Valley News – Community health workers in New Hampshire push for certification and Medicaid reimbursement

Community health workers are sometimes referred to as public health “bases”: They provide outreach and education, connect people to services, and remove barriers to seeking medical care.

A measure to bolster that workforce is up for a vote in the New Hampshire House of Representatives on Thursday.

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

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

“A program can lose funding and regain it a year later — but they start over again,” said Amber Culver, co-chair of the New Hampshire Community Health Worker Coalition.

Culver said the uncertainty is also driving some community health workers out of the workforce.

Community health workers do not provide clinical care, but rather act as intermediaries 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 caring for patients who don't have a fixed address.

The proposal, Senate Bill 403, passed the state Senate in March. The House Health, Human Services and Senior Affairs Committee was unable to agree on a recommendation and split largely along party lines.

At a hearing last week, Republican Rep. Jim Kofalt said the bill doesn't define the duties of community health workers clearly enough and puts a burden on taxpayers.

“This bill creates a reimbursement mechanism that would allow us to pay people whose responsibilities are, in my opinion, extraordinarily vaguely defined [and] open to expansion,” he said.

Rep. Erica Layon, a Republican from Derry, said she agrees with the idea of ​​community health workers doing a lot of good. However, she expressed concern that certification could create the false impression that they could provide services that they were not qualified to provide.

“I just want to make sure we don’t give our vulnerable people false hope,” she said.

Democratic Rep. Trinidad Tellez of Manchester, a doctor who previously led the state Office of Health Equity, dismissed those concerns.

“They don’t pretend to be clinical providers,” she said. “What they do is connect people with resources and help them figure out where to get help.”

At a community health worker summit in Concord this week, several workers said they were filling an important gap, pointing out that economic, social and other non-medical issues can have a big impact on people's health.

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

“You only see the effects over time,” he said. “But I know that little things or little efforts that we make will have an impact in the long run.”

Magna Krieger, who directs community health services at Harbor Care in Nashua, said the work is particularly important to reach vulnerable populations.

“We work with the homeless community,” she said. “We also work with people who have little or no insurance. And we are also able to offer linguistic access. My team, two of the community health workers, speak Portuguese and Spanish.”

Krieger said they also have a “mobile access unit” with community health workers that can park in different areas. Patients who cannot come to the health center in person can enter the mobile unit to schedule telemedicine appointments with medical providers.

Culver, who is also community health workforce program manager for the North Country Health Consortium, likes to tell a story about a woman whose doctors weren't sure why her medications weren't working.

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

Anna Harden

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