Supporting Community Health Workers at Scale

Across Texas, we are witnessing an important evolution in community-centered care.

Community Health Workers (CHWs) have long played a critical role in supporting maternal health, chronic disease management, care coordination, and trust-building within communities. Recent Medicare and Medicaid policy changes allow billing and reimbursement for certain CHW services. This reflects growing recognition of that value.

This progress matters.

It has also sparked new conversations across the state. Health systems, health plans, community-based organizations, and regional collaboratives are thoughtfully exploring how to integrate and support CHWs in more structured and sustainable ways. In many communities, this exploration is taking shape through “hub-like” models, centralized entities designed to recruit, train, employ, and administratively support CHWs.

The energy behind these efforts is encouraging. It signals commitment to strengthening whole-person care. At the same time, as with any emerging field, growth brings complexity.

In recent discussions with local leaders engaged in building or expanding hub structures, a consistent theme has surfaced: supporting CHWs at scale requires more than reimbursement authorization. It requires deliberate attention to the infrastructure that enables CHWs and for the organizations that employ them to thrive over time.

Reimbursement Alone Is Not Sustainable

Five areas consistently surface in these conversations:

• Workforce infrastructure — Recruitment, supervision, and retention systems that sustain a stable and supported workforce.
• Financial strategy — Thoughtful revenue models that recognize payments from health plans as a new, important component, but not the sole foundation, of sustainability.
• Training and skill alignment — Consistent preparation for evolving roles within interdisciplinary care teams.
• Compliance and reporting capacity — Administrative systems that meet payer expectations while protecting frontline focus.
• Career development pathways — Structures that elevate the profession and support long-term workforce growth.

Many organizations are already addressing aspects of these well. What is less clear and increasingly important is how these elements fit together in a cohesive and scalable way. This is not a critique of current efforts. In fact, it reflects their ambition.

Working Together to Sustain CHW Integration

As policy windows open and interest grows, Texas has an opportunity to ensure that ambition is matched by aligned infrastructures. The goal is not uniformity, nor centralization. Local leadership and innovation remain essential.

The opportunity lies in shared learning, thoughtful readiness assessment, and realistic sustainability planning so that communities do not have to navigate complex infrastructure decisions in isolation.

If we take this systems-level view now, we can reduce avoidable duplication, preserve local energy, and strengthen the long-term infrastructure needed to sustain the community-based workforce that helps address the non-medical drivers of health.

The integration of CHWs into care delivery and into managed care networks (health insurance/payers) as credentialed providers is a structural evolution in how we think about health. As that evolution continues, the infrastructure that supports it deserves the same level of intentional design as the policy shifts that enabled it.

As this work continues to evolve, we are grateful for the many local and regional leaders who are thoughtfully exploring how best to support CHWs in their communities. Through ongoing conversations with partners across Texas, there is both momentum and a shared desire to get this right.

Texas Health Institute will continue engaging with organizations, funders, and policymakers to better understand how aligned infrastructure, shared learning, and realistic sustainability planning can strengthen this next phase of CHW integration. We welcome continued dialogue with those navigating similar questions and are committed to stewarding this moment with intention and collaboration.