How States Leverage Policy to Build Up Community Health Workers
As frontline public health professionals, community health workers (CHWs) bridge gaps between health systems and the communities they serve by connecting patients to both health and social services. CHWs often share similar backgrounds or personal experiences navigating the health care system with the patients they serve. These similar experiences can allow CHWs to become trusted messengers and effectively address pressing health concerns
States and territories support the CHW workforce in a variety of ways, from establishing certification programs and supporting training programs, to exploring financial sustainability options through Medicaid and othertate laws and policies that bolster the CHW workforce through these pathways as well as improve access to care
Rural Health Transformation Program: Investments in CHWs
The Rural Health Transformation Program, enacted as part of H.R. 1 in July 2025, appropriates $10 billion per fiscal year for the CMS to award to states looking to improve rural health care. CMS encouraged states to focus on a range of opportunities to improve rural health, including bolstering the CHW workforce. Over half of states included CHW-related strategies in their plans, with a focus on workforce development and chronic disease management. These strategies included developing training and certification programs, directly employing CHWs as state employees, and working with CHWs to manage chronic disease.
CHWs can address certain access to care challenges, including transportation barriers, accessing telehealth appointments, and provider shortages, which are especially helpful in rural settings. Primary care health professional shortage areas impact 43 million people in rural areas. As a result, these patients may forego necessary care or require telehealth services to access needed care. CHWs can support patients in their communities by providing health education, chronic disease management support, and connections to other services. Additionally, CHWs can assist with accessing telehealth appointments, which may be particularly helpful for patients with low digital literacy. Programs that support the CHW workforce, especially in rural areas, are vital to improving health outcomes.
State Governance: Training and Certification for CHWs
CHW certification is an opportunity for a jurisdiction to affirm that a CHW has met a standard set of qualifications (e.g., education, work experience, skills) often aligned with core competencies. Many states follow recommendations from the National C3 Council, which established core skills and roles for CHWs, to outline qualifications for certification, though states have the flexibility to define their own qualifications that meet the needs of their CHWs and communities. In many states, CHW certification is established or authorized by state legislation, and administered and implemented by a state agency. Some jurisdictions have opted not to pursue certification and instead develop robust training programs to ensure CHWs have access to resources to support their development. Establishing CHW certification is a state-specific decision that can be made in collaboration with the workforce.
Several states have considered legislation in recent years to establish CHW certification or training programs. Nebraska enacted LB 912, referred to as the Community Health Worker Training Endorsement Act, which establishes the certification of training programs for CHWs to promote consistent standards of practice and improve access to preventive and primary care services. This legislation does not establish individual CHW certification but rather establishes a process for the state to acknowledge training programs that are aligned with core competencies. Conversely, in 2025, Arkansas enacted HB 1258, authorizing the Department of Health to oversee CHW certification, outlining the pathways to certification, and directing the creation and maintenance of a registry of approved CHW training programs. Mississippi (HB 1401) and Oklahoma (SB 424) also enacted legislation related to CHW certification in 2025. Finally, at least four states have considered legislation related to CHW standards in 2026. This includes Georgia’s HB 291, which would have established a CHW certification program as well as a committee to oversee standards, training, and certification processes, and New Jersey’s AB4837, which would create a CHW program in the health department and establish standard training and certification programs in the state. Alaska’s SB 220 would have directed the health department to adopt rules regarding CHW certification, including scope of practice, minimum qualifications, and continuing education requirements. Finally, Alabama’s HB 588 would have established a CHW certification board to set standards for certification of CHWs, including defining core competencies and training programs.
Sustainable Funding for the CHW Workforce
CHW programs have historically been funded by short-term public health grants, which can lead to high turnover, lack of job stability, and gaps in care for the patients CHWs serve. In recent years, many states have explored more sustainable opportunities to support the workforce, including through Medicaid coverage of CHW services. Twenty states have leveraged Medicaid State Plan Amendments and 15 states have leveraged 1115 waivers to authorize reimbursement for CHW services such as patient education for self-management of health conditions, health promotion education to prevent chronic illness, and CHWs delivering services through Whole Person Care pilot programs.
Several states have considered legislation to support reimbursement of CHW services in 2026. In addition to the bills discussed above in Alabama, Alaska, and New Jersey, Florida’s SB 1026 would have directed the state Medicaid agency to pay for certain CHW services and pursue federal approval as necessary to do so. A Virginia bill (HB 337) would have authorized the state Medicaid agency to collaborate with other state agencies to consider opportunities for care coordination in Medicaid managed care and other training and expansion opportunities. States may also consider other pathways to support CHW services, including through funding opportunities supported through the Rural Health Transformation Program, like in Wisconsin, which will offer grants to entities to expand or state a CHW program in a designated rural area, and Maine, which is pursuing an academic partnership to support expansion of CHW services in rural areas.
State and territorial health agencies can support the CHW workforce by establishing training and/or certification programs, collaborating with CHWs to advise on workforce needs, partnering with other state agencies to ensure reimbursement pathways, and engaging in national efforts to support the workforce. ASTHO will continue to monitor these legislative trends and provide updates to our membership on policies that advance access to care
Reviewed by Danny Staley, Senior Vice President, Public Health Practice and Programs; Christi Mackie, MPH, Vice President, Community Health and Prevention; Andy Baker-White, JD, MPH, Senior Director, State Health Policy; and Christina Severin, JD, Director, Public Health Law
The development of this product is supported by the Health Reth and Human Services under grant number 5 UD3OA22890-15-00. Information, content, and conclusions will be those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government
