Table 1.

Sample PPACA Programs Overview

Program	PPACA Support	CHW Role
Patient-Centered Medical Homes22	The PPACA indicates that it will establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional health teams that will support Patient-Centered Medical Homes. The PPACA defines Patient-Centered Medical Homes as having a whole person-orientation and delivering coordinated and integrated, safe, high-quality care through evidence-informed medicine, appropriate use of health information technology, continuous quality improvements, and expanded access to care. The PPACA also indicates that payment will reflect the value additional components of patient-centered care.	Care delivery: CHWs can work as part of health teams and support the provision of culturally appropriate, patient and family-centered health care. Care coordination: CHWs can assist in coordinating access to preventive and health promotion services, other providers and care settings, and community prevention and treatment programs and provide support during transitions in care. Data Collection: CHWs can assist in the collection and reporting of data for evaluation, including information on patient experience of care.
Health Homes26	Provides for payment to designated providers, a team of health care professionals operating with such a provider, or a health team, which is eligible to deliver Health Home services to Medicaid individuals with at least 2 chronic conditions, 1 chronic condition and be at risk for another, or 1 serious and persistent mental health condition. Health Homes must provide 6 core services: comprehensive care management; care coordination and health promotion; comprehensive transitional care, including appropriate follow-up from inpatient to other settings; patient and family support; referral to community and social support services; and use of health information technology to link services.	Outreach and engagement: CHWs can conduct outreach to engage eligible enrollees in Health Homes. Care delivery: CHWs can work as part of health teams to support care management and health promotion. Care coordination: CHWs can work as part of health teams to support care transitions, provide patient and family support, and coordinate referrals to community and social support services.
Maternal, Infant, and Early Childhood Home Visiting Program23	The PPACA includes support to assess, strengthen, provide, and improve programs and services for families who reside in high-risk communities. A required statewide needs assessment will identify communities at high risk. Offers services within the home to provide parents with information and support around positive parenting, nurturing homes, and child development during pregnancy and through the child’s first years of life.	Outreach and engagement: CHWs can conduct outreach to engage eligible high-risk populations in care and supportive services. Care delivery and care coordination: CHWs can—and in many places already do—provide health promotion and care coordination services as part of home visits under existing Maternal, Infant, and Early Childhood Home Visiting programs.
Center for Medicare and Medicaid Innovation27	The PPACA authorized $10 billion through fiscal year 2019 to establish the new CMMI under CMS. The goal of the CMMI is to test innovative payment and delivery models in Medicare, Medicaid and CHIP. Since its launch, the CMMI has issued a number of opportunities for new Medicare, Medicaid and the CHIP care delivery and payment models for states, providers, and other entities.47	Outreach and enrollment, care delivery, care coordination, and data collection: CHWs can perform numerous functions under many of the new models, including outreach and engagement, service delivery, care coordination, and data collection. CMMI awards and contracts have included models that incorporate CHWs into new models of care and payment.
Health Benefit Exchanges48	Starting October 1, 2013, Health Benefit Exchanges began to offer health insurance coverage through an insurance marketplace available to eligible individuals and employers. Some states established a state-based marketplace, other states worked with the federal government in a state partnership marketplace, and other states elected have a federally facilitated marketplace. State and federal grants were awarded to entities to have navigators (also known as in-person assistance workers and outreach and enrollment workers) and certified application counselors conduct outreach and education to people about exchanges and assist people in enrolling.	Outreach and enrollment: CHWs can conduct outreach and education and provide enrollment assistance, especially for hard-to-reach populations. For example, New York State has implemented a facilitated enrollment initiative to support community organizations and use of CHWs in assisting limited English proficient communities with enrollment in the exchange.

Abbreviations: CHIP, Children’s Health Insurance Program; CHW, community health worker; CMMI, Center for Medicare & Medicaid Innovation; CMS, Centers for Medicare & Medicaid Services; PPACA, Patient Protection and Affordable Care Act.