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The role of community health workers (CHWs) is a growing profession throughout the United States. These individuals have been a valuable supplement to healthcare systems because their work has reduced disparities in health access and contain costs, especially in hard-to-reach areas and underserved populations. However, issues of legitimacy, centralization, and sustainability challenge the effectiveness of such programs. In Connecticut especially, the CHW program lacks clarity and perhaps most importantly a sustainable means of financially supporting CHWs. This lack of steady funding leads to high attrition rates and missed opportunities for full-time employment of passionate individuals who can make a positive difference in communities where they live. Investigation into the potential payment methods for CHWs is critical if Connecticut is to have a long-term sustainable community-based program. Through a partnership with Southwestern Area Health Education Center (SW AHEC), Inc., our team of graduate and professional students from the Yale School of Public Health collected data from public and private payers regarding identification of sustainable payment methods for CHWs in the state. Interviews were conducted with key informants from various entities including Medicaid, State Innovation Model Connecticut (SIM-CT), private state payers, and private national payers. Our team hypothesized that payers would express interest in incorporating CHWs into their payment plans and would provide information regarding action steps toward making this change. The project deliverable was an analysis based on data collected from secondary sources and feedback from payer interviewees regarding how CHWs can become fully involved into delivering healthcare to underserved populations within healthcare reform programs. This analysis took into consideration new programs being recommended by the Patient Protection and Affordable Care Act (PPACA) and SIM-CT that will be presented to healthcare stakeholders, including SW AHEC, in order to advance the legitimacy and sustainability of the CHW program in Connecticut. Our findings show that several payers are interested in providing sustainable funding for CHWs through their plans but there still exist several barriers to make this advancement a reality. Future investigation is necessary to determine specific steps that ought to be taken to include CHWs in healthcare teams under the guidelines of PPACA. In addition, feedback from providers, who work directly with CHWs and other auxiliary health promoters should be gathered and analyzed.

Publication Date

Spring 2014


Yale School of Public Health


New Haven, CT


Public Health

Recommended Sustainable Payment Methods for Community Health Workers that Align with PPACA SIM-CT