Community Health Worker Access Act
- Sponsor
- Rep. Adams, Alma S. [D-NC-12]
- Committees
- Ways and Means Committee (primary)
- Last action
- Sep 16, 2026
Bottom line
The bill aims to integrate community health workers more deeply into federal healthcare programs to improve health outcomes and address social determinants of health, backed by federal funding incentives.
What it actually does
This bill expands coverage for community health worker services under Medicare Part B and creates a new state option under Medicaid to cover these services with an enhanced federal matching rate. It defines 'community health services' to include preventive care and services addressing social determinants of health, and establishes requirements for 'community health agencies' that would provide these services, focusing on workforce support and community engagement.
Proponents argue
Proponents argue that integrating community health workers (CHWs) into Medicare and Medicaid will significantly improve health equity, reduce healthcare costs by focusing on prevention and social determinants of health, and provide culturally competent care to underserved populations. They highlight the value of CHWs' lived experiences and trusted relationships within communities.
Opponents contend
Opponents may contend that expanding federal healthcare programs and increasing federal spending, particularly through enhanced FMAP, could place an undue burden on taxpayers and contribute to the national debt. Concerns might also be raised about the administrative complexity of establishing new reimbursement structures and oversight for a diverse CHW workforce and agencies.
The bill is concise and relatively straightforward, allowing an informed reader to grasp its core provisions and implications within the typical time allotted for legislative review.
Section 2(a)(1), Section 1861(s)(2)(KK) of the Social Security Act
Medicare Part B Coverage for Community Health Services
This provision amends the Social Security Act to include "community health services" as a covered benefit under Medicare Part B, effective January 1, 2027. This means that Medicare beneficiaries will be able to receive services from community health workers, which were not previously explicitly covered.
Supporters argue
Supporters argue this expands access to crucial, culturally competent care for seniors and individuals with disabilities, addressing health disparities and improving overall health outcomes by leveraging trusted community members.
Critics contend
Critics might argue that this represents an expansion of Medicare benefits that could increase federal spending without clear evidence of cost-effectiveness, potentially leading to higher premiums or taxes.
Tradeoffs
The provision balances the goal of expanding access to beneficial services with concerns about the potential increase in federal healthcare expenditures and the administrative burden of integrating a new service type into Medicare.
Section 2(a)(2), Section 1861(nnn) of the Social Security Act
Definitions of Community Health Services and Agencies
This section provides comprehensive definitions for 'community health services' and 'community health agency' for Medicare purposes. Community health services include a wide range of preventive services (e.g., screenings, care coordination, health education) and services addressing social determinants of health (e.g., needs assessment, linkage to food/housing resources). A 'community health agency' is defined as various entities that employ health workers with shared lived experiences, provide fair compensation, professional development, manageable caseloads, supervision, and worker engagement in decision-making.
Section 2(a)(3) and (4), Section 1833(a)(1) and (b) of the Social Security Act
Medicare Payment and Deductible Waiver
This provision establishes that Medicare will pay 100% of the lesser of the actual charge or a fee schedule amount for community health services. Additionally, it waives the Part B deductible for these services. This means beneficiaries will not have any out-of-pocket costs for covered community health services.
Section 3, Section 1903(cc) of the Social Security Act
State Medicaid Option with Enhanced FMAP
This section creates a new state option under Medicaid, allowing states to provide medical assistance for preventive services and services addressing social determinants of health furnished by community health workers, promotoras, or community health representatives. It waives statewideness and comparability requirements to allow flexibility. Crucially, states that adopt this option will receive a 6 percentage point increase in their Federal Medical Assistance Percentage (FMAP) for these services, starting January 1, 2027.
The bill sets specific requirements for 'community health agencies' to be eligible for Medicare reimbursement, including employing health workers who share lived experiences with the community, providing market wage compensation, professional development, manageable caseloads, ensuring worker safety, supervision, and engaging workers in organizational decision-making.
Section 2(a)(2), Section 1861(nnn)(2)(A)-(D) of the Social Security Act
Why it matters:This is standard legislative practice for defining eligible entities and their operational standards within a new program. However, the specificity of these requirements is crucial for the quality and equity of the CHW workforce.
Case for: Proponents argue these requirements are essential to ensure that CHWs are effectively supported, fairly compensated, and genuinely integrated into care teams, preventing exploitation and promoting high-quality, sustainable services.
Case against: Some might argue that such prescriptive requirements could create administrative burdens, particularly for smaller, volunteer-driven, or nascent community-based organizations, potentially limiting their ability to participate.
Estimated impact: These requirements will shape the operational models and employment practices of all entities seeking to provide CHW services under Medicare, influencing workforce standards nationwide.
The bill allows states to provide Medicaid medical assistance for community health worker services "notwithstanding section 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B) (relating to comparability), and any other provision of this title that the Secretary determines is necessary to waive."
Section 3(1), Section 1903(cc)(1) of the Social Security Act
Why it matters:This is a common legislative technique to grant waivers or exceptions to general statutory requirements. For Medicaid, statewideness and comparability are fundamental principles, so waiving them is significant.
Case for: Proponents argue that waiving statewideness and comparability allows states the necessary flexibility to pilot programs, target specific high-need populations or regions, and innovate in their approach to CHW services without being forced to implement them across the entire state or for all eligible groups immediately.
Case against: Critics might argue that waiving these principles could lead to uneven access to services within a state or create disparities among different groups of beneficiaries, undermining the foundational equity goals of Medicaid.
Estimated impact: This provision grants states substantial flexibility in designing their Medicaid CHW programs, potentially leading to a patchwork of services across different regions or populations within a state, at least initially.