding access to primary care and community‑based services. CHWs often share similar backgrounds with those they serve. This shared experience, combined with their expertise in navigating complex health care and social systems, positions them as trusted professionals.

Despite this, CHW services have historically been funded through grants, limiting sustainability and scale. Recent Medicaid and Medicare reimbursement pathways offer more stable funding streams. New York State Medicaid created additional options to fund CHW services through Social Care Networks and the Medicaid CHW benefit, which reimburses services such as health navigation, education, advocacy, and community violence prevention for eligible members.

This tool is designed to support organizations that employ CHWs and are enrolled Medicaid providers. It can help organizations assess readiness to seek reimbursement and plan for implementation. The tool includes a checklist of key requirements and a practical framework for getting started. While tailored to New York State, it may also inform similar efforts in other states.

This tool draws on lessons from the New York Community Health Worker Reimbursement and Sustainability Learning Collaborative, which supported community-based organizations and health systems in building capacity to access Medicare and Medicaid funding for CHW services. The initiative was led by the Center for Health Care Strategies with support from the New York Health Foundation.