A Setback for CHWs in Rhode Island: Seeking Models for Diversified Billing
Community Health Workers (CHWs) are vital to bridging health and social care, yet recent changes in Rhode Island are making it harder for them to sustain this work. Rhode Island's Medicaid Office has now prohibited billing for both home stabilization and CHW services within the same month—a policy shift that puts financial strain on CHWs, as well as the patients who rely on them.
For context, CHWs in Rhode Island traditionally bill using the H1016 code for direct services, reimbursed in 15-minute increments at around $13 per interval. This translates to $52 per hour, or approximately $45,760 annually if a CHW works 20 hours per week for 44 weeks, yielding a modest hourly rate of $22. But, due to the unpredictable nature of CHW work, it’s challenging to bill consistently, which makes financial viability difficult.
Home stabilization previously provided a solution for CHWs assisting patients facing homelessness or housing instability. This code allows CHWs to bill $313 for one 60-minute monthly visit—meaning a CHW with 20 clients for home stabilization could generate $75,120 per year. Combined with traditional CHW billing, these two codes provided a more sustainable income for CHWs addressing diverse needs: housing, medical appointments, food access, health education, and more.
Now, with the new restriction, CHWs can no longer bill both codes in the same month, reducing their ability to provide comprehensive services and putting their roles at risk.
Are there other models that allow diversified billing for CHWs? In many ways, CHWs serve as a lifeline for clients, connecting them with everything from housing to health education—similar to how physicians bill across codes for a range of services. If other states support diversified billing for CHWs, these models could provide a framework for advocating change in Rhode Island to better sustain CHW services and the patients who rely on them.
If you know of successful approaches, please share—these examples could make a real difference in advocating for policy shifts.
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