New Bill Would Expand Medicare and Medicaid Access to Community Health Workers
Key Takeaways:
- The Community Health Worker Access Act, introduced September 17, would expand Medicare reimbursement for community health worker (CHW) services and offer states enhanced federal Medicaid funding to cover similar services.
- The legislation would establish Medicare reimbursement for 2 categories of CHW services: preventive services and education and referrals addressing health-related social needs.¹
- Medicare already covers certain community health integration services that may be furnished by CHWs, while states have taken varying approaches to Medicaid coverage, creating an uneven reimbursement landscape that the legislation seeks to address.²,³
New federal legislation seeks to expand the role of community health workers within Medicare and Medicaid by establishing additional reimbursement pathways for services ranging from preventive care to health system navigation.
Reps Alma Adams, PhD (D-NC), and Raul Ruiz, MD (D-CA), and Sen Lisa Blunt Rochester (D-DE) introduced the Community Health Worker Access Act on September 17. The legislation would expand Medicare reimbursement for CHW services and provide states with additional federal financial support if they elect to cover those services through Medicaid.¹
Community health workers often serve as intermediaries between patients and health care systems, particularly for populations with complex medical or social needs. Their responsibilities can include health education, basic screenings, chronic disease support, care navigation, and connecting patients with community resources.¹,³
The proposal comes as both Medicare and state Medicaid programs increasingly experiment with reimbursement for services addressing nonmedical factors that can affect health and access to care.
What the Community Health Worker Access Act Would Do
1. Establish New Medicare Reimbursement for CHW Services
The legislation would establish Medicare reimbursement for 2 categories of community health worker services.¹
The first would cover preventive services intended to prevent illness, reduce physical or mental disability, and help individuals achieve or restore their highest possible functional level.¹
The second would cover education and referral services addressing health-related social needs. These services could include helping beneficiaries:
- navigate health insurance enrollment;
- address transportation barriers;
- connect with health care providers; and
- access community-based resources and support services.¹
The legislation's sponsors argue that creating a defined Medicare reimbursement pathway could help integrate CHWs more consistently into care delivery, particularly for beneficiaries with complex health and social needs.¹
How the Proposal Would Affect Medicaid
The legislation would take a different approach to Medicaid.
Rather than requiring every state Medicaid program to cover the services, the bill would allow states to provide coverage for the same CHW services and offer an enhanced Federal Medical Assistance Percentage (FMAP) to help offset state costs.¹
The financial incentive is designed to encourage broader adoption while preserving states' ability to determine whether to add the benefit.
That distinction matters because Medicaid coverage of CHW services varies considerably by state.
KFF found that, as of July 2022, 29 of 48 responding states allowed Medicaid payment for services provided by CHWs through at least 1 mechanism. States have used approaches including state plan benefits, Section 1115 demonstrations, health homes, interdisciplinary care teams, and Medicaid managed care arrangements.³
States also vary in how they define CHW qualifications, certification requirements, covered services, supervision, and reimbursement.³
An enhanced federal matching rate could encourage additional states to establish or broaden CHW benefits, but states would still need to make decisions about program design and implementation.
Medicare Already Covers Some CHW-Related Services
The legislation would build on, rather than create from scratch, Medicare's involvement with community health workers.
Since 2024, Medicare Part B has covered Community Health Integration (CHI) services designed to address nonmedical factors that interfere with the diagnosis or treatment of a beneficiary's medical condition.²
Covered CHI activities can include care coordination, health education, health system navigation, patient self-advocacy training, and social and emotional support. Medicare permits trained auxiliary personnel, including community health workers, to furnish these services under appropriate practitioner supervision.²
However, beneficiaries generally must first have an initiating visit with a physician or other eligible practitioner, and the usual Part B deductible and 20% coinsurance apply.²
The Community Health Worker Access Act would therefore represent a broader statutory approach to recognizing and reimbursing CHW services rather than relying solely on existing physician-supervised billing pathways.
Why Lawmakers Are Focusing on Community Health Workers
Supporters of expanded CHW reimbursement argue that these workers can help address gaps between clinical care and the everyday barriers that influence whether patients can access and follow treatment.
bill's sponsors cite research suggesting CHW programs could reduce Medicaid spending by an average of $4200 per beneficiary annually and generate more than $2 in savings for every $1 invested.¹ These estimates are cited by the bill's sponsors and should be interpreted in the context of the populations and programs studied rather than as guaranteed savings across Medicare or Medicaid nationally.
More broadly, CMS has found evidence that connecting beneficiaries with community resources can affect utilization and spending. The agency reported in February that its Accountable Health Communities Model generated more than $200 million in net savings after screening more than 1.1 million Medicare and Medicaid beneficiaries for needs involving housing, food, transportation, utilities, and interpersonal safety.⁴
CMS attributed the savings primarily to reductions in high-cost, potentially avoidable hospital and emergency department utilization.⁴
Although that demonstration was not specifically a test of the Community Health Worker Access Act, it provides broader evidence underlying federal interest in integrating health care with community-based support.
Potential Implementation Considerations
Expanding reimbursement does not necessarily guarantee widespread adoption.
State experiences demonstrate that CHW programs can vary considerably in their structure. Medicaid programs have adopted different approaches to certification, training, supervision, eligible services, and reimbursement.³
Greater standardization could make it easier for health plans and providers to integrate CHWs into care teams, but policymakers also face questions about how much flexibility to preserve.
KFF notes that some research has raised concerns that highly prescriptive certification requirements can create barriers to entering the profession and potentially undermine the community-based characteristics that distinguish CHWs from other health care personnel.³
Implementation would therefore require policymakers to balance reimbursement accountability with flexibility in how community health workers are trained, employed, and integrated into care.
Implications for Managed Care
The proposal could have several implications for managed care organizations if enacted.
Care management: CHWs could provide another mechanism for plans to engage beneficiaries who have difficulty navigating the health care system or managing chronic conditions.
Health-related social needs: Reimbursement for education, referrals, transportation navigation, and connections to community resources could complement existing payer initiatives addressing nonmedical barriers to care.
Medicaid program design: Enhanced federal funding could encourage more states to incorporate CHW services into managed care contracts or covered benefits.
Provider partnerships: Plans may have additional opportunities to work with health systems, federally qualified health centers, community-based organizations, and other organizations employing CHWs.
Utilization and costs: Supporters anticipate that improved navigation and preventive support could reduce avoidable high-cost utilization, although the magnitude of any savings would depend on program design, populations served, and implementation.¹,³,⁴
What Happens Next?
The Community Health Worker Access Act was introduced September 17 and will need to advance through the congressional committee process before receiving consideration by the full House and Senate.¹
The proposal builds on previous congressional efforts to expand CHW reimbursement as well as Medicare's existing CHI benefit and state Medicaid initiatives.
As lawmakers consider the legislation, key questions are likely to include how CHW services should interact with existing Medicare benefits, how states would use the enhanced Medicaid matching funds, and how reimbursement standards could support the workforce without creating unnecessary administrative barriers.
The Bottom Line
The Community Health Worker Access Act would expand federal recognition of community health workers by creating additional Medicare reimbursement for preventive and health-related social needs services while providing states with a financial incentive to expand Medicaid coverage.¹
The proposal builds on an existing trend: Medicare already reimburses certain community health integration services involving CHWs, and many state Medicaid programs have developed their own coverage models.²,³
For managed care organizations, providers, and policymakers, the legislation raises a broader question about how community-based support should fit into publicly financed health care. If enacted, its impact would depend not only on reimbursement but also on how states, plans, providers, and community organizations integrate CHWs into existing care delivery systems.
References
- Office of Rep Alma S. Adams. Reps. Adams, Ruiz, Sen. Blunt Rochester introduce bill to expand access to community health worker services. Published September 17, 2026. Accessed September 18, 2026. https://adams.house.gov/media-center/press-releases/reps-adams-ruiz-sen-blunt-rochester-introduce-bill-expand-access
- Medicare.gov. Community health integration services. Accessed September 18, 2026. https://www.medicare.gov/coverage/community-health-integration-services
- Haldar S, Hinton E. State policies for expanding Medicaid coverage of community health worker services. KFF. Published January 23, 2023. Accessed September 18, 2026. https://www.kff.org/medicaid/state-policies-for-expanding-medicaid-coverage-of-community-health-worker-chw-services/
- Centers for Medicare & Medicaid Services. Innovation Insight: CMS' AHC Model connects people to community resources and generates $200M in savings. Published February 17, 2026. Accessed September 18, 2026. https://www.cms.gov/priorities/innovation/innovation-insight-cms-ahc-model-connects-people-community-resources-generates-200-m-savings
