Official State of Rhode Island website

State of Rhode Island Department of Health

Medicaid Enrollment and Reimbursement for CHWs

What Medicaid recipients need to know as the COVID-19 Public Health Emergency comes to an end

 

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). MORE

The Rhode Island Executive Office of Health and Human Services (EOHHS) contracts with Neighborhood Health Plan of Rhode Island to administer Rhode Island's Medicare-Medicaid Plan (MMP). The MMP is designed to coordinate both Medicare and Medicaid benefits into one, integrated delivery system for eligible members. MORE

How to Enroll

  1. Access the RI Medicaid Healthcare Portal (HCP).
  2. Follow step-by-step instructions on the Healthcare Portal Resource Page.

CHW Eligibility

  1. Individuals certified by the Rhode Island Certification Board (RICB) as a CHW.
  2. 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.

Additional Resources

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