Reimbursement

Reimbursement Overview

A goal of the Community Health Worker Collaborative of South Dakota is to increase the number of payers providing reimbursement for Community Health Worker (CHW) services in South Dakota. Currently, South Dakota Medicaid is the only payer to reimburse for CHW services. In addition to seeking reimbursement from SD Medicaid for CHW services, organizations may also seek other funding mechanisms to assist in covering the costs of CHW services.

Funding Overview

To assist with the start-up of a CHW program, an organization may seek grant funding to assist with covering costs associated with the program. Though not sustainable for the long term, grants play an important role in helping CHW programs secure initial funding. Once a program is established and can be evaluated to quantify a return on investment (ROI) an organization may be able to use additional funds and cost savings to sustain the CHW program.

Medicaid Overview

As of April 1, 2019, South Dakota Medicaid has added CHWs to the list of services a Medicaid recipient may be eligible for. CHW services are preventative health services to prevent disease, disability, and other health conditions or their progression for individuals with a chronic condition or at risk for a chronic condition who are unable to self-manage the condition or for individuals with a documented barrier that is affecting the individual’s health. For questions about Medicaid coverage of CHW services, CHW provider enrollment, and Medicaid reimbursement, please contact South Dakota Medicaid.