Community Health Worker Credentialing: State Approaches

Authors: Peyton Miller, Taylor Bates, and Amy Katzen

Community health workers (CHWs) have shown, time and again, that they can improve health
outcomes while reducing healthcare costs. Reductions in chronic illness, improved medication
adherence, more patient involvement, and better community health have been accompanied by a
return on investment of more than $2 for every dollar invested. Yet several barriers are keeping
CHWs from being full participants in the healthcare system. According to a 2002 Institute of
Medicine report, inconsistent scope of practice, training and qualifications; lack of sustainable
funding; and insufficient recognition by other health professionals are all barriers to the
integration of CHWs into the broader system.

One approach states have explored to counteract these barriers is to develop some sort of CHW
credentialing system. The goals of credentialing, as described by Carl Rush in 2012, are to
achieve greater respect for CHWs among other healthcare professions, improved financial
compensation and working conditions, increased job stability, and opportunities for more
sustainable funding. The connection between insurance reimbursement and credentialing or
standardized training is particularly significant, as both public and private insurance plans are
likely to require some form of credentialing in order to pay for CHW services. At the same time,
many CHWs are concerned that credentialing will create barriers to entry for the individuals best
suited to the job (i.e., members of low-income communities who may not speak English as a first
language), and/or take CHWs away from their community connections by focusing on
credentialed ―skills‖ over community relationships.