Medicaid Enrollment and Reimbursement for CHWs: Department of Health

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Medicaid Enrollment and Reimbursement for CHWs

RI-Medicaid covers certain Community Health Worker (CHW) services. Active enrollment is required before a provider can begin seeing RI Medicaid members. Providers who currently participate with RI Medicaid and want to become a CHW provider must perform a separate enrollment for CHW services. CHW’s enrolling independently (i.e., not part of an agency) are required to submit proof of CHW certification from the Rhode Island Certification Board (RICB).

The Rhode Island Executive Office of Health and Human Services (EOHHS) partners with Neighborhood Health Plan to administer the RI-Medicaid Program and with Gainwell Technologies as its Fiscal Agent to process the state’s Medicaid Program claims, to enroll and train providers (including CHWs), and to fulfill other State and Federal requirements. EOHHS also oversees RI Medicaid program policy and procedures. More

Who Can Provide CHW Services

Individuals certified by the Rhode Island Certification Board (RICB) as a CHW.

Individuals who have a plan for working toward RICB certification, to be achieved within 18 months. An organization – whether a medical practice, hospital, other healthcare organization, or a community-based organization – can enroll as a CHW Provider and submit claims to RI Medicaid. There is no RICB CHW certification at the organizational level. Rather, an organizational CHW Provider must ensure the individuals delivering the CHW services billed to Medicaid are either certified or have a plan to become certified within 18 months.

Rhode Island Medicaid Billing Evaluation Study

In 2023, a Medicaid Billing Evaluation was conducted as a qualitative study focused on CHW Medicaid billing rollout and implementation. The goal of the evaluation study was to learn about medical and community-based organizations' experiences with Medicaid CHW billing, facilitators, and barriers to success, and recommendations for EOHHS and RIDOH to support organizations in adopting Medicaid CHW billing. Through interviews with state and national key informants, responses highlighted the experiences and perspectives of organizations and individuals doing CHW Medicaid billing and provided insights into the challenges and successes of billing.

Additional Resources

CHW Highlights

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Be ready. Stay Covered: Access EOHHS Medicaid Renewals Campaign Materials Here

Medicaid Enrollment and Reimbursement for CHWs

How to Enroll

Who Can Provide CHW Services

Rhode Island Medicaid Billing Evaluation Study

Additional Resources

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