Community health workers (CHWs) have well-documented effectiveness in health promotion and patient navigation. Medicaid policy allow billing for CHW services – adopted by 29 states to-date; yet implementation challenges exist. Using a mixed-methods community-based participatory research design, we examined implementation barriers and facilitators of the Medicaid CHW Benefit across California.

Key-informant interviews (N=39) and surveys (N=38) were conducted with community-based organizations, health plans, and health jurisdictions. Surveys included: Organizational Readiness for Change Assessment, Program Sustainability Assessment Tool, and Organizational Readiness for Implementation Assessment. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed using a hybrid inductive-deductive coding approach, informed by the Consolidated Framework for Implementation Research.

Findings revealed significant implementation barriers including financial sustainability concerns, low reimbursement rates, and administrative burden. All stakeholders, particularly community-based organizations, endorsed not having the necessary financial resources for implementation (2.9 on 1-5 scale). Interviews revealed ramp-up costs (including billing IT systems) as an implementation barrier, particularly for small organizations. High enthusiasm and leadership support were reported (5.9 on 1-7 scale); yet stakeholders emphasized staffing limitations. Conversely, facilitators included external funding sources, technical assistance support, and high commitment to implement the benefit (4.5 on 1-5 scale).

Infrastructure changes are necessary to further support program implementation. Additional avenues for financial sustainability and strategies to reduce administrative burden are recommended as priorities. Study findings provide actionable insights for timely solutions that better support the social services landscape through further integration of the CHW workforce.