A person’s access to resources like housing, food, employment, and childcare, can have more impact on a person’s health than genetic factors, according to the centers for disease control and prevention. Community health workers help connect people with more resources, and some legislators are looking at whether these workers could bill to Medicaid.
Grace Lowe is a community health worker in Galax. Before she started this job, she was unfamiliar with many of the free services that are available in her community.
“You know, I always tell people, ‘we’ve got to get these resources out there.’ Because I had no knowledge of them,” Lowe said.
Once a teacher, now she tries to approach her work partly as an educator, partly as a health coach, and partly as a social worker. The work of every community health worker is different, and each day for Lowe brings a new role. She’s often out in the community, at back to school events or tabling at senior centers and local businesses. She spends most of her time telling people about free services, like family planning, mammograms, cancer care. She also talks about the women, Infants and Children (WIC) program.
“I’m actually on WIC,” Lowe said. “I think it helps too when I go to someone and be like, ‘well I use it. I just applied to see if I could get it and I could, and I think it’s like the greatest thing ever.’”
Lowe is one of 1,300 community health workers across Virginia, according to estimates from the Bureau of Labor Statistics. However, Shanteny Jackson, Executive Director with the Virginia Community Health Worker Association, points out that number doesn't reflect the part-time or volunteer community health workers, or those who work independently. Her group estimates there are 2,500–3,000 community health workers in Virginia.
Some work at hospitals, others, like Lowe, work at local health departments. They connect people to help with housing, or food stamps. They can help translate prescriptions and medical appointments.
Money for these programs ebbs and flows each year, and often depends on grants. In some states, these workers can send a bill to Medicaid. Some groups in Virginia are backing legislation to study whether that could work in the Commonwealth, to create a more reliable source of funding. “Because one thing that we do know from data, both inside Virginia and outside, is that community health workers save Medicaid programs money,” said Ben Barber, Policy Director with Virginia Health Catalyst, a statewide non-profit public health organization.
“If you address the underlying issues, you can keep folks out of the emergency departments,” Barber said.
He uses the example of someone who has a broken arm. They go to a hospital and get their arm treated. But what if they don’t have enough food at home? Or can’t read their prescription or follow up appointments, because they don’t speak English? These barriers can cause life-threatening challenges.
“We know that if you have difficulty finding housing or food, or you are not safe at home, you can receive world-class care. You are not going to get better,” Barber said. “And that is because you are not having those underlying factors being known and addressed.”
Community health workers are often people who are already known in their communities. So people may have an easier time trusting them. Even then, it can be tough to ask for help. Lowe says in Southwest Virginia, where she works, some resources, like SNAP, carry stigma.
“And so like at events, I’ll just, make a point to say ‘hey, my phone number’s there. If you ever need me, please call me.’ And I have received phone calls from that. Just because, then it’s not in front of everybody,” Lowe said. “It’s just over the phone, me and that person.”
She tries to overcome stigma by telling them about her own experiences seeking assistance.
“And so I always tell people, I’m like, ‘I don’t know what I would do without it.’ And I kind of approach it that way,” Lowe said. “I think that helps that barrier too. Because then they can think, oh we have something in common.”
Often, when she goes to events to do trainings, people share their lived experiences. “You don’t need to go in with the plan that I’m gonna teach them something,” Lowe said. “Sometimes I learn more from them than they probably learn from me.”
The proposed legislation would create a work group, to study the impacts of Community Health Workers and explore what services, if any, could be billed to Medicaid.
