Michigan Medicaid expanded to cover health workers you may not have heard of

• Michigan has expanded Medicaid coverage to cover community health worker services
• These workers are trained to connect people with transportation and other services to break down barriers to care 
• The expanded coverage recognizes that environmental factors such as poverty and geography can strongly impact health

DETROIT—A shift in Michigan Medicaid policy has bolstered funding for a category of health care worker that can have a bigger impact on a patient’s health than the wisest doctor or specialist.

Starting this month, Medicaid coverage is expanded to reimburse the state’s community health workers — frontline public health workers, trained to connect patients to housing, transportation, technology, services and even health information they can understand.

Specifically, Medicaid will reimburse organizations and clinics from $4.21 to $10.26 for every 15 minutes they provide education and training to patients. (Under the policy, community health workers who aren’t employed by others — but rather work on their own — could be directly reimbursed for such services.)

The shift stabilizes funding for workers who can be found throughout health care and social services. That, in turn, is expected to expand a workforce that for too long has been funded piecemeal through grants or out of the razor-thin budgets of small clinics and community organizations, said Tressa Liba, executive director of the Michigan Community Health Worker Alliance. The group was chosen by the state to develop a training and certification process for community health workers and a registry of providers.

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The Michigan Department of Health and Human Services estimates the shift will extend their services to an estimated 50,000 or more Michiganders.

It’s unclear how many community health workers work in Michigan. The U.S. Bureau of Labor Statistics lists just 1,650. That’s likely a vast undercount, because these workers might go by different names — “community liaisons,” “navigators” “recovery coaches” or “maternal health workers,” for example, Liba said.

In health care, community health workers have expertise a doctor doesn’t typically have time to offer, said Dr. Felix Valbuena, chief executive officer at Community Health and Social Services (CHASS) in Detroit.

Medical care contributes 10 to 20 percent to a patient’s overall health, Valbuena said, referencing an often-reported statistic.

More crucial to a patient’s health is what they eat, where they live, their income, or the life stresses they face, he said. It’s a calculus known as the social determinants of health. 

“It's sometimes a little depressing after so many years in school to only be impacting 20 percent of the overall health and wellness of the patient in front of you as an M.D.,” Valbuena said.

Consider a patient who is teetering on the brink of diabetes.

Valbuena can warn about the disease, prescribe medicine and advise good diet and exercise in a 15-minute appointment.

But what then? What if the patient doesn’t know how to prepare healthy foods, lacks transportation to get a next medical appointment, or doesn’t have a reliable place to sleep, let alone to store medication?

Enter Teresa Anel-Morones, a community health worker at CHASS in southwest Detroit, who last week was writing informational slides about preventing diabetes, while her colleague, Teresa Plascencia, down the hallway was teaching a class on healthy foods to primarily Spanish-speaking patients.

Such workers — paid about $18 to $19 an hour at CHASS — can help patients find free cooking classes, support groups, and, for the uninsured, links to health coverage.

“We wear many hats,” Anel-Morones said.

It’s part of a larger, pro-active shift in health care to focus more on prevention and disease management and not waiting until people fall into a more expensive emergency room crisis.

In a 2021 study published in the American Journal of Public Health, University of Michigan researchers looked at the experiences of 284 Detroit-area patients contacted by a community health worker after multiple trips to the hospital.

Even with limited contact by community health workers, the small study group had a reduction in emergency hospital visits in the first year — 2.8 visits on average, compared to 3.1 visits for those who had no contact with a worker. The findings suggest that community health workers had helped walk back some care from crises.

“That's really what we want: more preventive care, more preventative screens, more being compliant with your treatment plan, like getting your labs … rather than people waiting until their illness advances to the point that they have to be admitted to a hospital or go to an emergency room,” said Julie Aronica, director of Plan Initiatives for Blue Cross Complete, which provides Medicaid plans throughout the state.

Through November of last year, the 46 community health workers in the Blue Cross plans had 143,056 telephone contacts, and 13,927 in-person visits with patients.

At MidMichigan Community Health Services, a community clinic in Houghton Lake in mid-northern Michigan, community health worker Tammy Frisbie has been trying to find housing for a woman living in a van, whose upper respiratory conditions are worsened by the winter cold. For others, Frisbee coordinates transportation since “it could be over 50 miles to get a patient just in to see their local doctor.”

“There's nobody designated out there who has all the control and the resources,” she said.