Medicaid managed care organizations; community health worker expansion, etc., report.

Plain English Breakdown

The bill does not provide specific details on how much funding will be allocated for these initiatives.

Medicaid Managed Care Organizations; Community Health Worker Expansion

This bill directs Virginia's Department of Medical Assistance Services to work with other state departments to evaluate, develop, and report on integrating community health workers into Medicaid care coordination models.

What This Bill Does

• Evaluates opportunities for Medicaid managed care organizations to embed certified community health workers (CHWs) in their care coordination models.
• Examines the feasibility of establishing Medicaid reimbursement for CHW-delivered services through a State Plan amendment or other mechanism.
• Develops statewide workforce pathways for CHW training that are accessible to people who receive Medicaid or SNAP benefits.
• Identifies opportunities to expand the use of community health workers in programs supporting high-cost Medicaid patients.

Who It Names or Affects

• People receiving Medicaid services
• Community health workers and their employers

Terms To Know

Community Health Worker (CHW)

A person who works in communities to help people access healthcare, understand medical advice, and navigate the healthcare system.

Medicaid

A government program that helps low-income individuals pay for healthcare services.

Limits and Unknowns

• The bill does not specify how much funding will be provided to implement these changes.
• It is unclear what specific recommendations the report will contain or if they will lead to new laws or regulations.

Official Summary Text

Department of Medical Assistance Services; community health worker expansion.
Directs the Department of Medical Assistance Services, in coordination with the Department of Health, Department of Social Services, Department of Behavioral Health and Developmental Services, and Department for Aging and Rehabilitative Services, to (i) evaluate opportunities for Medicaid managed care organizations to embed certified community health workers into care coordination models, (ii) evaluate the implementation of 2024 Medicare Community Health Integration services codes, (iii) develop and implement statewide workforce pathways for community health worker training, and (iv) identify opportunities to expand the use of community health workers in programs supporting high-cost Medicaid populations. The bill directs the Department of Medical Assistance Services to submit a report of its findings and recommendations to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and Senate Committee on Finance and Appropriations no later than December 1, 2026.

Current Bill Text

A BILL to direct the Department of Medical Assistance Services, in coordination with the Department of Health, the Department of Social Services, the Department of Behavioral Health and Developmental Services, and the Department for Aging and Rehabilitative Services
,
to evaluate, develop, and report on a statewide Community Health Worker integration strategy.

Be it enacted by the General Assembly of Virginia:

1.
§ 1.
That the Department of Medical Assistance Services, in coordination with the Department of Health, the Department of Social Services, the Department of Behavioral Health and Developmental Services, and the Department f
or
Aging and Rehabilitati
ve Services, shall (i) evaluate and identify opportunities to require Medicaid managed care organizations to embed certified
c
ommunity
h
ealth
w
orkers
(CHW)
into care coordination models, including but not limited to chronic disease management, aging-in-place programs, high-utilizer care coordination, and social determinants of health navigation;
(ii) evaluate the adoption and implementation of the 2024 Medicare Community Health Integration service
s
codes (HCPCS G0019 and G0022) and determine the feasibility of establishing Medicaid reimbursement for CHW-delivered services through a State Plan amendment or other mechanism; (iii
) develop
and implement
statewide workforce pathways for CHW training that are accessible to Medicaid and SNAP recipients who must satisfy the federal 80-hour monthly community engagement or work requirement, in coordination with
the Department of
Work
force Development and Advancement
, the Virginia Community College System, and the Department of Education; and (iv) identify opportunities to expand the use of CHW
s in programs supporting high-cost Medicaid populations, including individuals with multiple chronic conditions, behavioral health needs, disabilities, or complex social support needs.

§ 2. The Department of Medical Assistance Services shall submit a re
port of its findings, recommendations, and any proposed legislative or regulatory changes to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and the Senate Committee on Finance and Appropriations no later than December 1, 2026
, and based on those findings
and recommendations
shall design and implement a plan
for subsequent years.