State Approaches to Community Health Worker Certification

July 12, 2018|4:57 p.m.| ASTHO Staff

A community health worker (CHW) is defined as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.” CHWs typically share the lived experience of members of their communities. With a growing body of evidence supporting the effectiveness of CHWs, policymakers continue to explore ways to leverage the role of CHWs for improving health and wellbeing in the states and other jurisdictions. Some of these policy decisions focus on issues of reimbursement and funding for CHWs, as well as the scope of practice for CHWs. Another key policy issue for CHWs that continues to evolve is certification. Certification programs are often used to standardize the education and training requirements for a profession. However, such programs may also present a barrier if the certification requirements are too costly, time-consuming, or onerous for those seeking to join the profession. Below is a brief summary of how two states, Arizona and Maryland, addressed CHW certification during this past legislative session.

In Arizona, HB 2324 was enacted and directs the department of health services to implement a CHW certification program. In addition, it gives the department the authority to define the scope of CHW services, core competencies, and criteria for granting, denying, suspending, and revoking certification. The new law establishes a CHW advisory council, a nine-member group, the majority of whom must be CHWs, to advise the department about the certification program and provide recommendations, including:

  • Core competencies for CHW certification
  • Minimum education and training qualifications
  • Standards for CHW education and training programs
  • Requirements for continuing education, as well as training and education standards for CHW educators
  • Examinations or other methods to show that a CHW meets the standards for certification
  • Standards for unprofessional conduct

The law also allows certain CHWs to obtain certification based on their prior CHW experience. The department is directed to waive the certification’s minimum education and training requirements for CHWs that can document a minimum of 960 hours of paid or volunteer CHW experience through “a licensed healthcare facility or in the services of a licensed healthcare provider or a contractor” in the past three years. Finally, the Arizona law expressly states that certification is not required to practice as a CHW in the state. In addition, it prohibits the state or any political subdivisions from considering whether CHWs are certified when awarding public contracts for CHW services.

In Maryland, the governor signed SB 163 into law. The new law defines CHWs as a “frontline public health worker who (1) is a trusted member of, or has an unusually close understanding of, the community served, (2) serves as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, and (3) builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities, including outreach, community education, the provision of information to support individuals in the community, social support, and advocacy.”

The new Maryland law authorizes the state department of health to adopt initial regulations for CHW certification, specifies what the initial regulations may cover, and allows for additional regulations at the recommendation of a state community health worker advisory committee. This new committee is to consist of 19 members and include at least nine CHWs, as well as other key stakeholders who provide clinical care, social services, and employ CHWs. The committee is tasked with making recommendations about CHW training programs, fees for initial certifications and renewals, grandfathering provisions, criteria for and due process for denial, censure, probation, suspension, revocation, or reinstatement of a certification, as well as the appropriate length of a valid certification. In developing these recommendations, the committee is instructed to consult with relevant state agencies, professional associations, and other stakeholders. 

Under the law, the department of health is also charged with developing regulations and procedures for accrediting CHW training programs in consultation with the advisory council. The accreditation regulations must outline the procedure for reviewing applications, including timelines, curriculum requirements, as well as criteria and due process requirements to revoke an accreditation. Finally, the new Maryland law directs the department to adopt a process through which a person working as a CHW before Oct. 1 may be exempt from the certification’s training and education requirements.

Improving health outcomes for individuals and communities requires collaboration and alignment between clinical healthcare delivery and population-level public health interventions. CHWs can serve to bridge these two disciplines to address both medical care needs and social determinants of health. ASTHO will continue to inform its members of the ways state policymakers continue to leverage CHW practice to achieve optimal health for all.

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