Community Health Workers

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Funding for supporting content on this website was made possible by the Centers for Disease Control and Prevention (CDC) grant, Community Health Workers for COVID Response and Resilient Communities (CDC-RFA-DP21-2109). The views expressed in written materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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About

Information for

Programs

Publications

Partners

Funding Disclaimer

Funding for supporting content on this website was made possible by the Centers for Disease Control and Prevention (CDC) grant, Community Health Workers for COVID Response and Resilient Communities (CDC-RFA-DP21-2109). The views expressed in written materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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). More

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

How to Enroll

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

Who Can Provide CHW Services

  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.

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