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(Effective July 1, 2025)

PDFWAC 182-562-0600

Community health workersCovered services.

The medicaid agency covers the following services when performed by a community health worker (CHW):
(1) Conducting person-centered assessments within their focus to:
(a) Identify personal health goals and preferences;
(b) Assess for physical, mental, behavioral, and social challenges; and
(c) Collaborate with the client to establish health goals;
(2) Care coordination and health system navigation including the following:
(a) Coordinating additional supports or specialty services;
(b) Managing the client's care plan; and
(c) Assisting the client in identifying and accessing resources;
(3) Facilitating behavior change and client self-advocacy including the following:
(a) Promoting client motivation to participate in care and reach person-centered diagnosis or treatment goals;
(b) Teaching techniques for self-monitoring and self-advocacy; and
(4) Health education and promotion including the following:
(a) Helping clients to contextualize health education provided by the client's treatment team with the client's individual needs, goals, and preferences, in the context of the principal illness and/or SDOH need(s) and educating the client on how to best participate in medical decision making; and
(b) Building client self-advocacy skills, so that the client can interact with members of the health care team and related community-based services addressing the principal illness and SDOH need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 2024 c 376 s 211(43). WSR 25-06-056, s 182-562-0600, filed 2/28/25, effective 7/1/25.]