Sec. 401. Coverage of Community Health Worker services under Medicare and Increased FMAP for Community Health Worker services
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Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (s)(2), by adding at the end the following new subparagraphs: professional services furnished by a community health worker (as defined in subsection (nnn)) on or after October 1, 2026; certified community behavioral health clinic services (as defined in section 1905(jj)) furnished on or after October 1, 2026; ; and by adding at the end the following new subsection: The term community health worker means an individual who is a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served that enables the worker to build trusted relationships, serve as a liaison or link between health and social services and the community, facilitate access to services, improve the quality and cultural competence of service delivery, build individual and community capacity, and increase health knowledge and self-sufficiency through a wide range of community health worker core roles, including through— providing cultural mediation among individuals, communities, and health and social service systems; providing culturally appropriate health education and information; providing care coordination, case management, and system navigation; providing coaching and social support; advocating for individuals and communities; building individual and community capacity; providing direct service, including basic screening tests, such as weight and blood pressure screening, basic services such as diabetic foot checks, and meeting basic needs; implementing individual and community assessments; conducting outreach; and participating in evaluation and research .
Section 1833 of the Social Security Act ( 42 U.S.C. 1395l ) is amended— in subsection (a)(1)— in subparagraph (GG), by striking and at the end; and by inserting before the semicolon at the end the following: , and
(II)with respect to professional services furnished by a community health worker (as defined in section 1861(nnn)) and certified community behavioral health clinic services (as defined in section 1905(jj)), the amounts paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary for such services ; and in subsection (b)— by striking , and
(13)and inserting
(13); and by striking 1861(n). and inserting 1861(n),
(14)such deductible shall not apply with respect to professional services furnished by a community health worker (as defined in section 1861(nnn)), and
(15)such deductible shall not apply with respect to certified community behavioral health clinic services (as defined in section 1905(jj)) . Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended— in paragraph (31), by striking and at the end; by redesignating paragraph
(32)as paragraph (33); and by inserting after paragraph
(31)the following new paragraph: beginning on October 1, 2026, professional services furnished by a community health worker (as defined in section 1861(nnn)); and . Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— in subsection (b), by striking and
(ii)and inserting (ii), and
(kk); and by adding at the end the following new subsection: For each fiscal quarter beginning on or after October 1, 2026, the Federal medical assistance percentage for a State shall be increased by 6 percentage points with respect to amounts expended by the State for medical assistance for professional services furnished by a community health worker (as defined in section 1861(nnn)). .
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Sec. 401
Coverage of Community Health Worker services under Medicare and Increased FMAP for Community Health Worker services
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