Community health workers, Republicans disagree over who should pay for their services

Understanding the impact of a community health care worker requires connecting the dots. Paula Smith, director of the Southern New Hampshire Area Health Education Center, did that for lawmakers recently while asking them to secure funding for that workforce.

A New Hampshire community health care worker she knows was asked to check in on a man living in his van. She helped the man get glasses, which allowed him to get a job. With a job, he was able to afford an apartment. With housing and employment secure, he had a better chance of avoiding health problems.

“Helping to build an individual’s capacity to care for themselves is a fundamental part of the (community health care worker’s) role,” Smith said. When people are healthy, health experts argue, they are not using limited resources, like emergency rooms and medical appointments.

Health care leaders moved a step closer to securing the funding Thursday with the House’s passage of Senate Bill 403, which would allow community health workers to receive Medicaid reimbursement if they opted to be state certified. Currently, workers cover their services with grant funding; when a grant ends, their services often end unless they can find another grant.

But Thursday’s 188-178 party-line House vote suggests the bill still faces hurdles as it heads next to the Republican-controlled House Finance Committee. Members could recommend the full House change or defeat the bill when it returns to the floor for a second vote.

How to follow a bill and share your thoughts with NH lawmakers

House Republicans have raised concerns about the estimated $4.2 million annual cost of expanding Medicaid coverage to community health workers. Though, the Department of Health and Human Services aims to cover the expense with existing federal funding.

The department is among those supporting the proposed Medicaid funding. Patricia Tilley, director of the Division of Public Health Services, told lawmakers during a hearing that the state’s 100 community health care workers in New Hampshire have served almost 10,000 people since 2021.

Wanda Castillo-Diaz has been a community health care worker in New Hampshire for almost 24 years, most of those for Amoskeag Health, a primary care provider in Manchester. She currently works for the Manchester Health Department. Her daughter has followed in her footsteps and works with Nashua’s Public Health and Community Services Department 

“We basically fill in the gap between community health and social services,” Castillo-Diaz said in an interview last week. In Manchester, that can be following up with people who call the police frequently seeking help not for criminal matters but basic needs like food, medication they can’t afford, or transportation. In other communities, community health workers help residents monitor glucose levels or connect with nutritional counseling. Often the nature of the grant dictates the services they offer. 

“As long as there are individuals in need in the community, community health workers are needed,” Castillo-Diaz said. “It does not matter if it’s around health education, human services, or public safety.”

Dr. Paul Friedrichs, now retired after 35 years of practice on the Seacoast, told lawmakers the bill is a “slam dunk.”

“It is critical to our patients and makes a big difference in the long run,” he said. “It saves a lot of money by helping us keep people out of emergency rooms, in their own homes, and out of the hospital and nursing facilities.”

As a community health worker for Lamprey Health Care, Sue Gigliotti is a big part of the follow-up care for patients at risk of heart disease, the state’s leading cause of death in 2022, according to the Centers for Disease Control and Prevention. 

Gigliotti helps them get free gym memberships and learn how to manage chronic conditions like diabetes, high cholesterol, hypertension, and obesity. She follows up with them for the next six months, to check in on their progress and help them work around challenges. 

Grant funding also covers a second program for women at risk for breast and cervical cancer. Gigliotti can offer free mammograms, breast exams, Pap smears,  physicals, and lab tests to eligible women. 

“There are just huge benefits to this program, not only with their physical health but also their mental health,” Gigliotti said.

An 82-year-old woman she worked with wanted to begin practicing yoga for the health benefits but was concerned she did not have the arm or leg strength to do it. Gigliotti was able to connect her with a personal trainer for free.

When Gigliotti checked in on her, the woman had developed the strength to practice yoga – and more.

“She said it gets her out of the house, interacting with people, and she was making friends,” Gigliotti said. “All those benefits are just huge. They may look small but that was a big big win for us.”