Community Health Worker Access Act
- Sponsor
- Sen. Blunt Rochester, Lisa [D-DE]
- Committees
- Finance Committee (primary)
- Last action
- Sep 17, 2026
Bottom line
This bill aims to integrate community health workers more deeply into the Medicare and Medicaid systems by providing federal funding for their services and incentivizing states to expand their workforce.
What it actually does
This bill expands Medicare Part B coverage to include "community health services" furnished by "community health agencies," establishing a 100% payment rate for these services without a deductible. It also creates a new State Medicaid option to support community health workers, promotoras, and community health representatives by offering an increased Federal Medical Assistance Percentage (FMAP) of 6 percentage points for related expenditures, waiving certain statewideness and comparability requirements.
Proponents argue
Proponents argue that community health workers (CHWs) are crucial for improving health outcomes, especially for underserved populations, by addressing social determinants of health, providing culturally competent care coordination, and reducing health disparities. Expanding coverage and increasing federal matching funds would make these vital services more accessible and sustainable, leading to better preventive care and reduced healthcare costs in the long run.
Opponents contend
Potential opponents might raise concerns about the increased federal spending associated with expanding Medicare coverage and increasing FMAP for Medicaid. They might question the cost-effectiveness of these services, the potential for fraud and abuse within a new payment system, or the administrative burden on states and healthcare providers to implement new definitions and reimbursement structures.
The bill is short and relatively straightforward, making it accessible for a reader to understand its core provisions within a reasonable timeframe.
Section 2(a)(1) amending Section 1861(s)(2) of the Social Security Act
Medicare Part B Coverage for Community Health Services
This provision adds "community health services" to the list of services covered under Medicare Part B, effective January 1, 2027. This means that Medicare beneficiaries will be able to receive services from eligible community health agencies, which are designed to provide preventive care and address social determinants of health, directly through their Medicare benefits.
Supporters argue
Supporters argue this expands vital services to a vulnerable population, improving health outcomes and reducing long-term healthcare costs by focusing on prevention and social needs.
Critics contend
Critics might express concern about the expansion of Medicare benefits and the associated costs, potentially arguing that the scope of services could be too broad or difficult to define and monitor effectively.
Tradeoffs
Balances the desire to improve public health and reduce disparities with concerns about federal spending and the administrative complexity of integrating new service types into Medicare.
Section 2(a)(2) adding Section 1861(ooo) to the Social Security Act
Defining Community Health Services and Agencies
This section defines "community health services" to include preventive services (e.g., screenings, health education, care coordination, social support, transportation) and services addressing social determinants of health (e.g., needs assessment, outreach for health insurance, home visiting, linkage to resources for food, housing, employment). It also defines "community health agency" as various entities (nonprofits, FQHCs, public health departments, etc.) that meet specific requirements, including employing CHWs who share lived experiences, providing fair compensation and professional development, ensuring worker safety, and involving CHWs in decision-making.
Section 2(a)(3) & (4) amending Section 1833(a)(1) and 1833(b) of the Social Security Act
100% Medicare Payment and Deductible Waiver for Community Health Services
This provision mandates that Medicare will pay 100 percent of the lesser of the actual charge or the fee schedule amount for community health services. Additionally, the Medicare Part B deductible will not apply to these services. This aims to eliminate financial barriers for beneficiaries, ensuring that out-of-pocket costs do not prevent access to these crucial preventive and social support services.
Section 3 adding Section 1903(cc) to the Social Security Act
State Medicaid Option for Community Health Workforce Support with Enhanced FMAP
This section creates an optional State plan amendment for Medicaid, allowing states to provide medical assistance for preventive services and social determinants of health services furnished by community health workers, promotoras, or community health representatives, starting January 1, 2027. It waives statewideness and comparability requirements to facilitate this. Crucially, states that adopt this option will receive a 6 percentage point increase in their Federal Medical Assistance Percentage (FMAP) for these expenditures, with the increased FMAP amounts excluded from territorial caps.
The bill explicitly waives section 1902(a)(1) (statewideness) and section 1902(a)(10)(B) (comparability) of the Social Security Act for states implementing the Medicaid community health workforce support option.
Section 1903(cc)(1)
Why it matters:This is standard legislative practice to grant states flexibility for new optional programs, as strict adherence to statewideness and comparability could hinder pilot programs or targeted interventions, especially in the initial phases of implementation.
Case for: Proponents argue these waivers are essential to allow states to tailor programs to specific regional needs or target particular populations, fostering innovation and effective resource allocation without requiring a statewide rollout from day one.
Case against: Critics might argue that waiving comparability could lead to unequal access to services within a state, creating a patchwork system where some beneficiaries receive more comprehensive support than others based on their location or specific circumstances.
Estimated impact: Allows states to implement geographically limited or population-specific CHW programs, potentially leading to varied access across a state.
The portion of payments made to U.S. territories for expenditures for medical assistance described in the bill, which exceeds the amount that would have been paid without the 6 percentage point FMAP increase, shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108 (territorial caps).
Section 1903(cc)(3)(B)
Why it matters:This is a technical adjustment to ensure territories can fully benefit from the enhanced FMAP without hitting their statutory funding ceilings, which are often a barrier for them to access federal matching funds for new initiatives.
Case for: Supporters argue this is crucial for territories to meaningfully participate and benefit from the enhanced FMAP, as their capped funding often limits their ability to draw down federal funds for new initiatives.
Case against: No specific opposition is typically raised against this type of technical adjustment for territories, though some might view it as an additional federal expenditure without broader application.
Estimated impact: Provides additional federal funding to U.S. territories for CHW services, potentially increasing their capacity to address health disparities.