2023: A Year of Legislative Gains for the Community Health Workforce

From shaping policy at state and federal levels to championing the community health workforce, this year has been a testament to the power of collective action. Below, we reflect on advocacy gains from the year.

Community Health Workers and Allies Host Federal Briefing and Hill Day

PIH-US and the National Association of Community Health Workers coordinated a Congressional briefing on community health workers, bringing over 40 frontline workers and allies to Capitol Hill to advocate for long-term support for community health workers and promotoras. This event aimed to educate members of Congress and staff on the diversity and significance of the community health workforce, emphasizing their deep community connections and their fundamental role in promoting health equity. After the briefing, participants visited over 40 Congressional offices and connected with over 100 Congressional staffers, providing policymakers an opportunity to engage with this workforce and foster a deeper understanding of their critical work.

North Carolina Expands Medicaid, as Community Health Worker Advocacy Grows

In the spring, North Carolina’s General Assembly voted to pass Medicaid expansion, providing access to health coverage for over 600,000 North Carolinians. PIH-US supported Medicaid expansion as a member of the Care4Carolina coalition, which has been organizing for years to achieve this win for health equity. As more people become eligible for health services starting on December 1, 2023, community health workers will play a vital role in connecting these communities with health coverage, care, and social support. PIH-US also advocated alongside local grassroots coalitions and the North Carolina Community Health Worker Association (NCCHWA) for community health workers to be included in the NC state budget. This included co-hosting with NCCHWA North Carolina’s first Community Health Worker Advocacy Day in April, inviting over 80 community health advocates to travel to Raleigh, N.C., and attend over 50 meetings with legislative staffers to raise awareness. Although community health workers were ultimately excluded from the state’s final budget, our efforts in identifying champions and building an engaged coalition have established a strong foundation for future advocacy initiatives.

States Explore Medicaid Financing for Community Health Workers

After extensive statewide advocacy, including a letter from PIH-US supporting Medicaid coverage for community health worker and community health representative services and urging the state to prioritize community leadership, Arizona began paying community health workers for services delivered to Medicaid members in April. In Arizona and beyond, Medicaid offers an important avenue for sustainable funding for community health workers. With more and more states initiating policy changes to include this workforce and their services in Medicaid, PIH-US developed recommendations for state policymakers to follow to support community health workers through Medicaid financing and promote health equity.

Medicare Agency Introduces Payments for Community Health Worker Services

In August, The Centers for Medicare and Medicaid Services (CMS) proposed updated payments in the Medicare program, which provides health insurance to over 65 million Americans, primarily those 65 and over. For the first time, CMS will pay for new Medicare services that have been designed explicitly for community health workers. Effective nationwide January 1, 2024, this shift acknowledges the vital role community health workers play in health care. To influence this policy proposal, PIH-US collaborated with the National Association of Community Health Workers and over 100 community health workers, advocates, and allies to ensure community health worker voices were included in the policy process. This collective developed and disseminated accessible resources, from policy summaries to comment templates, which led to the submission of over 25 unique comment letters. Medicare funding for community health workers unlocks a new, sustained funding source that can support the workforce and improve the health of Medicare enrollees.

Congress Recognizes Community Health Workers Through Resolution

In September, Senator Bob Casey, Jr., and Representative Raul Ruiz, M.D., introduced a resolution to declare August 28 – September 1, 2023, as “National Community Health Worker Awareness Week.” This resolution was a significant acknowledgment of the essential contributions made by community health workers. It coincided with the inaugural National Community Health Worker Awareness Week organized by the National Community Health Worker Association, which saw over 80 organizations nationwide, including PIH-US, coming together to celebrate, unite, and raise awareness about the diverse roles of community health workers, their historical importance globally, and their impact on health and racial equity in the United States. 

PIH Engage Advocates for Community Health Worker Funding

PIH Engage, a grassroots organizing network of PIH supporters working to build a movement for the right to health, advocated to build policymaker support for community health workers in the U.S. In August, 160 PIH Engage leaders representing 80 local teams from across the U.S. came together in Washington, D.C., to develop their community organizing skills, learn about global health equity, and craft year-long legislative advocacy, peer-to-peer fundraising, and community building campaigns in support of PIH's mission. On "Hill Day," Engagers met with the offices of 100 Senators and Representatives to kick off a year of advocacy engagement for global and domestic health policy priorities, including legislation to provide funding for community health workers.

These wins signal a turning point for the community health workforce. In a year that continued to challenge the resilience of public health systems, we were reminded that community health workers are not just a necessity but a cornerstone of building robust, sustainable health ecosystems. We have ambitious goals for the new year as we continue to advocate for sustained support and recognition of the community health workforce, as well as greater investments in public health infrastructure—fundamental steps toward creating healthier, more resilient communities for all.