This story was reported and written by VPM News.
Community health workers employed by local health departments won funding in Virginia’s newly signed fiscal 2025 and 2026 budget. Bipartisan legislation that would have allowed some CHWs’ work to be reimbursed by Medicaid failed.
The new money came as the federal grants that had funded state CHW jobs during the early COVID-19 pandemic were starting to end. The resulting funding cliff could have left more than 100 community health workers out of a job in the next two years, significantly impacting many state health initiatives.
The budget amendment was led by Del. Mark Sickles (D–Fairfax County) and state Sen. Lashrecse Aird (D–Petersburg). Virginia’s fiscal year runs from July 1 through June 30.
“CHWs have proven their critical value to families which led to my initial efforts to improve access to their services in 2020,” said Aird. “I am proud to have worked with the Virginia Interfaith Center advocates and Delegate Sickles in the House to secure funding and ensure we do not go backwards and the life-saving work of CHWs will go on in our communities.”
The Virginia Department of Health also celebrated the funding. Dr. Susan Fischer Davis, chief deputy commissioner for community health services, said the agency “is grateful to the governor and General Assembly for including this funding in the upcoming biennial budget.”
Community health workers are on-the-ground public health staffers who often come from within the communities they serve. Their work has been essential in the Virginia Department of Health’s COVID-19 vaccination efforts, opioid-overdose reversal training, STI prevention and other initiatives around the commonwealth.
The profession has grown in Virginia by more than two-thirds in the last five years, Bureau of Labor Statistics data shows. Some of that is due to increasing recognition the workers can often simultaneously improve health outcomes and cut costs. It’s also because of an explosion in federal grants, often from the Centers for Disease Control and Prevention, that were available during the first years of COVID-19 and allowed local health departments to hire CHWs to address disparities.
Their work often serves communities that had rarely been acknowledged by mainstream U.S. public health institutions like people of color in rural areas, people experiencing addiction and others.
Gov. Glenn Youngkin did not include funding for CHWs in his initial budget proposal last year. But the General Assembly added the new funding to the two-year budget in an amendment that made it into the version he went on to sign.
Youngkin did not respond to VPM News/WMRA’s request for comment.
“It means a victory because now we can see, in monetary figures, the investments that local governments are making into the workforce,” said Shanteny Jackson, executive director of the Virginia Community Health Worker Association. “Particularly starting with local health departments, who now are able to put aside their concerns in terms of sustaining a program.”
Jackson, who is also a CHW, added, “But most importantly, it means that communities will be able to receive the care that they need.”
VPM News/WMRA broke the news about the CHW funding cliff late last year. Around that time, a mixture of advocacy, policy research and nonpartisan CHW groups came together to mount a significant effort to secure sustainable funding for the workers.
In addition to health departments, CHWs are also employed by hospitals, schools and other institutions. Virginia has 1,380 CHWs, according to the most recent Bureau of Labor Statistics data.
The average pay for a CHW employed at one of Virginia’s local health districts was $50,141 as of July, 2023, according to internal health department documents VPM News/WMRA obtained earlier this year.
The new Virginia budget includes $6.4 million for CHWs at local health districts, spread across two years. That means the funding could cover as many as 64 CHWs’ work for the next two years. But the actual number will likely be less because that doesn’t account for expenses like laptops, cell phones, training and benefits like health insurance.
The Virginia Department of Health employed 112 CHWs as of July of last year, according to internal health department documents. However that was likely an undercount because the documents only include CHWs employed at 25 of the commonwealth’s 35 local health districts.
That means potentially less than half of the known and at-risk positions will be funded as of July 1. Though the potential loss will likely be less severe because the grants that have funded the positions end on different dates over the next two years, making the funding cliff more like a staircase.
Kathryn Haines is health equity manager at the Virginia Interfaith Center for Public Policy and was instrumental in securing the new funding. She said part of the reason the money might not cover all health department CHW jobs is because it wasn’t clear how many CHWs there were.
“Not everybody filled out the survey,” Haines explained. “We got exactly what we needed based on what we knew. Virginia Beach didn't fill it out. So what does that mean? Did Virginia Beach need the money? I think so, but I can't tell you that for sure.”
The money came with the condition this year that VDH would prioritize using money from federal grants if they’re extended, potentially allowing some state money to return to the general fund. Fischer Davis said the agency is in the process of determining what grants have approved no cost extensions beyond the end of June.
“Once that has been determined, we will work with [the Department of Planning and Budget] to reduce the [2025 Fiscal Year] appropriation by an appropriate amount,” Fischer Davis said.
Fischer Davis did not directly answer questions from VPM News/WRMA about how much of the new state funding they expected to need this year and if the money would cover all CHWs’ jobs or if they’d have to lay some people off.
“There are many sources of funding used to support the establishment of Community Health Workers in health districts,” she said in response to those questions. “These includes 100% local funds, non-federal grants from local or national organizations, and the cooperative budget. Some are city or county employees, some are part of a non-profit. Funding source may be considered.”
Virginia’s total budget amounted to $188 billion for the next two years, with $63.5 billion of that being spent on the Office of Health and Human Resources, where the CHW outlays will come from.
With funding secured for the next two years, CHWs and their allies are turning their attention to finding sources of longer-term support.
The failed Medicaid reimbursement legislation would have allowed some of the services state certified CHWs provide to Medicaid-enrolled Virginians to be reimbursed by the national insurance program for low income Americans.
More than 20 states currently reimburse some CHW services, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission. In recent years, Virginia has approved similar Medicaid reimbursement policies for state-certified doulas and certified peer-recovery workers.
Advocates and CHWs have already refocused their efforts.
“It is still a goal,” Haines said. “There were a number of Medicaid benefits that were asked for this session and it's just not possible. DMAS is only so large … I think part of what happened is that it was a tight budget year, and there were a lot of asks of Medicaid.”
A big part of future efforts to secure funding, according to Jackson, will be conducting research that shows what CHWs do and the return on investment they bring. Jackson said that while national data on CHW effectiveness is clear, there’s currently a shortage of localized data.
“I think this is the beginning of the intentional collection of data,” she said. “How can we measure the reach of community health workers or the effectiveness of a community health worker if we're not tracking that data? And then, most importantly because it boils down to a bottom line, the return on investment.”
And early Virginia research does back up national conclusions. A 2017-18 CHW initiative in Danville aimed at lowering emergency room visits succeeded by between about 20% and 75% for various patient groups. And a 2016 CHW pilot program by Sentara saved $1.1 million on a $342,000 investment, while also lowering hospital admissions.
The new funding came with the conditions that it prioritizes localities with the highest rates of maternal mortality. The agency said it’s in the process of determining what health districts will get the money.
“We are in the process of reviewing the most recent data to identify districts where there is the highest burden of maternal morbidity and mortality,” said Fischer Davis. “After considering these factors … VDH will allocate these positions to health districts.”
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