Meeting Families Where They Are: How Medicaid Can Strengthen Children’s Health Through Community Health Workers
When a child misses a well-child visit, falls behind on immunizations, or goes undiagnosed with a chronic condition, the consequences can ripple across a lifetime. Children whose health needs are addressed early are more likely to thrive academically, economically, and physically as adults. Yet for families navigating delays to care amid fragmented health and social care systems, early intervention too often doesn’t happen. CHWs have been shown to increase well-child visit attendance, improve parental experience with care, and reduce unnecessary emergency department visits. Research shows that including CHWs in the health system improves outcomes. One study examined the impact of CHW home visits for Medicaid-enrolled children with asthma, concluding that the kids in the program had more symptom-free days and less need for urgent health services. CHWs offer a prime opportunity to uplift and connect maternal, infant, and child health through a pediatric care and whole-family health lens.
A new infographic from the Center for Health Care Strategies (CHCS) gives an overview of a brief released last year from the Center for Health Care Strategies (CHCS), Promoting Healthy Foundations: Medicaid Opportunities to Support Community Health Workers in Child Health Care, which makes the case that Medicaid can play a vital role in the expansion of this workforce.
Community health workers (also known as “promotores”, peer navigators, or community health representatives) are trusted members of the communities they serve. They fill a critical role in the health care system because they work in homes, schools, clinics, and other community settings to connect families with the care and social services they need. Importantly, CHWs have potential to build trust between communities who have been historically marginlized.
For pediatric primary care, especially for young children healthy development is not only seen through the lens of the child but the entire family. This whole-family approach accounts for parents, caregivers, housing, food security, and more. CHWs are uniquely positioned to bridge the gap between clinical care teams and the everyday realities families face. In states like Washington, CHWs are being used as part of pediatric primary care teams to promote early relational health– or safe, stable and nurturing relationships that are the cornerstone of children’s earliest development. The CHCS brief highlights a range of innovative models already putting this into practice such as:Texas Children’s Hospital (UpSTART Community Programs), BLOOM: Black Baby Equity Clinic (San Francisco, CA), Linking Families to Support (LiFTS) (Philadelphia, PA), and Telehealth ROCKS (Missouri and Kansas)
As of mid-2025, at least 35 states have established some form of Medicaid reimbursement for CHW services through state plan amendments (SPAs), 1115 waivers, or managed care contractual requirements. Most of these mechanisms were built with adults in mind and the scope and details are up to the given state.
There is much more opportunity here to expand use and application of CHWs to center children and their families. In addition to CHCS, other expert panels and organizations have recommended CHWs to support team-based pediatric care, including the National Academy of Sciences and Nurture Connections. The CHCS brief identifies six concrete action steps states can take to integrate CHWs into pediatrics. Medicaid reimbursement for CHWs is an important action step to ensure sustainability.
The Rural Health Transformation (RHT) program came out of H.R. 1 as a pathway for states to support rural health, hospitals, providers, etc. in the wake of the bill’s otherwise detrimental provisions cutting health care, specifically Medicaid and CHIP. Thirty-two states included CHW-related initiatives in their applications, building on the already promising momentum in CHW reimbursement and another significant number of states proposed maternal and infant health initiatives.
A review of the applications shows the investments take different forms but many set the initial steps towards Medicaid reimbursement for CHWs. Some states include instructions to establish certification or study integration while other state applications focus on the development of career pathways and training programs for CHWs. As our colleagues identified, some of these CHW proposals are directly focused on supporting perinatal and maternal health.
CHWs do not solve every problem, but they help fill gaps that the clinical system structurally cannot by building trust with families where the system has historically broken it. They show up in homes, schools, and shelters. They often also speak the language and fill cultural connections for the families they serve.
As the CHCS brief reminds readers, integrating CHWs into pediatric care will enhance child health by supporting the continuum of care in the critical years of early childhood as well as positive outcomes across family units. With Medicaid covering 39% of children in the US, Medicaid reimbursement for CHWs is a key opportunity for states to invest in kids’ long term health by meeting families where they are.
Source: “Promoting Healthy Foundations: Medicaid Opportunities to Support Community Health Workers in Child Health Care – Center for Health Care Strategies.” 2025. Center for Health Care Strategies. August 21, 2025. https://www.chcs.org/resource/promoting-healthy-foundations-medicaid-opportunities-to-support-community-health-workers-in-child-health-care/.
To read the full brief, visit https://www.chcs.org/resource/how-can-medicaid-integrate-community-health-workers-into-childrens-health-care/
