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extract: 2025-01-01-nashp-chw-policy-trends-2024-2025

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domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md
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@ -51,6 +51,12 @@ The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidenc
IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at least one category of preventive intervention (CHW programs) generates returns fast enough to be captured within annual budget cycles, not just 10-year windows. This suggests the scoring methodology problem may be less severe for interventions with rapid return profiles. IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at least one category of preventive intervention (CHW programs) generates returns fast enough to be captured within annual budget cycles, not just 10-year windows. This suggests the scoring methodology problem may be less severe for interventions with rapid return profiles.
### Additional Evidence (challenge)
*Source: [[2025-01-01-nashp-chw-policy-trends-2024-2025]] | Added: 2026-03-18*
CHW state policy expansion is now threatened by federal funding uncertainty from DOGE-era Medicaid cuts. States are building CHW infrastructure specifically as a hedge against federal pullback—Milbank Memorial Fund's August 2025 framing positions state-level CHW offices and SPAs as 'resilience against federal instability.' This inverts the budget scoring problem: rather than federal scoring undervaluing prevention, states are now planning for CHW programs WITHOUT federal matching funds because they anticipate federal support will disappear. The 10-year window problem becomes moot when states expect zero federal contribution.
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Relevant Notes: Relevant Notes:

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inbox/queue/2025-01-01-nashp-chw-policy-trends-2024-2025.md
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@ -7,9 +7,13 @@ date: 2025-01-01
domain: health domain: health
secondary_domains: [] secondary_domains: []
format: policy-report format: policy-report
status: unprocessed status: enrichment
priority: medium priority: medium
tags: [community-health-workers, chw, medicaid, state-policy, spa, reimbursement, scaling, workforce] tags: [community-health-workers, chw, medicaid, state-policy, spa, reimbursement, scaling, workforce]
processed_by: vida
processed_date: 2026-03-18
enrichments_applied: ["federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
--- ---
## Content ## Content
@ -69,3 +73,15 @@ NASHP annual update on state community health worker Medicaid policies, tracking
PRIMARY CONNECTION: Session 1 CHW scaling claim — updated baseline from 20 to >24 SPAs with coverage in more than half of states PRIMARY CONNECTION: Session 1 CHW scaling claim — updated baseline from 20 to >24 SPAs with coverage in more than half of states
WHY ARCHIVED: Annual CHW policy update — tracks progress on the infrastructure scaling that Session 1 identified as the binding constraint WHY ARCHIVED: Annual CHW policy update — tracks progress on the infrastructure scaling that Session 1 identified as the binding constraint
EXTRACTION HINT: Don't just extract the number of states. Extract the pattern: steady incremental progress on CHW coverage is now threatened by federal funding uncertainty from DOGE/Medicaid cuts, adding a new risk dimension to the scaling timeline. EXTRACTION HINT: Don't just extract the number of states. Extract the pattern: steady incremental progress on CHW coverage is now threatened by federal funding uncertainty from DOGE/Medicaid cuts, adding a new risk dimension to the scaling timeline.
## Key Facts
- 24-25 states now have full Medicaid State Plan Amendments (SPAs) for CHW reimbursement as of January 2025, up from 20 in March 2024
- More than half of state Medicaid programs have some form of CHW/P/CHR coverage and payment policy
- Four new SPAs approved in 2024-2025: Colorado, Georgia, Oklahoma, Washington
- 7 states now have dedicated CHW offices
- 15 states have Section 1115 waivers for CHW services
- CHW fee-for-service rates range from $18 to $50 per 30 minutes across states
- Milbank Memorial Fund published model SPA guidance in November 2025
- Transportation is the largest overhead cost for CHW programs and is not covered by Medicaid as a CHW program cost
- Community care hub model emerging as coordination layer between payers, CBOs, and CHW workforce