REIMBURSED

the cost of the new bene t.

Colorado now has about 170 community health workers. State o cials estimate that number would grow to about 330 workers by 2026, after Medicaid begins reimbursing for the work and more health clinics hire social wellness workers. Under the proposed law, a community health worker is de ned as a frontline public health worker who is a liaison to medical, dental or mental health care, or community programs that “combat social determinants of health.” e program, called Resource Connect, helps patients sign up for food assistance or Medicaid, and connect with nonpro ts that provide school backpacks, formula and diapers, or mortgage or rental assistance. e push for new funding in Colorado is a recognition that people’s health is a ected mainly by what happens outside of a medical appointment. A pediatrician can provide vaccinations and give advice about a healthy diet, but that doesn’t matter as much as the fact that a child might live in a house with mold or a family that can’t a ord healthy food. e Colorado Cancer Screening Program, within the University of Colorado Cancer Center, learned years ago that patient navigators could make a huge impact in getting medically underserved people to screening appointments. e no-show rate at one safety net clinic dropped to 10% from 75% in one year after navigators began working with patients in their native languages, and o ering to pay for transportation to screenings, prescriptions or child care. Prior to the extra help, Medicaid patients were not showing up for appointments or showing up without following the instructions, including fasting or taking the bowel-preparation medicine before a colonoscopy.

Children’s Hospital Colorado, for example, opened a social wellness center, including a food pantry lled with fresh vegetables and meat, in its child health pavilion three years ago.

Patients are referred to the center based on their answers to questionnaires given during medical appointments. “In the last 12 months, did you ever worry that your food would run out before you had money to buy more?” they ask.

Since Medicaid does not reimburse for the work, the program has relied on grants, donations and operational funds from the hospital. Under the new plan, Medicaid would reimburse hospitals and clinics for the social wellness work, but not for the costs of food, some of which is grown in the hospital’s garden.

Public health experts hope that it’s one day nancially feasible for even small doctors’ o ces to have a community health worker on sta .

Andi Dwyer, director of patient navigation at the screening program, called this year’s legislation a “gamechanger.” e legislation requires the state Medicaid division to begin covering community health work as soon as the state receives approval from the federal Centers for Medicare and Medicaid Services. Next year, the state is expected to spend about $300,000 as sta seek federal approval, hold four public meetings with community health workers, and lay out the speci cs of the coverage. is story is from e Colorado Sun, a journalist-owned news outlet based in Denver and covering the state. For more, and to support e Colorado Sun, visit coloradosun.com. e Colorado Sun is a partner in the Colorado News Conservancy, owner of Colorado Community Media.

“If this was a pill or device, we would have probably seen payment for this 10 years ago,” she said.

Salud Family Health Centers, a nonpro t that has 13 clinics in Colorado that provide medical, dental and mental health services, has wanted Medicaid to reimburse for community health work for at least 10 years. Salud focuses on low-income and medically underserved people, including migrant and seasonal farm workers, and employs a few “care managers” who work with patients who require the most hospitalizations.

Medicaid funding would allow Salud to hire more care managers to help a broader group of patients, said Jen Morse, Salud’s vice president of development. Finally, health care policy is catching up with research that shows how health outcomes are improved when providers can address “all these additional stressors in their life that really a ect health care,” she said.

“ e fact that this bill is even getting some feet under it shows that there is some recognition at a policy level,” she said.

Dr. Hans Elzinga, a family medicine physician at Salud’s Longmont clinic, said it’s “a stereotype in medicine that Medicaid patients are going to be more likely to no-show.” In the past decade, though, health providers have realized that if they can identify patients’ barriers to care, and help them overcome them, they will show up. “We need to identify why those things aren’t happening and then make it possible,” he said.

Elzinga works with Tania Maldonado, a patient navigator who speaks English and Spanish. In some cases, she said, patients don’t need assistance getting to an appointment, they just need better communication. She has had patients who only spoke Spanish and were having their young children try to interpret and explain medical directions, she said.

In other states, community health work can occur not just in health facilities, but in schools, community centers or patients’ homes.

Prime sponsors of the legislation are Sens. Kyle Mullica, a ornton Democrat, and Cleave Simpson, an Alamosa Republican.