Indiana Medicaid adds coverage of community health worker services


Evidence shows that using community health workers (CHWs) to extend the reach of healthcare providers in underserved communities reduces health disparities, enhances provider communication, and improves health outcomes and overall quality measures. Accordingly, effective July 1, 2018, the Indiana Health Coverage Programs (IHCP) will provide reimbursement for services provided by CHWs. Coverage for CHW services applies to all IHCP programs subject to limitations established for certain benefit packages, for dates of service (DOS) on or after July 1, 2018.


Covered and noncovered CHW services

The IHCP will cover the following CHW services:

 Diagnosis-related patient education for members regarding self-managing physical or mental health, in conjunction with a healthcare team – This service allows a CHW to extend education efforts associated with any physical or mental health concern that a member may encounter.

 Facilitation of cultural brokering between a member and the member’s healthcare team – This service allows a CHW to act as a facilitator between a Medicaid member and a provider when cultural factors (such as language or socioeconomic status) become a barrier to properly understanding treatment options or treatment plans.

 Health promotion education to a member on behalf of the healthcare team to prevent chronic illness – This service allows a CHW to discuss and promote healthy behaviors with a member to increase awareness and avoid the development of chronic illnesses.

 Direct preventive services or services aimed at slowing the progression of chronic diseases

The IHCP will not cover the following CHW services:
 Insurance enrollment and “navigator” assistance
 Case management and care coordination
 Arranging for transportation or providing transportation for a member to and from services
 Direct patient care outside the level of training and certification an individual has attained

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