Medicaid Reimbursement for Community Health Workers

The Colorado Legislature passed Senate Bill 23-002 in May 2023 to add community health worker (CHW) services as a Health First Colorado (Colorado's Medicaid program) benefit starting July 1, 2025. 

HCPF will seek federal authorization from the federal Centers for Medicare and Medicaid Service (CMS) by July 1, 2024, to add CHWs  as a covered benefit. 

April 2024 Updates

Project Timeline

We are working to develop policy, system impacts, resources for providers, and preparations to begin conversations with CMS. 

FAQ Document Update

HCPF staff are actively sorting questions that have been received from stakeholders and working with our partners to ensure accurate answers. Topics that will be covered in the FAQ document include:

Community Health Workers and SB 23-002

Federal Authority

Community Health Worker Training and Workforce Development

Services, Qualifying Conditions, and Medical Necessity

Accountable Care Collaborative (ACC 3.0) and Regional Accountable Entities (RAEs)

Supervision

Enrollment

Billing and Reimbursement

Documentation and Referral Requirements

Evaluation and Reporting

Miscellaneous Questions

This document will be updated on an ongoing basis as the benefit becomes closer to implementation.

Community Health Worker Networking Opportunities

Colorado Community Health Worker Community of Practice 

CDPHE facilitates a quarterly Community of Practice for Community Health Workers (CHW). If you are a CHW, Health Navigator, Patient Navigator, Promotora de salud or similar role you are invited to join a network of CHWs from all over Colorado, to share best practices and identify training opportunities that fits your needs. The Community of Practice will be designed for Community Health Workers from all over Colorado who are working in health or community-based settings to learn from one another, share resources and best practices and provide you the opportunity to explore new training opportunities in your roles. 


In addition, CDPHE is providing the opportunity to learn more about diabetes and cardiovascular prevention and management and how you can incorporate programs such as National DPP and DSMES into your communities.


The Community of Practice will convene on a quarterly basis and the audience is a CHW or similar role in practice or individuals interested in being a CHW. If you are a supervisor of a CHW or similar role, please consider allowing your CHWs to learn from other CHW across the state. The next CHW Community of Practice meeting will take place on May 23, 2024 at 12:00 PM. Please register at Colorado CHW Community of Practice . If you have any questions please contact Yvette Camarena  yvette.camarena@state.co.us. 

CDPHE Training Program Recognition Review Committee

 We need your help to identify potential committee participants!

CDPHE will convene a committee to review Community Health Worker training program applications.


If you or someone you know would be interested in being part of CDPHE Training Program Recognition Review Committee, please complete the reviewer application. For further questions please contact Yvette Camarena yvette.camarena@state.co.us. 


Website Updates

We are actively adding new information and resources to our website to better suit stakeholders needs. All resources can be found under the "Resources" section on our webpage. New additions include:

Are you on our mailing list?

Stay connected to the CHW implementation! The best way to receive updates about the implementation process is to sign up for our mailing list. Updates will be sent out on an as needed basis.

Questions?

Any questions can be directed to HCPF_CHW_Benefit@state.co.us.