NH community health workers push for certification, Medicaid reimbursement

Community health workers are sometimes called the “boots on the ground” of public health: doing outreach and education, connecting people with services and addressing barriers to getting care.

A measure aiming to strengthen that workforce is up for a vote in the New Hampshire House Thursday.

The legislation – part of a broader package meant to address ongoing workforce shortages in health care – would create a voluntary certification program for community health workers. It would also allow their services to be reimbursed by Medicaid.

Public health leaders say that would make funding more sustainable. Currently, many community health worker programs in New Hampshire are funded by short-term grants.

“A program may lose funding and regain it a year later – but they’re starting from the ground up again,” said Amber Culver, the co-chair of the New Hampshire Community Health Worker Coalition.

Culver said that uncertainty also drives some community health workers out of the workforce.

Community health workers don’t provide clinical care, but serve as liaisons between the health system and their communities. That could include connecting people with insurance, helping them understand medical information, making sure they have transportation to appointments and following up with patients who have no fixed address.

The proposal, Senate Bill 403, passed the state Senate in March. The House Health, Human Services and Elderly Affairs Committee failed to reach a recommendation on it, splitting mostly along party lines.

At a hearing last week, Republican Rep. Jim Kofalt said the bill does not define community health workers’ duties clearly enough, and puts taxpayers on the hook.

“This bill creates a reimbursement mechanism in which we would be paying for people whose responsibilities, I believe, are extraordinarily vaguely defined [and] open to expansion,” he said.

Rep. Erica Layon, a Derry Republican, said she’s sympathetic to the idea that community health workers do a lot of good. But she expressed concern that certification could create a false impression that they can perform services they’re not qualified to provide.

“I just want to make sure that we’re not putting out false hope to our vulnerable people,” she said.

Democratic Rep. Trinidad Tellez of Manchester, a medical doctor who previously led the state’s Office of Health Equity, pushed back on those concerns.

“They do not pretend to be clinical providers,” she said. “What they do is they connect people to resources, they help people identify where to go for help.”

At a summit for community health workers in Concord this week, several workers said they fill an important gap, noting that economic, social and other nonmedical issues can have a large impact on people’s health.

Luis Porres has been a community health worker for the city of Nashua for 18 years. He said he likes being involved in the city where he lives.

“You don’t see the impact until a lot of time goes by,” he said. “But I know that little things, or little efforts that we do, are going to make an impact in the long run.”

Magna Krieger, who directs community health services at Harbor Care in Nashua, said the work is especially important for reaching vulnerable populations.

“We work with the homeless community,” she said. “We also work with folks that are uninsured or barely insured. And we also are able to provide language access. My team, two of the community health workers speak Portuguese and Spanish.”

Krieger said they also have a “mobile access unit” staffed with community health workers, which can park in different areas. Patients who can’t get to the health center in person can step into the mobile unit to have telehealth appointments with medical providers.

Culver, who’s also a community health worker program manager for the North Country Health Consortium, likes to tell a story about a woman whose doctors were mystified as to why her medication wasn’t working.

“I think it was one or two visits and just conversation and getting her to trust me, we realized she just couldn’t take the cap off of her pill bottle,” she said. “And so it was simply a phone call to the pharmacy to talk to them about, you know, an arthritis-friendly pill bottle cap.”