February 19, 2025
IU faculty members advocate for community health workers in Indiana: IU News

Across the world, community health workers serve as a trusted source for health education, social support, and navigating health and social services. Research shows that these professionals address gaps in health care and lower health care costs.

As this profession grows in Indiana, two Indiana University faculty members are conducting research to generate data and policy recommendations to support this critical workforce.

The project, funded by the Indiana Department of Health, is led by Dr. Debra Litzelman, director of education for the IU Center for Global Health Equity and faculty member at the IU School of Medicine, and Michael Scanlon, health policy scholar for the center and adjunct faculty member at the IU Fairbanks School of Public Health.

Two women holding a notebook and talking Dr. Debra Litzelman, left, speaks with community health worker Matherne Esperance about her important role in the community. Photo courtesy of IU Center for Global Health Equity

“Community health workers serve as a vital resource in their communities, which are often lower income and facing many obstacles to accessing traditional health care services,” Litzelman said. “Growing this part of the health workforce will have a positive impact on health care access and costs, improve health literacy, and ultimately improve the health of Hoosiers in our state’s most vulnerable communities.”

Community health workers can have many different titles and work for a variety of programs and organizations. But their work is characterized by their close connection to community members and focus on personalized outreach, coaching, and linkage to services and support. The Bureau of Labor Statistics reports that Indiana had 980 community health workers in May 2023, out of more than 63,000 nationally, although these are likely underestimates given the various titles used for this type of work.

The WeCare program led by Litzelman employs community health workers to support pregnant women and new mothers from Indianapolis ZIP codes with the highest risk for infant mortality, with a goal of reducing maternal and infant mortality. An evaluation of the program found improvements in mental health, reductions in substance use and smoking, and increases in infant safe sleep practices and breastfeeding.

“I love the fact that I’m able to help others,” said Matherne Esperance, a WeCare community health worker. “That is something that I’ve always wanted to do. I love constant human interaction and being able to help different people no matter the background or where they’re from. I love knowing that I’m making a difference in my community.”

Over the past year, Litzelman and Scanlon have led a statewide survey of community health workers in Indiana, interviewed these workers’ employers and other key stakeholders, and conducted comparative policy analyses on how different states are supporting this workforce.

“There are many challenges to sustaining and growing the community health workforce, including sustainable funding and reimbursement for positions, ensuring that appropriate training and career development paths are available to community health workers, and addressing high levels of work-related stress faced by many of these workers,” Scanlon said. “While some of these challenges are unique to Indiana, many are shared by these professionals and organizations throughout the country.”

“The goal of the project is to generate data and policy recommendations to support and grow our state’s community health workforce,” Litzelman added. “In addition to the positive health outcomes, this will provide career opportunities in communities that often struggle with good jobs.”

A recent increase in Indiana’s Medicaid reimbursement rate is a positive first step toward this goal, Scanlon said.

“Indiana became only the second state to reimburse for community health worker services by the state Medicaid program through a state plan amendment in 2018,” he said. “But the rate was set at $9.70 for a 30-minute visit and remained unchanged until 2023.”

Through their research, Litzelman and Scanlon found that that reimbursement rate for a visit with a trained community health worker was tied for the lowest reimbursement rate in the country. They shared their findings with policymakers at the Family and Social Services Agency, and in 2024, the rate more than doubled, with an additional increase scheduled for 2025.

“We hope this increase will encourage more organizations to examine how their programs could benefit from hiring community health workers and utilize this reimbursement mechanism as a sustainable funding source,” Scanlon said.

The IU team works in collaboration with other organizations, including the Indiana Department of Health, Purdue University Center for Heath Excellence, Quality and Innovation, and Indiana Community Health Workers Association, as well as local health departments, health systems and community organizations. In September, Litzelman and Scanlon co-led a Community Health Worker Sustainability Summit that brought together over 70 individuals from academic institutions, health systems, state and county health departments, and community-based organizations in Indiana.

“In the future we plan to set up pilot programs and a dashboard for community health workers, employers and policy makers that houses useful information and recommendations about community health worker sustainability,” Litzelman said. “We hope to see Indiana become a leader in supporting and funding this critical workforce that will have so many positive impacts on the health of Hoosiers.”

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