1052: Strengthening Access to Care: Community Health Workers, Medicaid, and Rural Health

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, January 14, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today, as we continue our Legislative Prospectus Series, examining the health policy trends set to shape 2026, we'll hear about community health workers, or CHWs, and the critical role they play in bridging the gap between health systems and the communities they serve, especially in rural and underserved areas. My guest is Alex Kearly, ASTHO senior director of population health.

So, Alex, when we say community health workers, who are we talking about?

ALEX KEARLY 

Yeah, so community health workers are frontline public health workers who have trusting relationships with the people they serve, based off of experience in the communities they live in, and often having shared life experiences with the communities that they serve.

SHEEHAN: 

And how do these workers help strengthen the relationship between the public health system and with better health,

KEARLY 

Yeah. So, they work directly with the communities that they provide services to, and those include services like coaching, navigation of health and social services, and social support. So, with their unique expertise of the communities and of health and social services, they're uniquely equipped to address both health and social needs. So, by establishing trust early on, CHWs can work with individuals to understand the social, cultural, and community context and make connections to social services to address the root causes of health outcomes.

SHEEHAN: 

And when considering, sort of, CHWs in the context of increasing access to care, it makes sense why it would be advantageous for people like CHWs and doulas to be- to be reimbursed by Medicaid.

KEARLY 

Yeah. So, there's now a large body of evidence demonstrating that CHWs and doulas can, in fact, improve health outcomes, particularly for disadvantaged populations with complex care needs, facing multiple comorbidities. So, for Medicaid programs, CHWs and doulas can improve health outcomes and the quality of care delivered. While CHWs have historically been supported by time-limited grants, and out-of-pocket costs for doulas are often out of reach for many, Medicaid offers a sustainable financing mechanism for both of these types of services. In addition, Medicaid reimbursement often requires a CHW to work with a Medicaid billing provider, which can allow the CHW to be a more integral part of their clinical care team. It's also important to keep in mind that Medicaid reimbursement is only allowable for specific eligible services, whereas CHWs may provide additional comprehensive wraparound services. So, states should consider comprehensive funding approaches to ensure that CHWs are able to provide a wide array of both clinical and social services,

SHEEHAN: 

Yeah, especially considering, as you just mentioned, how CHWs are, sort of, these- these parts of the community that are really, sort of, important to keeping those- those connections.

KEARLY 

Exactly.

SHEEHAN: 

So, in continuing to talk about, sort of, expanding access to care, rural communities face particular challenges and specific challenges. Could you discuss why residents in rural areas have a harder time?

KEARLY 

Yeah, so, about 80% of rural communities are considered to be medically underserved. These communities face health care provider shortages in areas such as primary care, maternal health, dental, and mental health. There's a projected shortage of about 90,000 primary care providers by the year of 2037, which will particularly impact rural communities. Rural communities also face hospital closures that have resulted in health care deserts. Financial stress is the primary cause of these closures, often due to low patient volume and greater vulnerability to economic fluctuation. These closures particularly impact access to maternity care, with patients living in rural communities facing lower access to prenatal care services and experiencing higher rates of preterm births.

SHEEHAN: 

Yeah, that seems like a very distressing statistic. What steps can- can states take to help out their rural residents?

KEARLY 

Yeah, so, states can consider a number of solutions to expand access to care in rural areas. They can consider expanding access to telehealth through a number of different ways. They can allow for reimbursement of audio-only telehealth interactions and consider remote patient monitoring initiatives. Audio-only telehealth ensures that patients can still talk to their providers, even if they don't have a video-enabled device or live in an area with low broadband connection. In addition, remote patient monitoring is particularly impactful for people with chronic diseases, as it allows more real-time health information to be collected, and providers can address changes with health indicators early on. In addition, broadband initiatives can support patients interacting with providers or receiving services via other forms of technology. Through the CMS-led Rural Health Transformation Program, many states are proposing efforts to invest in workforce retention and recruitment programs, enhance technology innovation through investment in electronic health records for rural facilities, and expanding interoperability through regional and state health information exchanges. States can also consider advancing systems of care, including regional hospital networks, mobile health, and community paramedicine initiatives. And states also are thinking about expanding efforts to bolster access to care and maternal health, behavioral health, and food as medicine initiatives to address chronic disease.

SHEEHAN: 

Well, Alex Kearly, thanks so much for checking in with us on the Prospectus.

KEARLY 

Thanks so much.

SHEEHAN: 

Alex Curley is ASTHO's senior director of population health. She joined us as part of our Legislative Prospectus Series, examining the policy trends set to shape public health in 2026.

Where we live, learn, work, and play shapes our health, but funding solutions for the social determinants of health isn't simple. Discover how braiding and layering funding can help sustain initiatives that improve access to food, housing, and transportation. In this new series of white papers, explore real-world case examples and best practices for using multiple funding streams to support shared SDOH goals. Learn what works, what lasts, and how to build sustainable solutions that advance health equity. Find a link to resources in the show notes.

Join Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health and ASTHO President, and John Auerbach, senior vice president for public health, ICF, for an Insight and Inspiration webinar that examines how clear, purposeful leadership strengthens both internal and external trust through discussion and reflection. We will examine how leaders embody steadiness amid uncertainty, set a sustainable pace, and provide calm direction that builds trust and drives performance. This conversation aims to inspire participants to recognize their composure and capacity, not as a personal indulgence, but as a fundamental leadership function that shapes the overall tone, focus, and confidence of their organizations. Join us for this 'Steady Hands, Steady Teams: Leading with Confidence and Composure' session happening February 11 at 4 p.m. Eastern. The link to register is in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.