Connecticut legislators considered expanding Medicaid coverage on Tuesday to include sustainable funding for community health workers — public outreach liaisons who help residents navigate a range of health care and social services.
As a winter storm blanketed most of the state in snow Tuesday, the Human Services Committee heard largely remote testimony on a bill that would require the Social Services Department to amend Connecticut’s Medicaid plan to support certified community health workers by October.
Community health workers, or CHWs, often work for nonprofits and are integrated in the communities they serve. They may help residents apply for mental health services, assist people struggling with addiction in accessing substance abuse programs, or aid elderly patients navigate the health care systems and available nursing homes.
Throughout the worst days of the COVID-19 pandemic, CHW’s served as a crucial link between marginalized Connecticut communities and vital services like testing and vaccines.
During a morning press conference, Rev. Robyn Anderson, executive director of the Ministerial Health Fellowship, said CHWs had helped members of her community access everything from health insurance coverage to prenatal care.
“We are in such a dire need,” Anderson said. “It does matter that these are community health workers that know the community, that the community actually trusts… trusts that they’re going to connect them to the services, explain those services, advocate with them for those services.”
The proponents of Tuesday’s bill believe that the funding mechanism for CHWs, largely based on grants, may make them unsustainable. Last year, state policymakers adopted a new law that increased existing grant caps of CHWs serving people impacted by COVID and extended that program until next June.
However, proponents say Connecticut should join a growing number of states which have broadened their Medicaid eligibility to support community health workers and remove the uncertainty grant funding.
Sen. Matt Lesser, a Middletown Democrat who co-chairs the Human Services Committee, said Connecticut lagged behind other states that had found ways to fund CHWs through their Medicaid programs.
More than 70 residents submitted written testimony in support of the bill ahead of the committee’s hearing. Of the three written objections, most either did not articulate an argument against the concept or generally opposed additional government spending.
However, Andrea Barton Reeves, commissioner of the Social Services Department, the agency that oversees Connecticut’s Medicaid plan, opposed the bill. During the hearing, Reeves praised CHWs as “highly valued” liaisons with the community but said the bill was currently written too broadly for her agency to implement.
“We don’t have specific things that we would be asking community health workers to do that in particular would be Medicaid reimbursable and that really is very critical,” Barton Reeves said. “The state funding that we have, as we know, is limited. So we would like to ask for a more focused approach.”
During the press conference, Lesser said there was room to compromise on the bill to address some of the agency’s concerns.
“We’ve had some good conversations with DSS about providing some parameters that would narrow the scope and fund it the way they’re looking to, which is through existing organizations,” Lesser said. “I think we can get there.”
In her written testimony, Barton Reeves also worried about the bill’s potential cost. Gov. Ned Lamont had not included funding for the contemplated expansion of Medicaid when he crafted his two-year budget proposal.
The bill does not yet have an estimate of its fiscal impact by legislative analysts, but is expected to require upfront costs. Proponents argue funding community health workers will save money in the long run.
Ayesha Clarke, interim executive director of Health Equity Solutions, pointed to estimates that interventions by CHWs saved around $2 for every dollar spent funding their work.
“We also know that community health workers have a high return on investment. CHWs have a high impact on health outcomes and a high return on this work,” she said.