Community health workers (CHWs) — also referred to as promotores, peer navigators, or community health representatives — are playing an increasingly vital role in addressing the health and social needs of Medicaid enrollees, including children and their families. Because CHWs often share similar backgrounds with the communities they serve, they are uniquely positioned to build trust and offer support in ways that resonate with families. This connection also supports medical care teams in providing more culturally responsive care.

CHWs typically provide services like health navigation, health education, screening and assessments, care coordination, and advocacy for individuals and communities. Robust evidence demonstrates that CHW programs can improve health outcomes by supporting social service referrals, access to preventive and primary care, and care coordination for chronic conditions or other special health care needs.

How can CHWs impact child health outcomes?

For pediatric populations, CHWs can connect children and families with the resources and services they need — often meeting them where they are, whether in homes, schools, or community settings. CHWs provide essential support across a wide spectrum of needs: helping postpartum mothers and infants during critical early stages; guiding families of children with special health care needs in navigating the health care system; facilitating access to early intervention services for children with developmental concerns; and offering education around chronic conditions most prevalent in children, such as asthma. CHWs can also connect families to community resources, such as peer-support groups and skill-building workshops.

What is the Medicaid policy landscape for CHWs serving pediatric populations?

Historically, CHW services have been primarily funded through grant funding. An increasing number of states have sought to expand Medicaid coverage for CHWs, including those serving pediatric populations, based on the strength of evidence for these programs. State Medicaid mechanisms to cover CHW services include state plan amendments, 1115 waivers, and managed care contract requirements. State policies to integrate CHWs into pediatric care include Medicaid eligibility pathways for children or postpartum women to receive CHW services, as well as child-specific core competency or continuing education training programs.

What is the evidence behind CHWs working with pediatric populations?

CHWs can work across a variety of settings and serve diverse pediatric populations. Their flexibility in delivering services contributes to positive outcomes for children and their families. These outcomes include reductions in emergency department visits, increased attendance at well-child visits, improved identification of health-related social needs, and enhanced parental experiences with care teams.

• Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial: The PARENT intervention, which embeds CHWs in the well-child visit structure, led to improved outcomes and offers lessons for efficient pediatric staffing models.
• Projected Cost Savings of a Community Health Worker Model for Asthma Home Visits in the Massachusetts Pediatric Medicaid Population: This study projected that expanding a CHW home visiting model statewide in Massachusetts for pediatric Medicaid-eligible patients with uncontrolled asthma could yield cost savings of approximately $567 per patient.
• Community Health Worker Home Visits for Medicaid-Enrolled Children with Asthma: Effects on Asthma Outcomes and Costs: Children with uncontrolled asthma and their caregivers enrolled in Washington State’s Health Homes Program reported greater asthma self-management. The program showed a $1.90 return for each dollar invested.
• Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health: This preliminary study of a CHW program for caregivers of children with special health care needs showed significant improvement in caregiver distress scores and increased confidence in caregiver understanding of their child’s diagnoses.
• Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial: This study assessed outcomes of Project Developmental Understanding and Legal Collaboration for Everyone (DULCE), where connections with trained family specialists resulted in improved care visit attendance, rates of immunization, and support service referrals for participating families with newborn children.

What do child-focused CHW interventions look like in practice?

The following resources offer insights into how child-focused CHW programs are designed, implemented, and scaled.

• Outcomes of CHW Grant Program: This report details the outcomes of a two-year grant project awarded to the Washington Health Care Authority to integrate CHWs into pediatric primary care clinics. The report includes details on the implementation considerations, strengths, successes, challenges, and opportunities to achieve sustainable funding.
• Toolkit for Integrating Community Health Workers in Schools: This toolkit showcases best practices and considerations for implementing CHWs in school settings using a model adopted in Chicago Public Schools.
• Community Health Workers: Bridge to Pediatric Mental Health Equity: This article suggests how pediatric CHWs can identify and address health-related social needs associated with adverse mental health outcomes as part of a clinician or community-led care team.
• Promoting Healthy Foundations: Medicaid Opportunities to Support Community Health Workers in Child Health Care: This brief illustrates examples of CHW models serving children and families and describes Medicaid pathways for CHW integration into pediatric care.
• Community Health Workers Advancing Child Health Equity: Part II: This brief outlines CHW programs in California that support children and families using community-based organization funds and Medi-Cal CHW Benefit reimbursement.
• Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges: This article shares the self-described roles, challenges, and successes of 10 pediatric CHWs in various pediatric health care settings across three urban U.S. cities: Philadelphia, New York City, and Cincinnati.