Community Health Worker (CHW) Grant

Background

A community health worker (CHW) is a frontline public health worker who is a trusted member of or has a unique understanding of the community served. This trusting relationship enables the worker to serve as a liaison between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

2022 Legislative session

In The 2022, the Children and Youth Behavioral Health Workgroup’s Behavioral Health Integration into Primary Care subgroup and the Washington Chapter of the American Academy of Pediatrics’ (WCAAP) First Year Families steering committee provided legislative priority recommendations included for funding non-licensed professionals, such as health navigators or CHWs, in primary care settings.

Rationale for this recommendation included:

• Rising behavioral health concerns
• Delays to accessing mental health services
• Improving care coordination across primary care and behavioral health services

Advocates for health equity indicated CHWs are critical to supporting clinics in culturally and linguistically relevant services in primary care clinics and medical homes.

Engrossed Substitute Senate Bill 5693, Section 211 (103) directs the Health Care Authority (HCA) to do the following:

• Establish a two-year grant program for primary care clinics to embed CHWs as part of care teams working with children and youth birth through age 18
• Develop and submit legislative reports on the impacts of the grant program
• Explore longer term reimbursement in collaboration with key partners

2024 Legislative session

In the 2024 Legislative session, the pediatric CHW program was extended for an additional six months, concluding on June 30, 2025.

HCA was directed to submit a final report including details of impact of the program and any measurable health outcomes. The proviso also provided authority for HCA to implement a CHW Medicaid benefit reimbursing community health workers.

Grant overview

The following primary care clinics will participate in the CHW grant from January 2023 through January 2025. These clinics will embed CHWs in their care teams to support families of children and youth birth through age 18. These CHWs will provide outreach, informal counseling, and social supports for health-related social needs.

In alignment with DOH’s CHW pediatric curriculum, CHWs funded through this grant will support one of the following populations and areas of need:

• Early relational health (ERH): birth – age 5
• K12 mental health (K12 MH): age 5 – 18

See the related forms and publications section to learn more about key facts and the development of the CHW grant.

Participating clinics

Greater Columbia

• Yakima Neighborhood Health Services: one early Relational health CHW and one K12 mental health CHW

Great Rivers

• Child and Adolescent Clinic: one early relational health CHW and one K12 mental health CHW
• Grays Harbor County Public Hospital District #1 DBA Summit Pacific Medical Center: one K12 mental health CHW
• Northwest Pediatric Center: one K12 mental health CHW
• SeaMar Community Health Centers Grays Harbor Count: one early relational health CHW
• Valley View Health Center Chehalis: one early relational health CHW and one K12 mental health CHW
• Valley View Health Center Raymond: one early relational health CHW and one K12 mental health CHW
• Valley View Health Center Toledo: one early relational health CHW and one K12 mental health CHW

King

• Harborview Medical Center: one early relational health CHW
• Hope Central Pediatrics and Behavioral Health: one early relational health CHW and one K12 mental health CHW
• Seahurst Pediatrics: one early relational health CHW and one K12 mental health CHW
• Seamar Community Health Centers King County: one early relational health CHW
• UW Medicine Primary Care Kent Des Moines Clinic: one early relational health CHW and one K12 mental health CHW

North Central

• Lake Chelan Health: one early relational health CHW and one K12 mental health CHW

North Sound

• Lummi Nation - Lummi Tribal Health Center: one early relational health CHW and one K12 mental health CHW
• SeaMar Community Health Centers Skagit County: one early relational health CHW
• SeaMar Community Health Centers Whatcom County: one early relational health CHW

Pierce

• Community Health Care Eastside Clinic: one K12 mental health CHW
• Community Health Care Lakewood Clinic: one K12 mental health CHW
• Pediatrics Northwest PS Baker Center: one early relational health CHW and one K12 mental health CHW
• Pediatrics Northwest PS Gig Harbor: one early relational health CHW and one K12 mental health CHW
• Pediatrics Northwest PS and James Center: one early relational health CHW and one K12 mental health CHW
• SeaMar Community Health Centers Pierce County: one early relational health CHW

Thurston-Mason

• South Sound Pediatrics: one K12 mental health CHW

Resources for clinics

• CHW Grant FAQ
• CHW Grant implementation plan template
• CHW Grant annual report template
• Community Health Workers Grant monthly clinic and client report template

Resources for patients and families

• CHW patient and family evaluation FAQ

Tribal CHW program

Legislative proviso SSB 5693 Sec 211 directed HCA to identify whether federal match funds were able to be accessed. HCA identified the ability to draw down approximately $2 million.

The initial HCA CHW grant used a Request for Applications (RFA) process to identify clinics to participate. HCA recognized that only one tribe submitted an application. In recognition of the 29 Federally recognized tribes and two Urban Indian Organizations (UIO) in Washington, HCA identified a need to reinvest funding from federal match ensure tribes were afforded the opportunity to participate in the CHW grant and American Indian/Alaskan Native communities are afforded the opportunity to access CHW services.

HCA hosted a listening session and sent a Dear Tribal Leader Letter to tribes informing of the identified funding and intent to reinvest in a tribal-specific grant opportunity. Rather than asking tribes and UIOs to apply, HCA used a Request for Inquiry (ROI) process where tribes could indicate an interest in participating which is more aligned with our government-to-government relationship with tribes.

The tribal CHW program offers a parallel grant for CHWs or community health representatives (CHRs) in collaboration with tribes and UIOs using a government-to-government process that honors tribal sovereignty.

History of CHRs

The CHR workforce is one of the oldest federally funded CHW workforces in the US. CHRs are a group of highly-trained CHWs that work to address the medical and social needs to American Indian Communities.

Participating tribes

HCA is pleased to announce the six tribes who will participate in the tribal CHW program.

North Sound region

• Lummi Tribal Health Center (or Lummi Nation)
• The Tulalip Tribes

North Central region

• Lake Roosevelt Health Center (or Colville Tribes)

Salish region

• Port Gamble S'Klallam Tribe

Greater Columbia region

• Yakama Nation Behavioral Health (or Yakama Nation)

Implementing Apple Health reimbursement

In addition to initiating and funding the grant, ESSB 5693, Sec. 211 (103) directs HCA to develop a CHW Medicaid benefit pursuant to Centers Medicare and Medicaid Services (CMS) approval. HCA will use the feedback gathered from community presentations in 2023 to inform approaches for implementing an Apple Health CHW benefit.

HCA will work with federal, state, and community partners to develop and implement the CHW benefit. This is anticipated to take about a year with a goal of having reimbursement accessible by July 1, 2025

2024-2025 estimated timeline

• March - May 2024
  • Legislative budget finalized
  • Internal HCA processes to estimate cost and begin State Plan Amendment (SPA) process
• June 2024 - January 2025
  • Initiate SPA with Centers for Medicare and Medicaid Services (CMS)
  • Timelines for SPAs vary, though typically takes at least 9 months
• February - June 2025
  • Create clinical policy and establish reimbursement rates
  • Develop billing guidance and update billing system
  • Partner with managed care organizations (MCO) on implementation

View CHW Medicaid reimbursement FAQ.

Webinars and workshops

Project updates

Sign up for the Pediatric Health GovDelivery list to receive project updates.

CHW curriculum development

The Department of Health (DOH) and the Washington Chapter of the American Academy of Pediatrics hosted the inaugural pediatric CHW training from February 28 - March 2, 2023.

This training includes foundational CHW skills and knowledge as well as training to support:

• Early relational health (ERH): birth – age 5
• K12 mental health (K12 MH): 5 – age 18

Visit DOH’s Community Health Worker Training webpage to learn more about their CHW training program and the CHW leadership Committee.