Hourly Wages and Turnover of Community Health Workers According to US State Certification Policy and Medicaid Reimbursement, 2010–2021

Abstract

Objectives. To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. Methods. A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. Results. CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. Conclusions. CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. Public Health Implications. Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities. (Am J Public Health. Published online ahead of print August 11, 2022:e1–e9. https://doi.org/10.2105/AJPH.2022.306965 )

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

“…These barriers may be associated with burnout and the high turnover rate of CHWs (Table 4). There is growing literature on the importance of attending to CHW workforce needs, though much of this work has taken place outside the US . Given the very limited literature on burnout among US-based CHWs, more work is needed .…”

“…These barriers may be associated with burnout and the high turnover rate of CHWs (Table 4). 41 There is growing literature on the importance of attending to CHW workforce needs, though much of this work has…”

Evaluating the impact of community health worker certification in Massachusetts: Design, methods, and anticipated results of the Massachusetts community health worker workforce survey

“…Since this landmark report, multiple state and national surveys have also assessed various aspects of the CHW workforce and CHW employers ( 3 , 23 – 26 , 35 ). Further, a national evaluation of the impact of state-level CHW certification and Medicaid reimbursement on CHW wages and turnover returned mixed results, and it is still unclear how state policies impact CHW employment ( 25 , 36 ). Nevertheless, this study addressed a critical question related to CHW certification, including potential inequitable impacts by CHW subpopulation ( 25 ).…”

“If You Don’t Have the Heart to Help, You Cannot Do This Job”: The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic

“…The hard-fought Medicaid reimbursement of CHW services in many U.S. states has been an important step toward job security and increasing wages (e.g., Sabo et al, 2021), important to CHW financial wellbeing. However, gender and racial inequities persist in recent pay increases for CHWs following Medicaid reimbursement implementation, with White, male, and part-time workers experiencing the most financial gains (Jones et al, 2022). Furthermore, Medicaid typically does not provide reimbursement for other activities that CHWs engage in that contribute to community resilience, such as advocacy work (Nawaz et al, 2023).…”