The Michigan Department of Health and Human Services (MDHHS) recently announced an expansion of Medicaid coverage effective Jan. 1, 2024 to include community health worker (CHW) services. The MDHHS also issued a final policy establishing this coverage for Medicaid fee-for-service and health plan enrollees.
CHWs are trained public health professionals and trusted community members who focus on addressing social determinants of health (SDOHs) while serving as links between health and social resources. A health risk and/or SDOH screening/assessment tool must be used to assess the need for CHW services. CHW services must be recommended by a licensed healthcare provider for conditions including but not limited to:
- Diagnosis of one or more chronic health conditions including behavioral health.
- Unmet health-related social needs.
- Pregnancy and up to 12 months postpartum.
Individuals providing CHW services must meet certain criteria to be verified by the MDHHS designated contractor prior to Community Health Automated Medicaid Processing System enrollment for Medicaid reimbursement. CHW services must be provided face-to-face in the language of the beneficiary’s choice when available and are limited to two hours per day and 16 visits per month, for a maximum of 32 hours per month, per beneficiary. This limit may be exceeded based on medical necessity determined in collaboration with the recommending licensed provider and requires prior authorization.
Members with questions may contact Kelsey Ostergren at the MHA.