A pediatric neurologist who treats children with epilepsy told lawmakers Monday that she’s still grappling with the loss of her team’s only community health worker, who helped families navigate care and connect them with local resources.
Dr. Christina Briscoe, who treats more than 80 children in Lawrence, said she lost her team member in July when federal grant funding for the position was rescinded.
“She built trust, guided families through the door, coordinated appointments and connected parents to community resources,” Briscoe, who testified on behalf of Boston Children’s Hospital, told the Public Health Committee. “She helped families whose babies were struggling from epilepsy get everything from diapers to winter coats, and without her, I cannot adequately serve these families and children.”
Briscoe joined providers advocating for legislation sponsored by committee co-chair Rep. Marjorie Decker and Sen. Robyn Kennedy (H 359 / S 251) that would require public and private health insurers to cover the cost of services offered by community health workers, including health education, outreach, patient navigation, social and emotional support, and self-advocacy skill-building. The workers can support behavioral health, mental health and substance use disorder services, among other care areas.
The legislation last session died in the Health Care Financing Committee.
Supporters say that community health workers can reduce disparities by connecting people with culturally and linguistically competent care to vulnerable and hard-to-reach patients, particularly by guiding them through the often complex care system. As the state grapples with rising health care costs, advocates say community health workers also drive down expenses by tamping down on avoidable hospital visits.
The head of the Massachusetts Association of Health Plans said she’s concerned that the legislation “would mandate coverage of CHW services across a wide range of health care settings, regardless of credentialing, scope of practice, or cost.”
“Without clear standards, such a mandate could inadvertently create risks for patient safety, undermine health plans’ ability to design high-quality provider networks, and add costs that ultimately fall on employers and consumers,” Lora Pellegrini, CEO of MAHP, said in a statement to the News Service.
“Massachusetts has already established a voluntary CHW certification program that emphasizes advocacy, navigation, and outreach, important competencies that are distinct from clinical practice,” she added. “Health plans also provide care coordination through licensed professionals. Mandating separate reimbursement for CHWs without defined parameters risks duplicating services, creating administrative burdens, and eroding affordability at a time when premiums are already under pressure from numerous mandated benefits.”
About half of the state’s community health workers earn less than $40,000, and their salaries are “almost entirely grant-dependent,” said Lissette Blondet, executive director of the Massachusetts Association of Community Health Workers.
“That means at the end of a fiscal year, most CHWs are wondering if they will have a job or not,” Blondet said. “These unreliable funding streams make it very hard for CHWs to stay in the profession, for organizations to plan long-term and for clients to rely on services. We must make community health worker services reimbursable.”
Blondet said her organization represents about 10,000 community health workers.
The Massachusetts Health and Hospital Association, which supports the legislation, did not directly answer how much the proposal would cost.“The biggest cost factor is the big potential for long-term savings – since CHWs can help people avoid costly hospitalizations and readmissions in the first place,” MHA spokesperson Sam Melnick told the News Service.
Briscoe said her clinic lost its grant after the Trump administration this spring moved to slash funding to AmeriCorps, which provides community services, including those tied to public health efforts. The White House in late August agreed to release $184 million for AmeriCorps, in response to a lawsuit filed by a coalition of two dozen attorneys general, including Massachusetts Attorney General Andrea Campbell, and two governors.
“I think the challenge again for the Legislature is going to be is that we’re not going to be able to substitute dollar for dollar, not only government federal dollars, but also grants that get taken,” Decker told Briscoe. “But the larger challenge and opportunity is to figure out how do we maximize dollars. And I think what we’re hearing is that the community health workers are about prevention, as well as preventing acceleration of any worsening health outcomes and making sure people get the care they need before it becomes even more costly.”
The legislation would also establish a workforce development task force charged with analyzing the certification of community health workers and the “sustainability of reimbursement of community health workers in health care and community-based settings.”
Andria Benvenuto, Somerville’s director of community health workers, said the city employees a team of four workers. Sharing examples of their roles, Benvenuto mentioned how a worker helped a man avoid thousands of dollars of medical debt after being hospitalized and losing his job.
“With stable funding and reimbursement opportunities, we could expand our existing model by weaving CHWs across all city departments, increasing accessibility to services wherever our residents interact with the city,” Benvenuto said.
Pellegrini urged lawmakers to “reconsider” the legislation’s approach, as she called on them to “work collaboratively with stakeholders to strengthen CHW certification, support integration into care teams, and identify opportunities that both advance health equity and protect affordability.”
