Health plans and providers seeking to provide culturally competent care and services to individuals from diverse backgrounds have incorporated community health workers (CHWs) in interdisciplinary care teams.1 CHWs – also known as promotoras de salud, community health representatives, community health advisors, or health navigators – are frontline public health workers who have an ethnic, linguistic, cultural, or experiential connection with the population they serve because they come from a similar background, speak the same language, or live in the same community as the individuals they support.2 CHWs draw on a wide range of skills and knowledge of the community to provide individualized, culturally appropriate, and highly personalized help to members. As a result, CHWs often serve as a bridge between members and the services they need.
CHWs’ linguistic and cultural alignment with the populations they serve may be particularly useful for providers and plans serving individuals dually eligible for Medicare and Medicaid.
- In 2014, approximately 1.8 million dually eligible individuals had limited English proficiency,3 and in 2016, 37% of dually eligible beneficiaries were members of racial or ethnic minority groups.4
- Dually eligible individuals on average also have lower incomes and more complex health conditions than enrollees in Medicare or Medicaid alone, and higher levels of unmet health care and health-related social needs.5,6
- CHWs can draw on their knowledge of the community to connect dually eligible individuals with needed resources.
Resources for Integrated Care has developed resources to help providers and plans serving dually eligible beneficiaries in supporting CHWs. Providers and plans may find these compiled resources useful if they are considering hiring, or have recently hired, CHWs to coordinate care and address unmet health and social needs of dually eligible individuals.
1 Snyder, J. (2016). Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform. Retrieved from https://aspe.hhs.gov/system/files/pdf/168956/CHWPolicy.pdf.
2 Centers for Disease Control and Prevention (2016). State Law Fact Sheet: A Summary of State Community Health Worker Laws. Retrieved from https://www.cdc.gov/dhdsp/pubs/docs/SLFS-Summary-State-CHW-Laws.pdf.
3 Proctor, K., Wilson-Frederick, S. M., & Haffer, S. C. (2018, May 1). The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries. Retrieved from https://www.liebertpub.com/doi/full/10.1089/heq.2017.0036.
4 Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission (2018). Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid. Retrieved from: http://medpac.gov/docs/default-source/data-book/jan18_medpac_macpac_dualsdatabook_sec.pdf?sfvrsn=0.
5 Center for Health Care Strategies (2009, July). Supporting Integrated Care for Dual Eligibles. Retrieved from https://www.chcs.org/media/Integrated_Care_Policy_Brief.pdf.
6 Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission (2020). Retrieved from https://www.macpac.gov/macstats/.
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