| In an effort to raise the stature (and pay) of CHWs, a number of efforts have been made to set standards for CHW skills, duties and practices. This page summarizes key efforts. CHWs have operated on the margins of many communities, working as volunteers or for low wages. Where better-paying positions are available, they are often part of grant-funded projects which end after a year or two. As CHWs have grown in numbers, many of them have voiced their desire for respect and acceptance from others in health and social services. The need for sustainability, and the potential for CHWs to improve the effectiveness of major public programs, has led to pressure for skills standards: they must be accepted as "providers" of some defined set of services. All this has led to a drive for credentialing. At the same time, recognizing their own unique qualities and their relationship to the communities they serve, many CHWs have resisted becoming "professionalized," which they see as creating (a) a distance between themselves and their neighbors and (b) barriers for others seeking to enter the field. |
State of Indiana The Indiana State Health Department created a maternal and child health program using home visitors trained under a version of the Resource Mothers curriculum (see Curriculum page). The State issues a Community Health Worker certification based on this curriculum. Ohio Credentialing Law Ohio became the second state to adopt credentialing with House Bill 95 in 2003. Credentialing is the responsibility of the State Board of Nursing.
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Maryland Medicaid Managed Care A 1998 Bill in Maryland (House Bill 650) was aimed at requiring HMOs to employ CHWs to educate Medicaid recipients. This bill was modified to require only that the HMOs report on their outreach plans. |
Oregon Licensing Bill A measure in the 2001 Oregon Legislature (Senate Bill 791) would have created licensure for CHWs and appropriated funds for CHW services. The bill was not reported out of committee. The bill would have created a nine-member licensing board (including five CHWs), and would have explicitly defined CHW services as eligible for Medicaid reimbursement. |
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New Mexico Study Bill (Memorial) A 2003 bill in New Mexico (Senate Joint Memorial 76) requests that the State health department "lead a study on the development of a community health advocacy program... that utilizes various categories of community health advocates." An advisory committee has begun work on this study. |
Massachusetts CHW bill A piece of legislation proposed in 2001 in Massachusetts provides another strategy for State support of CHWs, dedicating a $10 million annual appropriation for employment of CHWs. Click here to view a flyer describing this bill. |
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Federal legislation A number of bills have been proposed in Congress since the early 1990s. Recent bills include the IMPACT Act (H.R. 716), the Right Start Act (S.18), the Hispanic Health Improvement Act of 2003 (S.1159) and the Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2003 (H.R.918). Each of these bills would have laid out a specific role for CHWs. To read any of these bills go to http://thomas.loc.gov and type in the bill number (no formatting or punctuation needed). |
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