1. Paying for CHWs Claudia Medina, Director
Community Health Worker Initiatives
University of New Mexico Health Science Center

2. One shared data base monitoring outcomes.
UNM-OCH COMMUNITY HEALTH WORKER INITIATIVES
Coordinated CHW Programs
I-PaCS
CHWs integrated in Primary Clinics.
5 UNMH clinics
1 FCCH clinic
1 HMS Clinic
18 CHWs
CHWs in Community 3
PATHWAYS
CHWs placed in community based Organizations.
14 agencies.
20 CHWs 1
HUHUBB
HUB 4
CARENM
CHWs connecting Medicaid enrolled members to resources.
State wide program.
9 CHWs 2
Emergency
Department
8 CHWs (4 staff & 4 student Interns).
CHWs screening Medicaid patients for SDH.
Connecting MP with PCP and Resources.
CHWs at Clinics
All CHWs cross-trained and referring to each other.
One shared data base monitoring outcomes.

3. The ACA and opportunities to fund CHWs jobs
Allows reimbursement for Preventative Care Services rendered by non-licensed providers (CHWs).
Allows the creation of Health Homes for beneficiaries living with chronic diseases. (care-coordination, support, health education).
Creates funding for State Innovation Models.
Impose fines to hospitals for re-admission of patients.
Increased significantly the volume of individuals enrolling in Medicaid ( NM: 230,000 new Medicaid enrollees x a total 857,500 since the ACA)

4. Paying for CHW Jobs after the ACA
Funds from State, local & Federal Government
Private funding
Medicaid Fee for service Reimbursement
MCOs
With Medicaid Dollars
SIM implementation Models.
CMS
HRSA
U.S. Department of Labor.
Counties (Mill Levy-tax dollars)
Healthcare facilities paying for their own CHWs, with their own funds,
Private Foundations
Fee for Service reimbursed by Medicaid to healthcare providers for work carry out by CHWs.
Not available in NM.
Directly hiring CHWs
Paying a PMPM to subcontractors whose CHWs serve high risk MCO members.
Capitation or global budget to pay for CHWs to serve any MCO member at a clinic.
Shared Savings

5. LOCAL FUNDING FOR PATHWAYS
CHWI
COUNTY
NON PROFITS

6. MCOS FUNDING FOR HIGH RISK (LEVEL 3) MEDICAID MEMBERS
Stratification of Medicaid Members
MCOS FUNDING FOR HIGH RISK (LEVEL 3) MEDICAID MEMBERS
Paying agencies a PMPM to find members difficult to find or high ED utilizers. Agencies hire CHWs.
MCOs hiring their own CHWs.

7. Primary Care Linked Strategy
I-PaCS
Medicaid beneficiaries who self-selected the clinic
MCO referred members
Medicaid beneficiaries reached by CHWs in community around clinic.
Members
Primary Care Linked Strategy
Screening
CHW
Provides
Services
Data collection and analysis informs population health strategies to address disparities
Data Collection & Analysis
Basic Patient
Support
Intensive Patient Support
(additional payment)
PCMH

8. Current Payment Models for CHWs at healthcare facilities
pay Small PMPM for an entire population of level 1 and 2
members empaneled at a given healthcare facility who receive
preventative services.
Contribute to a Global Budget that covers salaries of CHWs and
partial salary of their supervisor.

9. Potential job creation for CHWs:
NM 99 Primary Care Clinics, 50 School Based HC & 56 Hospitals.

10. Lessons Learned and Recommendations
Relaying on MCOS to pay for CHWs in large scale is unrealistic, specially for rural clinics where volume is small.
Working with local governments is a viable option to serve un-insured or under-insured individuals.
A state Medicaid Plan Amendment to institute some alternative to Fee for Service may be the best option.

11. Questions?