Are State-Level Policies Supporting Community Health Worker Employment? The Jury Is Still Out

ABSTRACT

In AJPH and elsewhere, a steady stream of research articles, blogs, and opinion pieces have been published supporting the expansion of the community health worker (CHW) workforce.1 As frontline public health workers, CHWs have played an important role in COVID-19 response and prevention.2 Moreover, there is ever-increasing evidence of their effectiveness in promoting access to primary and preventive care, building bridges between communities and health care systems, and improving health outcomes for chronic conditions, particularly in underserved communities.3 Workforce growth is predicated upon sustainable, dedicated financing mechanisms. In the United States, CHW employment often relies on grants and other short-term resources.1,4 Long-term flexible funding models are important for both workforce development and program continuity.5 Medicaid coverage for CHW services has been identified as a potential solution for the constraints to CHW program sustainability.4 Similarly, occupational certification for CHWs provides a pathway for career development and higher earning potential while encouraging workforce growth and integration.6 Although Medicaid coverage and certification are commonly touted as enablers of workforce growth, we actually know very little about how these two policies affect the CHW labor force. Jones et al. state that low wages are the main predictor of resignations among frontline health workers, but they did not examine how wages affect turnover. Because of data limitations, turnover in this study was narrowly defined as leaving the CHW workforce altogether;job transitions within the field were not captured.