Community Health Workers (CHW)

Background

A community health worker (CHW) is a frontline public health worker who is a trusted member of or has a unique understanding of the community served. This trusting relationship enables the worker to serve as a liaison between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

Benefit overview

Effective July 1, 2025, Washington State launched a new Community Health Worker (CHW) benefit under a State Plan Amendment (SPA). This new Apple Health (Medicaid) benefit is designed to:

• Strengthen community-based health initiatives.
• Improve access to preventive health services.
• Support underserved populations across the state.

Who Can Provide CHW Services?

CHW services are available through Apple Health when recommended by a licensed provider such as a physician or other licensed practitioner. These services can be delivered by:

• Community Health Workers (CHWs)
• Community Health Representatives (CHRs)

CHRs are trained, medically guided individuals from tribal and Native communities who deliver essential health services within American Indian/Alaska Native (AI/AN) communities. They are recognized as CHWs for the purpose of this benefit.

CHW and CHR requirements

To qualify for the Apple Health CHW benefit, CHWs and CHRs must:

• Have relevant lived experience
• Complete at least 2,000 hours of supervised work
• Obtain either:
  • A CHW/CHR Certificate, or
  • A Supervision Attestation from a Apple Health-enrolled licensed supervisor confirming completion of health-specific training

Covered CHW services

CHWs are reimbursed for providing the following services:

Person-centered assessment

CHWs conduct assessments to understand a patient's needs and collaborate on a care plan based on personal health goals.

Care coordination and health system navigation

CHWs help patients navigate the health care system, facilitate referrals to other health care providers, and assist with care transitions between health care settings.

Facilitating behavior change

CHWs motivate patients to meet health goals, provide social and emotional support, and help with behavior changes that support long-term health.

Health education and promotion

CHWs help patients understand their health conditions, treatment options, and how to navigate the health care system to improve the patient’s health outcomes. They help patients become better self-advocates in medical settings.

Resources for benefit implementation

• CHW benefit billing guide
• CHW benefit billing guide FAQ
• CHW WAC
• CHW benefit fact sheet

Project updates

Sign up for the CHW email list to receive project updates.

CHW benefit open office hours

Past webinars and workshops

Date	Meeting materials
December 15, 2025	Topic: Code and billing guide updates Webinar slides (12/15/2025) Presentation details: Code changes Billing guide revisions Modifier use and time thresholds Clarification on primary vs. add-on codes CHW service examples and documentation expectations
May 27, 2025 June 10, 2025 June 27, 2025	Topic: CHW Medicaid Benefit Office hours Audience: CHWs, health care professionals, advocates, and community members Webinar slides (5/2025)
May 6 and 13, 2025	Topic: CHW Medicaid reimbursement Audience: CHWs, health care professionals, advocates, and community members Webinar slides (5/2025)

CHW training

Visit the Department of Health (DOH) CHW training page to learn more about their CHW training program and the CHW leadership committee