Medicaid Enrollment and Reimbursement for CHWs
Rhode Island Medicaid covers select Community Health Worker (CHW) services for Medicaid reimbursement. All CHWs or organizations seeking to provide CHW services to Medicaid members must be enrolled and screened through the state's Medicaid Fiscal Intermediary, Gainwell Technologies, prior to delivering any services. Gainwell manages provider enrollment, claims processing, and payment for CHW services under fee-for-service Medicaid. For more information regarding CHW provider enrollment in Medicaid, please consult the Rhode Island Medicaid CHW Service Manual available on the Executive Office of Health and Human Services (EOHHS) website.
Effective May 2025, the Rhode Island Medicaid Program announced updated requirements for Community Health Worker services. These updates aim to:
- Strengthen program integrity
- Align services with national best practices
- Ensure delivery of high-quality, medically necessary care
Healthcare professionals and CHWs are encouraged to review the updated Medicaid CHW Provider Manual and compliance calendar to understand all applicable changes and compliance timelines. Visit the EOHHS website to learn more.
Contact
- James Day
Program Administrator