Poster #90 - “Natural advocates, but not for themselves": CHW Advocacy for Medicaid Reimbursement in the Southeast US

• In Event: Friday Poster Reception

Abstract

Introduction/Background: Community health workers (CHWs) are frontline public health professionals who share lived experience and high levels of trust with the communities they serve and address health disparities through outreach, health education, care coordination, and advocacy (Knowles et al., 2023). Despite evidence that CHW programs improve health outcomes and deliver positive returns on investment (Kangovi et al., 2014), workforce sustainability remains undermined by fragmented funding (Allen & Koradia, 2023). While over half of state Medicaid programs have implemented some form of payment for CHW services nationally (Haldar & Hinton, 2023), existing policies are often restricted to narrow populations or services or are temporary demonstration projects (NASHP, 2024). CHW associations in the Southeast United States have led state-level advocacy to secure Medicaid reimbursement despite being very young organizations with little experience in legislative policymaking.  

Purpose/Research Question: This study examines the growth of CHW association leaders' advocacy experiences and skills across the Southeast United States, focusing on strategies, barriers, and lessons learned related to advancing Medicaid reimbursement.

Data: Semi-structured interviews were conducted in summer 2024 with purposively selected leaders of CHW associations across seven Southeast states (Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, and Mississippi), all members of the Southeast CHW Network. Of 11 eligible association leaders, eight participated.  

Research Design and Methods: Interviews were conducted virtually using a structured guide covering advocacy activities, planning, policy outcomes, and future priorities. Transcripts were analyzed using inductive thematic analysis (Braun & Clarke, 2006) in NVivo. Two researchers independently coded transcripts and collaboratively refined the codebook. A member-checking session was conducted with participants to validate findings.  

Results/Findings: Five major themes emerged. First, associations described a common sequencing of advocacy priorities, progressing from building policymaker awareness of the CHW scope of practice, to pursuing certification legislation, and ultimately seeking Medicaid reimbursement. Kentucky had achieved Medicaid reimbursement while Virginia had enacted certification legislation, with most states at earlier stages. Second, strategic narrative advocacy emerged as a central strategy, combining CHW-led storytelling in legislative visits with audience-adaptive messaging, emphasizing workforce development and cost savings over terms that may not resonate with policymakers. Third, cross-sector coalition building with state agencies, health systems, and bipartisan legislative champions was critical to advancing policy goals. Fourth, persistent structural barriers included policymaker confusion about CHW roles, limited organizational capacity within volunteer-led associations, legislative resistance, and advocate burnout. Fifth, advocacy capacity building, including advocacy training, mock legislative meetings, and learning labs, was described as both a strategy and a valued outcome, equipping CHWs with skills for sustained policy engagement.  

Conclusion/Implications: This study documents the advocacy experiences of CHW association leaders in a region where most states have not yet achieved Medicaid reimbursement for CHW services. Findings suggest states benefit from sequencing certification before pursuing reimbursement, investing in CHW association capacity, and centering CHW-led narratives in legislative engagement. These lessons informed a CHW advocacy toolkit disseminated across the Southeast region and offer practical guidance for policymakers and CHW associations working to integrate CHWs into publicly financed health systems.

Author

• Gahssan Mehmood, University of South Carolina
  Presenting Author