Community Health Worker Certification Program

A Community Health Workers (CHWs) is a frontline public health worker who is a trusted member or has a very close understanding of the community served. This trusting relationship enables the CHW to serve as a bridge between health and social services and the community. They facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency. They do this through outreach, community education, informal counseling, social support, and advocacy.

The Community Health Worker Certification and Reimbursement Act (Public Act 410 ILCS 67), passed in 2021. This law calls for the Illinois Department of Public Health (IDPH) to establish a CHW Certification Program (“Program”). This Program will help ensure high quality, comprehensive, and ongoing training of the Illinois CHW workforce. The law also calls for the Illinois Department of Healthcare and Family Services to pursue payment for services provided by certified CHWs through the Medicaid program.

This law establishes a CHW Review Board to advise IDPH as they develop the CHW Certification Program. Co-chaired by a representative from IDPH and from a statewide association of CHWs, this diverse Board includes statewide representation of CHWs, CHW employers, CHW training organizations, colleges, health and social service providers, associations, legislators, and policy experts.

CHW certification will be voluntary. CHWs may continue to work in Illinois without certification. CHW certification is required for Illinois Medicaid payment for the CHW’s services.

In Illinois, many CHW positions are funded through short-term grants. This Program will create an ongoing funding stream to support certified CHWs through the Medicaid program. The Medicaid program will recognize CHWs as a new provider type in Illinois. This will improve the stability and security of CHW positions.

The date for accepting applications for certification is not yet determined. It is necessary to first develop a set of rules to administer the program. Refinement and approval of these administrative rules is a lengthy process. This may take up to two years or more.

Yes, the law allows for a work experience or “grandfathering” pathway. The details of this pathway will be determined in the rules.

These details are not spelled out in the law and will be worked out in the rule development process. Draft rules are now under review and are not yet public. Ways to provide input into these rules are described below.

Individuals with little or no experience working as a CHW will need to successfully complete an IDPH-certified academic or community- based training program as part of the certification process. CHW training programs will need to meet training program certification criteria through an application and on-site review process. To maintain certification, training programs will need to be re-approved on a regular basis.

The law sets forth the following minimum core competencies:

• communication
• interpersonal skills and relationship building
  
• service coordination and navigation skills
  
• capacity-building
  
• advocacy
  
• presentation and facilitation skills
  
• organizational skills
  
• cultural competency
  
• public health knowledge
  
• understanding of health systems and basic diseases
  
• behavioral health issues
• field experience

Additional competencies may be considered in the rules development process.

Employers will have the ability to bill Illinois Medicaid for services provided to Medicaid clients by certified CHWs. The type of services and reimbursement rates will be spelled out in the Medicaid fee schedule. Employer organizations interested in reimbursement through Medicaid must enroll in the Medicaid Program if they are not already enrolled.

The State of Illinois recognizes the effectiveness of CHWs in improving health outcomes, reducing healthcare costs, and bridging the gap in health disparities. A key asset of CHWs is a deep understanding of their communities through lived experience. This connection helps to make the CHW role effective in improving health outcomes. Examples of evidence of CHW effectiveness can be found in: Community Health Workers: Evidence of Their Effectiveness.

Not necessarily. The certification process helps to ensure that CHWs achieve core competencies. It also helps CHWs remain current in the field by completing ongoing training requirements. Many non-certified CHWs may be very skilled and keeping up in the field which is why the certification is voluntary. Certification is only required by the State for Medicaid reimbursement to help ensure high quality services are provided to enrollees in the Medicaid Program.

These are some ways you can provide input into the development of the CHW Certification Program:

• attend CHW Review Board meetings as a member of the public; information on Board Meetings may be found on the CHW Review Board webpage.
• request to speak at public comment session of CHW Review Board meeting/s.
  
• if you are a subject matter expert, serve on a relevant committee as needed and as requested by CHW Review Board co-chairs.