Community Health Worker Certification Programs on the Rise: A 2015 State Legislative Update

To date, nine states have passed legislation relating to the certification of CHWs. State legislative recognition of CHWs began in 1993, when Alaska first provided grants through legislation for the third-party training of CHWs. In 1999, Texas enacted the country’s first CHW certification legislation, which included the creation of the Promotor(a) Program Development Committee. In 2007, Minnesota became the first (and so far only) state to provide Medicaid reimbursement for specific Certified CHW-provided services.

In 2014, Illinois, Maryland and New Mexico passed legislation authorizing the creation of a CHW governing board tasked with establishing certification standards and requirements for the state. So far, New Mexico has enacted regulations implementing the CHW certification program, including application requirements, core competencies and a scope of practice. New Mexico will begin certifying CHWs through a grandfathering process in spring 2015 and will pilot the curriculum throughout the remainder of the year, with the first CHW courses beginning in early 2016. Both Illinois’ and Maryland’s CHW governing bodies are developing certification requirements, which both states expect to release in summer 2015. Massachusetts, which passed CHW certification legislation in 2010, expects to release implementing regulations in summer 2015, as well.

Both Florida’s and North Dakota’s 2015 CHW certification bills are progressing through the state legislatures. Florida’s SB 482 (HB 285) passed the Senate Health Policy Committee 9–0 on March 11. Florida’s bill relieves the state health department from operating a single certification program. Instead, the bill authorizes third-party credentialing entities to develop and administer voluntary CHW certification programs that are approved by the Department of Health. North Dakota’s SB 2321 passed the Senate 47-0 and was transferred to the House on March 4. The bill allows the Department of Health to credential CHWs that complete the curriculum and requires Certified CHWs to receive Medicaid reimbursement for specific services.

The CHW certification landscape varies from state to state, especially around the definition of “Community Health Worker.” Many states use the American Public Health Association (APHA) definition created in 2009. Others, however, go further than the APHA definition and include a broader array of services that CHWs may provide. A state’s definition of “Community Health Worker” is important to understanding whether the certification program includes, for example, certified Asthma Educators, as well as other public health professionals.

The Association of State and Territorial Health Officials (ASTHO) tracks CHW certification legislation on an ongoing basis. For more detailed information on state certification and training programs, please see ASTHO’s CHW Training/Certification Standards summary document.

Steven Ferraina, JD, is a public health attorney and Senior Analyst, Public Health Law & Policy at the Association of State and Territorial Health Officials (ASTHO).