Georgia Medicaid Community Health Workers: A Complete Guide to CHW Coverage Pathways, Maternal Health, and Workforce

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Last verified May 12, 2026

Community Health Workers (CHWs) are frontline public health workers who serve as a trusted bridge between communities and the health and social service systems that exist to support them. In maternal health, CHWs and doulas reduce maternal mortality. In chronic disease, CHWs improve adherence and outcomes. In behavioral health, peer support specialists support recovery. In social drivers of health, CHWs connect people to housing, food, and transportation. The federal Medicaid framework supports CHW coverage through several pathways. Georgia's Medicaid program is steadily expanding CHW-adjacent coverage, anchored by the 2024 doula benefit and the longstanding peer support workforce, with significant room to grow.

This guide explains how Section 1905(a)(13) of the Social Security Act and 42 CFR 440.130(c) authorize preventive services coverage, how CMS State Health Official letter SHO #13-002 and the 2014 Preventive Services final rule permit non-licensed CHWs to deliver services under state plan amendments, how Section 1115 maternal health and HRSN demonstrations expand CHW coverage, how In Lieu of Services under 42 CFR 438.3(e) and SMD #23-001 allow managed care plans to pay for CHW services, how Targeted Case Management under 42 CFR 441.18 and HCBS waivers under Section 1915(c) support CHW roles, how ACA 2010 §5313 HRSA grants and ACA §5403 workforce strategic plan build CHW infrastructure, how Georgia's maternal mortality crisis drives demand for CHW investment through DPH MMRC and the 2024 doula benefit, how FQHCs and 340B funding support CHW staff, and how Georgia families across Atlanta, Macon, Savannah, Albany, Augusta, Columbus, and rural communities access CHW services. :::

::: callout title="Key takeaways"

• A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of, or has an unusually close understanding of, the community they serve. The American Public Health Association definition is widely adopted; the C3 Project codified ten core CHW roles.
• CHWs go by many titles: promotor/promotora de salud, lay health worker, peer support specialist, community health representative, patient navigator, doula, peer recovery specialist.
• CHWs improve outcomes across multiple domains: maternal mortality, hypertension, type 2 diabetes, asthma, behavioral health, HIV care continuum, cancer screening.
• Federal Medicaid does not have a single "CHW benefit." Coverage flows through multiple authorities including state plan preventive services, Section 1115 demonstrations, In Lieu of Services, targeted case management, and HCBS waivers.
• Section 1905(a)(13) preventive services authority allows states to cover non-licensed CHWs through a State Plan Amendment when services are recommended by a physician or licensed practitioner. CMS SHO #13-002 and the 2014 final rule established this pathway.
• Section 1115 maternal health demonstrations in NY, NJ, CA, MA, NC, IL, and other states explicitly include CHW and doula services. Health-Related Social Needs (HRSN) demonstrations in NC, OR, WA, MA, AZ, and NJ include CHW navigation alongside housing, nutrition, and transportation supports.
• In Lieu of Services (ILOS) under 42 CFR 438.3(e) and CMS SMD #23-001 allow managed care plans to provide CHW-style services as cost-effective substitutes for State Plan services.
• Georgia covers doulas in Medicaid. DCH submitted a State Plan Amendment covering doula services for prenatal, labor and delivery, and postpartum care, which has been approved by CMS.
• Georgia covers behavioral health peer support. Certified Peer Specialists (CPS) credentialed by DBHDD deliver Medicaid-billable peer support services as rehabilitative services under Section 1905(a)(13).
• Georgia has extended postpartum Medicaid to 12 months. Adopted via SPA, this benefit extends Medicaid coverage from 60 days to 12 months postpartum.
• The Georgia Maternal Mortality Review Committee (GA MMRC) reports the majority of pregnancy-related deaths are preventable. Black women die at significantly higher rates than white women.
• Georgia does not yet have a statewide CHW certification system or a comprehensive Medicaid CHW State Plan Amendment as of 2026. FQHCs, hospital systems, and DPH districts employ CHWs through grants, hospital community benefit, and PPS-funded operations.
• Federal Section 340B drug pricing supports CHW funding at FQHCs and other qualifying entities. :::

What is a Community Health Worker?

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of, or has an unusually close understanding of, the community they serve. CHWs serve as a liaison between health, social services, and the community to facilitate access to services and improve the quality and cultural competence of service delivery. They build individual and community capacity by increasing health knowledge and self-sufficiency through outreach, community education, informal counseling, social support, and advocacy.

The American Public Health Association (APHA) developed this widely-adopted definition. The C3 Project (Community Health Worker Core Consensus Project) further codified ten core CHW roles:

1. Cultural mediation among individuals, communities, and health and social service systems
2. Providing culturally appropriate health education and information
3. Care coordination, case management, and system navigation
4. Providing coaching and social support
5. Advocating for individuals and communities
6. Building individual and community capacity
7. Providing direct service (e.g., screening, basic clinical tasks)
8. Implementing individual and community assessments
9. Conducting outreach
10. Participating in evaluation and research

CHWs go by many titles depending on setting and community:

• Promotor / promotora de salud
• Lay health worker / lay health advisor
• Peer support specialist
• Peer recovery specialist
• Community health representative (CHR), used in tribal settings
• Patient navigator
• Doula (specific to pregnancy/birth/postpartum)
• Health coach
• Family partner / parent peer specialist

What unifies these roles is a model of trusted community-based workers who improve health by improving relationships, navigation, knowledge, and connections.

Why CHWs matter

Maternal mortality

The United States has the highest maternal mortality rate among high-income nations, and the rate is rising. Georgia consistently ranks among the states with the highest maternal mortality rates. The Georgia Maternal Mortality Review Committee (MMRC) reports that:

• The majority of pregnancy-related deaths are preventable
• Black women in Georgia die at significantly higher rates than white women
• Behavioral health (depression, substance use, intimate partner violence) and chronic disease (hypertension, cardiomyopathy) drive significant proportions of deaths
• The postpartum period is the highest-risk period (the majority of maternal deaths occur after delivery)

Multiple studies and randomized trials show CHWs and doulas reduce maternal morbidity, improve prenatal care use, increase breastfeeding rates, reduce cesarean delivery, and increase patient satisfaction. The American College of Obstetricians and Gynecologists (ACOG) endorses doula support.

Chronic disease management

Randomized trials and quasi-experimental studies show CHWs improve outcomes in:

• Hypertension: Lower systolic and diastolic blood pressure with CHW-supported self-management
• Type 2 diabetes: Lower HbA1c with CHW-supported self-management
• Heart failure: Reduced 30-day readmissions with CHW transitional care
• Asthma: Reduced ED visits, improved controller medication adherence with CHW home-based interventions
• HIV care continuum: Improved linkage to care, retention in care, and viral suppression
• Cancer screening: Higher mammography, colorectal screening rates with CHW outreach

The Penn Center for Community Health Workers IMPaCT model, the MOMI (Mothers and Children Initiative) trials, and many other studies have demonstrated statistically significant and clinically meaningful improvements.

Behavioral health

Peer support specialists (a CHW role specific to behavioral health) improve engagement with mental health and substance use disorder treatment, reduce hospitalization, and support long-term recovery. Georgia's DBHDD operates a Certified Peer Specialist (CPS) program that has been in place since the early 2000s. Peer support is Medicaid-billable in Georgia.

Health-related social needs

CHWs effectively connect people to non-medical resources that drive health outcomes:

• Housing assistance and rental subsidies
• Food security programs (SNAP, WIC, food pantries, medically tailored meals)
• Transportation services (NEMT, rural transit)
• Employment services
• Legal aid for benefits, immigration, and family law
• Intimate partner violence services

Medicaid is increasingly funding social driver of health services through Section 1115 demonstrations and In Lieu of Services arrangements. The CHW workforce is central to implementing these initiatives.

Federal Medicaid pathways for CHW coverage

There is no single "CHW benefit" in federal Medicaid law. Instead, multiple authorities can be used to cover CHW services.

Section 1905(a)(13) preventive services

Section 1905(a)(13) of the Social Security Act includes "other diagnostic, screening, preventive, and rehabilitative services" as an optional Medicaid benefit. 42 CFR 440.130(c) defines preventive services as "services provided by a physician or other licensed practitioner of the healing arts within the scope of practice under State law to prevent disease, disability, and other health conditions or their progression."

Historically, federal regulation required preventive services to be provided by a licensed practitioner, which effectively excluded most CHWs from billing for preventive services as a distinct Medicaid service.

The 2013 CMS State Health Official letter SHO #13-002 and the 2014 final rule (Update on Preventive Services Initiatives) changed this. The rule clarified that preventive services covered under 42 CFR 440.130(c) may be provided by:

• A licensed practitioner
• Other practitioners as defined by the state when the service is recommended by a physician or other licensed practitioner

This means a state can submit a State Plan Amendment (SPA) to cover CHW-delivered preventive services as long as a physician or other licensed practitioner recommends the service. The recommendation can be a standing order or a referral. The CHW does not need to be licensed.

A growing number of states have adopted CHW SPAs covering some range of preventive services. Common covered services include:

• Health education (e.g., chronic disease self-management classes)
• Self-management coaching (one-on-one)
• Navigation (connecting to clinical care, social services)
• Home assessment for environmental triggers (e.g., asthma triggers, fall risks)
• Care coordination (between primary care, specialty, behavioral health)
• Screening (e.g., social driver of health screening)

Georgia has not yet submitted a comprehensive CHW SPA as of 2026. Doula services are covered under a separate approved SPA.

Section 1115 demonstrations

Section 1115(a) of the Social Security Act allows the Secretary of HHS to waive certain Medicaid requirements and approve demonstration projects that further the objectives of the Medicaid program. Several types of Section 1115 demonstrations support CHW coverage:

Maternal health Section 1115 demonstrations: New York, New Jersey, California, Massachusetts, North Carolina, Illinois, and other states have approved or pending demonstrations that explicitly include CHW services, doula services, and related supports for maternal health. These demonstrations are part of CMS's Maternal Health Strategy.

Health-Related Social Needs (HRSN) Section 1115 demonstrations: North Carolina (Healthy Opportunities Pilots), Oregon, Washington, Massachusetts (MassHealth), Arizona, and New Jersey have approved demonstrations that include:

• Nutrition supports (medically tailored meals, food prescriptions)
• Housing supports (rental assistance, utility assistance, housing transition services)
• Transportation (NEMT plus non-medical)
• CHW navigation services

CMS's 2022-2023 HRSN framework guidance set parameters for these demonstrations. HRSN services in these demonstrations are explicitly time-limited and targeted to specific populations (e.g., people with specific clinical conditions plus specific social risks).

Workforce Section 1115 demonstrations: Some states have used Section 1115 authority to expand health workforce, including CHW training and infrastructure investments.

Georgia's current Section 1115 demonstration is Pathways to Coverage, which is narrow and focused on work-requirement-conditioned coverage expansion. It does not include CHW or HRSN provisions.

In Lieu of Services (ILOS) under 42 CFR 438.3(e)

42 CFR 438.3(e)(2) and CMS State Medicaid Director Letter SMD #23-001 allow Medicaid managed care plans to provide In Lieu of Services (ILOS), services that are not covered under the State Plan but that are medically appropriate, cost-effective substitutes for State Plan services. ILOS are paid from the plan's capitation; they do not count as a State Plan benefit for the member.

Examples of ILOS that include CHW-adjacent services:

• Housing transition services as ILOS for nursing facility level of care
• Home modifications as ILOS
• Medically tailored meals as ILOS for cardiac/diabetes patients
• CHW navigation as ILOS for high-risk members

Georgia's CMOs (Amerigroup, CareSource, Peach State Health Plan) can negotiate ILOS in their contracts with DCH. As of 2026, Georgia CMOs use case management (provided as part of the capitation) rather than explicit ILOS arrangements for CHW-like services. Future contract cycles may include more formal ILOS provisions.

Targeted Case Management (TCM)

42 CFR 441.18 and Section 1915(g) of the Social Security Act authorize Targeted Case Management as an optional Medicaid State Plan benefit. TCM provides assistance to eligible individuals in gaining access to medical, social, educational, and other services. CHWs can deliver TCM services where the state has adopted TCM with a target group definition that fits the CHW caseload.

TCM target groups in Georgia include:

• Certain pregnant women (high-risk)
• Infants
• Foster care children
• Certain disability populations
• Substance use disorder populations

The TCM benefit is delivered through providers contracted with DCH or through CMO case management.

Section 1915(c) HCBS waivers

Section 1915(c) waivers can include CHW services as a waiver service. Common CHW-adjacent services in HCBS waivers include:

• Case management / care coordination
• Community living supports
• Family education
• Crisis intervention
• Peer mentoring

Georgia's seven 1915(c) waivers (CCSP, SOURCE, ICWP, NOW, COMP, Katie Beckett, Georgia Pediatric Program) include case management and care coordination, often delivered by staff who function like CHWs.

Federally Qualified Health Centers (FQHCs) and 340B

FQHCs receive enhanced Medicaid reimbursement under Section 1902(bb) of the Social Security Act (Prospective Payment System rates). Many FQHCs employ CHWs as part of their care team, and the cost is built into the FQHC PPS rate. CHWs at FQHCs are typically not separately billable but are funded through the PPS reimbursement.

The 340B Drug Pricing Program (Section 340B of the Public Health Service Act, 42 USC 256b) provides FQHCs and other qualifying entities with discounted drug pricing. The savings can be used to fund additional services including CHW staff. Many Georgia FQHCs use 340B savings to support CHW programs.

ACA workforce provisions

ACA 2010 §5313 authorized HRSA grants for CHW development. ACA §5403 included CHWs in the federal Health Workforce Strategic Plan. ACA §3501 authorized the Primary Care Extension Program, which supports CHWs and team-based primary care.

Funding under these ACA provisions has been variable depending on annual appropriations. HRSA grants continue to fund CHW training, certification infrastructure, and integration into primary care. Several Georgia institutions (Morehouse School of Medicine, Mercer School of Medicine, Augusta University MCG) have received HRSA workforce grants supporting CHW initiatives.

Anti-Kickback Statute and Stark concerns

When CHWs are hired by providers and provide services to Medicaid beneficiaries, structures must comply with the federal Anti-Kickback Statute (42 USC 1320a-7b) and Stark Law (42 USC 1395nn). Safe harbors and exceptions exist for common CHW arrangements including:

• Employed CHWs at FQHCs and clinical practices
• Community-based safe harbor for certain free or below-FMV services to beneficiaries
• Charitable provision of services
• Patient navigation safe harbors

Federal guidance on AKS safe harbors specifically applicable to CHW programs has expanded since 2020.

Georgia's maternal mortality crisis and CHW policy response

Georgia has one of the highest maternal mortality rates in the United States. The Georgia Maternal Mortality Review Committee (GA MMRC), established under DPH, reviews every pregnancy-associated death to identify causes and prevention opportunities. Annual MMRC reports consistently find:

• The majority of pregnancy-related deaths are preventable
• Racial disparities are stark, with Black women dying at significantly higher rates than white women
• Behavioral health drives a significant portion of deaths
• The postpartum period is the highest-risk period

GA MMRC findings have driven several policy responses:

Pregnancy Medical Home Initiative

GA DPH operates a Pregnancy Medical Home initiative through public health districts and partner providers. The initiative emphasizes coordinated care, screening for social drivers of health, and connection to community supports.

Healthy Mothers, Healthy Babies

A statewide coalition focused on maternal and child health, supporting community-based services and CHW-adjacent work. The coalition operates a statewide helpline at 1-800-822-2229.

Doula coverage (2024)

DCH submitted a State Plan Amendment, approved by CMS, to cover doula services for Medicaid-eligible pregnant women. Doula coverage in Georgia Medicaid includes:

• Prenatal visits (multiple visits during pregnancy)
• Labor and delivery support
• Postpartum follow-up visits

Doulas must be enrolled with DCH as Medicaid providers and meet training requirements set by DCH. Reimbursement is set in the Medicaid fee schedule. This is the most significant CHW-adjacent Medicaid benefit Georgia has added in recent years.

Postpartum coverage extension to 12 months

The American Rescue Plan Act of 2021 and subsequent CMS guidance allowed states to extend postpartum Medicaid coverage from 60 days to 12 months. Georgia adopted the 12-month extension via state plan amendment. This extension is critical for behavioral health treatment, chronic disease management, and continued CHW/doula support during the highest-risk postpartum period.

Section 1115 maternal health potential

Several advocacy groups and providers have urged Georgia to pursue a Section 1115 maternal health demonstration similar to those approved in other states (NY, NJ, CA, MA, NC). As of 2026, no such demonstration has been submitted by Georgia.

Georgia's behavioral health peer support workforce

Georgia has a more established peer support workforce in behavioral health. Through DBHDD, Georgia has:

Certified Peer Specialists (CPS): DBHDD-credentialed peer specialists deliver peer support services in mental health treatment settings. The CPS program has been in place since the early 2000s. Training is provided by DBHDD-approved providers; certification requires completion of training, supervised practice, and an examination.

Certified Addiction Recovery Empowerment Specialist (CARES): A recovery support workforce specifically for substance use disorder. CARES is also DBHDD-credentialed and Medicaid-billable.

Parent Peer Specialists: For families of children with serious emotional disturbance. Particularly important for children in the foster care and juvenile justice systems.

Peer support reimbursement: DCH covers peer support services in the Medicaid State Plan as rehabilitative services under Section 1905(a)(13). Reimbursement is set in the Medicaid fee schedule. Peer support is delivered in clinical settings, community-based organizations, and (increasingly) FQHCs.

These peer support roles are a longstanding example of CHW-adjacent workforce in Georgia's Medicaid system.

Georgia's existing CHW-adjacent workforce

Beyond formal Medicaid coverage, CHW-like work happens across Georgia in:

FQHCs and RHCs

Many Georgia FQHCs employ CHWs in chronic disease management, maternal health, and outreach roles. Examples include:

• Mercy Care (Atlanta)
• Albany Area Primary Health Care
• MedLink (Northeast Georgia)
• Curtis V. Cooper Primary Health Care (Savannah)
• East Georgia Healthcare Center
• South Central Primary Care Center (Cordele)

CHWs at FQHCs are funded through PPS reimbursement, 340B savings, HRSA grants, and (in some cases) state and federal demonstration funds.

Hospital systems

Children's Healthcare of Atlanta (CHOA) has a robust CHW program for pediatric asthma, food security, and high-risk family support. Other hospital systems with CHW initiatives include Emory, Piedmont, Wellstar, Phoebe Putney (Albany), Memorial Health (Savannah), and St. Mary's (Athens).

Public health districts

DPH's 18 public health districts employ outreach workers in various roles: HIV linkage and partner notification, WIC outreach and enrollment, immunization promotion, refugee health navigation, and pregnancy outcome improvement.

Community-based organizations

Many community-based organizations operate CHW-style programs in Georgia:

• Family Connection coalitions (statewide)
• Black Mamas Matter Alliance (Atlanta-based, national)
• SisterSong (Atlanta-based, national)
• Georgia Latino Health Initiative
• Georgia Refugee Health & Mental Health

Academic institutions

Morehouse School of Medicine (Community Engagement, Master's in Public Health programs), Mercer School of Medicine (Community Medicine), Augusta University MCG (community-based medical education), Emory Rollins School of Public Health (Maternal and Child Health Center), and Georgia State University School of Public Health all support CHW training, research, and program implementation.

The infrastructure exists. What's missing as of 2026 is a comprehensive Medicaid coverage framework that pays for these services consistently across settings.

CHW certification

There is no national CHW certification standard. Each state has its own (or no) certification framework.

Some states have established:

• State certification through the state health department or workforce agency
• Training curriculum standards
• Continuing education requirements
• Certification renewal cycles

Examples from other states:

• Texas: Certified Community Health Workers through Texas DSHS (one of the earliest state programs)
• Massachusetts: Massachusetts Department of Public Health certification
• Ohio: State certification through the Ohio Board of Nursing
• Minnesota: Statewide certification with college-level training
• Indiana: Certification through Indiana Department of Health
• Florida: Certification through Florida Certification Board

Georgia, as of 2026, does not have a statewide CHW certification system administered by DPH or DCH. Several training programs exist informally through:

• The Georgia Community Health Worker Association (GCHWA)
• Morehouse School of Medicine
• Mercer University School of Medicine
• Augusta University Medical College of Georgia
• Workforce development partnerships through DPH districts
• Children's Healthcare of Atlanta (CHOA) CHW training for pediatric chronic disease

A U.S. Department of Labor Registered Apprenticeship program exists nationally for CHWs, offering an industry-recognized credential.

Advocacy for a Georgia statewide CHW certification framework continues. Such a framework would support Medicaid State Plan Amendment submission, professionalize the workforce, and enable sustainable wages.

Worked example 1: Tasha 26 Atlanta pregnant, CHW-doula team

Tasha is pregnant with her second child. She has Medicaid (pregnancy category). She lives in southwest Atlanta in a ZIP code with high maternal mortality rates. Her CMO connects her with:

• A Medicaid-covered doula (under Georgia's doula SPA)
• The CMO's high-risk pregnancy case manager
• A CHW employed by her local FQHC who has a relationship with Tasha through her first pregnancy

The team works together across the perinatal period:

Prenatal (weeks 8-40):

• Doula meets with Tasha monthly initially, weekly in the third trimester
• CMO case manager calls monthly to check on prenatal visits, screen for warning signs, and address barriers
• FQHC CHW provides ongoing relationship-based support: rides to appointments, help understanding insurance, connection to WIC

Labor and delivery:

• Doula attends labor and birth at the hospital
• Doula provides continuous emotional and physical support
• Doula advocates for Tasha's preferences with hospital staff

Postpartum (12 months under the extended postpartum coverage):

• Doula visits weekly for the first 6 weeks
• Doula screens for postpartum depression (PHQ-9 administered at week 2 and week 6)
• Doula provides breastfeeding support, infant care guidance
• CMO case manager continues monthly contact
• FQHC CHW maintains the relationship and connects Tasha to ongoing pediatric and primary care

Outcomes:

• Tasha has a healthy pregnancy and birth
• Her postpartum depression is identified at week 4 (PHQ-9 of 14) and treated with therapy plus medication
• She breastfeeds successfully for 6 months
• She remains engaged in postpartum care through 12 months

This is the kind of integrated CHW-doula-clinical team that the federal Medicaid framework increasingly supports. Georgia's doula benefit and 12-month postpartum extension are key building blocks.

Worked example 2: Eleanor 78 Macon, Hypertension CHW home visits

Eleanor has uncontrolled hypertension (BP 180/100 at last visit) and lives alone after her husband's death two years ago. Her CMO's care management identifies her as high-risk based on multiple ED visits, missed primary care appointments, and uncontrolled BP. The CMO contracts with a community-based organization in Macon that employs CHWs.

The CHW, Brenda, begins working with Eleanor:

Initial weeks:

• Brenda visits Eleanor weekly
• Helps her organize medications in a pill box (Eleanor was confused about her medications)
• Coaches on healthy diet within her budget
• Identifies that Eleanor's stove is broken and connects her with a community resource for repair
• Identifies social isolation as a factor

Ongoing months 2-6:

• Visits transition to biweekly
• Brenda connects Eleanor with NEMT for medical appointments
• Eleanor enrolls in a senior center; Brenda accompanies her on the first visit
• Brenda coordinates with Eleanor's PCP, sharing observations and getting updates on the care plan
• BP logs are kept by Eleanor at home and reviewed with the PCP

Outcomes:

• Eleanor's BP comes down to 140/85 within 6 months
• ED visits drop to 0 in the 6 months after CHW involvement
• She attends the senior center twice a week
• Her medication adherence is high
• The community-based organization is reimbursed by the CMO through a case management arrangement built into the CMO contract

This is an example of how a CMO can use existing case management authority to fund CHW services in Georgia without a separate State Plan Amendment.

Worked example 3: Marcus 45 Albany, Diabetes FQHC-employed CHW

Marcus has uncontrolled type 2 diabetes (HbA1c 11.2 at presentation), hypertension, and obesity. He works full-time at a chicken processing plant. He gets his primary care at Albany Area Primary Health Care, an FQHC.

The FQHC employs CHWs as part of the diabetes care team. Marcus's CHW, Latrice, works with him:

Initial intervention:

• Latrice meets Marcus during his clinic visit and builds rapport
• Schedules ongoing phone and in-person contact
• Helps Marcus understand his medications (metformin, insulin, lisinopril) and how to take them
• Refers him to the FQHC's diabetes education classes
• Helps him use a glucose meter and log readings

Workplace barriers:

• Marcus's chicken processing plant has limited flexibility for medical appointments
• Latrice helps Marcus work with HR to get accommodations
• His work schedule is adjusted to allow morning appointments before his shift

Food insecurity:

• Latrice screens for food insecurity (positive)
• Connects him with a food pantry that has diabetes-friendly options
• Helps him apply for SNAP

Care team integration:

• Latrice attends weekly diabetes huddles at the FQHC
• She tracks Marcus's blood sugar logs and identifies patterns to discuss with the doctor
• She shares updates with his PCP

Funding: Latrice is paid by the FQHC's general operating budget, supported by:

• PPS Medicaid reimbursement (CHW costs are built into the all-inclusive rate)
• 340B drug pricing savings
• A HRSA workforce grant
• Hospital community benefit through partnership with Phoebe Putney

There is no separate Medicaid billing for her services. The FQHC funding model makes the CHW workforce financially sustainable.

Outcomes:

• Marcus's HbA1c drops to 7.4 in 12 months (a clinically meaningful improvement)
• He has not been hospitalized
• His employer accommodation reduces missed appointments
• He maintains employment

Worked example 4: Aisha 32 Savannah, Postpartum depression peer support

Aisha had her first baby 8 weeks ago. She is struggling with postpartum depression: persistent sadness, sleep disturbance beyond what's typical of new motherhood, intrusive thoughts, and difficulty bonding with her baby. Her OB screened her with PHQ-9 at her 6-week postpartum visit (score 18, severe range) and referred her to behavioral health.

Her CMO connects her with a Certified Peer Specialist (CPS) through DBHDD who has lived experience of postpartum depression. The peer specialist, Tameka:

First weeks:

• Meets with Aisha weekly initially
• Shares her own recovery story (the foundational element of peer support)
• Supports Aisha through medication initiation (consultation with psychiatrist)
• Helps Aisha understand that what she's experiencing is illness, not failure

Ongoing weeks 4-12:

• Helps Aisha connect with a support group for new moms with postpartum depression
• Practical support: planning her week, identifying childcare for her own appointments
• Communication with her partner (psychoeducation)
• Coordinates with her therapist (CBT)

Outcomes:

• Aisha's depression improves over 4 months (PHQ-9 down to 6 by month 4)
• She continues medication and ongoing therapy
• The peer support relationship transitions to less intensive monthly check-ins
• She bonds with her baby and is functioning well

Funding: Peer support is reimbursed by Georgia Medicaid as a rehabilitative service. The CPS is DBHDD-credentialed and employed by a community mental health provider.

Aisha also has continued Medicaid coverage through 12 months postpartum under Georgia's extended postpartum coverage. This continuity of coverage is critical: without the 12-month extension, her Medicaid would have ended at 60 days, in the middle of acute treatment.

Worked example 5: Jamil 8 Columbus, Asthma CHW home assessment

Jamil has moderate persistent asthma with frequent ED visits (4 in the past year). His pediatrician at CHOA's outreach clinic in Columbus refers him to CHOA's asthma program, which includes CHW home visits.

The CHW, Marcus:

Home assessment (first visit):

• Conducts a comprehensive home environmental assessment
• Identifies mold in the bathroom (longstanding leak)
• Identifies dust mite triggers (carpeted bedroom, no mattress encasements)
• Identifies a smoking household member (Jamil's grandfather)
• Notes that the family is not consistently using the controller medication

Intervention plan:

• Provides education to the family on the asthma action plan
• Connects the grandfather to tobacco cessation (he is also a Medicaid beneficiary)
• Works with the landlord to address the mold (using Georgia Legal Services as a backstop if needed)
• Distributes mattress and pillow encasements (free through the CHOA program)
• Sets up controller medication adherence support: reminder calls, medication tracking

Ongoing follow-up:

• Monthly home visits or phone calls for 6 months
• Coordinates with pediatrician and school nurse
• Helps the family update the school asthma action plan

Outcomes:

• Jamil's ED visits drop to 0 in the next 12 months
• His controller medication adherence improves to 85+ percent
• The grandfather quits smoking (with primary care support)
• The mold is remediated by the landlord under Georgia Legal Services pressure
• Jamil's school attendance improves

Funding: CHOA's CHW program is supported by:

• Hospital community benefit
• Grants (HRSA, RWJ Foundation, others)
• Medicaid Targeted Case Management billing (for eligible target groups)
• DPH District 7 collaboration

This is an example of where Medicaid TCM combined with hospital community benefit and grant funding sustains CHW work.

Worked example 6: Diana 65 rural Georgia, Social drivers of health CHW

Diana, 65, lives in rural southwest Georgia. She is dual-eligible (Medicare + Medicaid). She has heart failure and COPD. After a heart failure hospitalization at a regional hospital, the hospital social worker identifies that Diana is:

• Food-insecure (PHQ-9-style screening)
• Has unstable housing (living with her adult daughter who is also struggling financially)
• Has limited transportation in a rural area with no fixed-route transit

The hospital's transitional care CHW, Patricia:

Discharge (within 7 days):

• Visits Diana at home for an initial assessment
• Connects her with the local Council on Aging for home-delivered meals
• Connects her with the rural transit authority for medical transportation
• Helps her apply for SNAP (food stamps)

Weeks 2-4:

• Helps her enroll in PACE (Program of All-Inclusive Care for the Elderly) at the regional PACE center 30 miles away
• Coordinates with her PCP and the cardiology clinic 90 miles away
• Works with the daughter on stable housing arrangements

Ongoing:

• Once Diana enrolls in PACE, the PACE care team takes over much of the case management
• Patricia transitions to monthly check-ins
• Connects the family with Georgia Legal Services for benefits questions

Outcomes:

• Diana is not readmitted to the hospital in the next 12 months
• She enrolls in PACE successfully
• Her SNAP benefits stabilize food access
• Her daughter maintains housing

Funding: Hospital community benefit supports the transitional care CHW program. Future expansion through:

• Section 1115 HRSN demonstration potential
• ILOS arrangements in CMO contracts
• Federally Recognized HRSN services in Medicaid (subject to ongoing CMS guidance)

This is the kind of CHW work that drives outcomes in rural Georgia where access barriers are highest.

Practical guidance for Georgia families

How to find a CHW or related support

For pregnancy and postpartum:

• Ask your obstetrician or midwife if they work with a doula or have a CHW
• Contact your CMO and ask about doula coverage (under the 2024 SPA) and high-risk pregnancy case management
• Call Healthy Mothers, Healthy Babies at 1-800-822-2229
• Connect with community-based maternal health organizations (Black Mamas Matter Alliance, SisterSong, GA Latino Health Initiative)

For chronic disease management:

• Ask your primary care provider, especially if you go to an FQHC, about CHW or care coordinator support
• Contact your CMO and ask about case management for your condition
• Look for community-based chronic disease self-management programs

For behavioral health:

• Ask about peer support specialists at your community mental health center
• Contact Georgia Crisis and Access Line (GCAL) at 1-800-715-4225 for behavioral health resources, including peer support
• For substance use disorder, ask about CARES (Certified Addiction Recovery Empowerment Specialist) support

For social drivers of health:

• Call 211 Georgia (dial 211) for connection to community resources
• Contact your CMO's care coordination line
• Ask your provider's social work or care coordination team

How to become a CHW

If you are interested in CHW work in Georgia:

• The Georgia Community Health Worker Association (GCHWA) offers training and networking
• Morehouse School of Medicine, Mercer University School of Medicine, and Augusta University MCG offer training programs
• Many FQHCs and hospital systems train and employ CHWs
• DOL Registered Apprenticeship programs offer a national credential
• DBHDD's CPS program provides peer support training and certification

Advocacy

If you want to advocate for expanded CHW coverage in Georgia Medicaid:

• Engage with the Georgia Medicaid Coalition
• Submit comments during DCH State Plan Amendment public comment periods
• Engage with state legislators on appropriations for DPH and DCH workforce
• Engage with the Georgia Maternal Mortality Review Committee through public comments

::: accordion title="Frequently Asked Questions"

What is a Community Health Worker?

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of, or has an unusually close understanding of, the community they serve. CHWs serve as a liaison between health, social services, and the community to facilitate access to services. The C3 Project codified ten core CHW roles including cultural mediation, health education, care coordination, social support, advocacy, and outreach. CHWs go by many titles: promotor/promotora de salud, lay health worker, peer support specialist, community health representative, patient navigator, doula, and peer recovery specialist.

Does Georgia Medicaid cover CHWs?

Georgia Medicaid does not yet have a comprehensive State Plan Amendment covering CHW services. However, several CHW-adjacent benefits are covered: doulas (added 2024), behavioral health peer support specialists (long-standing, through DBHDD's CPS program), and case management embedded in CMO contracts. FQHCs and hospital systems employ CHWs whose work is funded through PPS reimbursement, 340B savings, grants, and hospital community benefit. Advocacy for a comprehensive Georgia CHW SPA continues.

How does the 2024 doula benefit work?

DCH submitted a State Plan Amendment, approved by CMS, to cover doula services for Medicaid-eligible pregnant women. Doula coverage in Georgia Medicaid includes prenatal visits, labor and delivery support, and postpartum follow-up visits. Doulas must be enrolled with DCH as Medicaid providers and meet training requirements. Reimbursement is set in the Medicaid fee schedule. Doula services are available through Medicaid managed care; ask your CMO about how to access them.

What is CMS State Health Official letter SHO #13-002?

SHO #13-002 (2013) and the 2014 Preventive Services final rule clarified that preventive services covered under 42 CFR 440.130(c) may be provided by non-licensed practitioners (including CHWs) when the service is recommended by a physician or other licensed practitioner. This opened the path for states to submit State Plan Amendments covering CHW-delivered preventive services. A growing number of states have adopted such SPAs.

What are Section 1115 maternal health demonstrations?

Section 1115(a) of the Social Security Act allows the Secretary of HHS to approve demonstration projects that further the objectives of Medicaid. Several states (NY, NJ, CA, MA, NC, IL) have approved or pending Section 1115 maternal health demonstrations that explicitly include CHW services, doula services, and related maternal health supports. These demonstrations are part of CMS's Maternal Health Strategy. Georgia has not submitted a Section 1115 maternal health demonstration as of 2026.

What are Health-Related Social Needs (HRSN) demonstrations?

HRSN demonstrations are Section 1115 demonstrations that allow Medicaid to fund certain social driver of health services (housing supports, nutrition supports, transportation) for specific populations. North Carolina (Healthy Opportunities Pilots), Oregon, Washington, Massachusetts, Arizona, and New Jersey have approved HRSN demonstrations. CMS's 2022-2023 HRSN framework guidance set parameters. CHW navigation is typically a key component. Georgia has not submitted an HRSN demonstration.

What are In Lieu of Services (ILOS)?

ILOS under 42 CFR 438.3(e) and CMS State Medicaid Director Letter SMD #23-001 allow Medicaid managed care plans to provide services that are not covered under the State Plan but are medically appropriate, cost-effective substitutes for State Plan services. ILOS examples include housing transition services, home modifications, medically tailored meals, and CHW navigation. Georgia's CMOs can negotiate ILOS in their DCH contracts; as of 2026, formal ILOS arrangements are limited.

How are CHWs paid for at FQHCs?

FQHCs receive enhanced Medicaid reimbursement under Section 1902(bb) of the Social Security Act through the Prospective Payment System (PPS). The PPS rate is an all-inclusive rate per visit that bundles together physician services, nurse services, behavioral health, and ancillary services including CHW work. FQHCs do not separately bill for CHW services; the CHW costs are built into operations. Many FQHCs also use 340B Drug Pricing Program savings (Section 340B of the Public Health Service Act) to fund additional CHW staff.

What is the Georgia Maternal Mortality Review Committee?

The Georgia MMRC, established under DPH, reviews every pregnancy-associated death in Georgia to identify causes, racial disparities, and prevention opportunities. Annual MMRC reports consistently find that the majority of pregnancy-related deaths are preventable, that Black women in Georgia die at significantly higher rates than white women, and that the postpartum period is the highest-risk period. MMRC findings have driven Georgia's doula coverage, 12-month postpartum extension, and other policy responses.

Does Georgia have CHW certification?

As of 2026, Georgia does not have a statewide CHW certification system administered by DPH or DCH. Several training programs exist informally through the Georgia Community Health Worker Association (GCHWA), Morehouse School of Medicine, Mercer University School of Medicine, Augusta University MCG, and Children's Healthcare of Atlanta (CHOA). The U.S. Department of Labor Registered Apprenticeship program offers a nationally recognized CHW credential. Advocacy for a Georgia statewide certification framework continues.

How does peer support work in Georgia behavioral health?

DBHDD operates the Certified Peer Specialist (CPS) program, which has been in place since the early 2000s. CPS workers deliver Medicaid-billable peer support services in mental health treatment settings. The Certified Addiction Recovery Empowerment Specialist (CARES) program serves substance use disorder. Parent Peer Specialists support families of children with serious emotional disturbance. Peer support is reimbursed by Georgia Medicaid as a rehabilitative service under Section 1905(a)(13).

What if I want to expand CHW services in Georgia?

Several pathways for advocacy:

• Engage with the Georgia Medicaid Coalition and the Georgia Public Health Association
• Submit public comments during DCH State Plan Amendment processes
• Engage state legislators on DPH and DCH workforce appropriations
• Engage with the GA MMRC on maternal health workforce
• Support GCHWA's certification advocacy
• Engage with CMO contract renewal cycles on case management and ILOS provisions

How are CHWs different from social workers or care coordinators?

CHWs are frontline community-based workers who typically come from and remain connected to the communities they serve. Their effectiveness is rooted in trust and cultural familiarity. Social workers typically have a Master's degree and licensure (LMSW, LCSW) and provide clinical services including therapy. Care coordinators are typically nurses or social workers focused on care navigation. CHWs complement (not replace) social workers, nurses, and care coordinators by providing the community-based bridge that the other roles cannot fully provide.

How does the 12-month postpartum extension help?

The American Rescue Plan Act of 2021 allowed states to extend postpartum Medicaid coverage from 60 days to 12 months. Georgia adopted the extension via SPA. This extension is critical because most pregnancy-related deaths occur in the postpartum period, often beyond 60 days. With 12 months of coverage, mothers can continue behavioral health treatment, chronic disease management, contraception access, and CHW/doula support during the highest-risk period.

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::: cta title="Important contacts for Georgia community health worker resources"

DCH Medicaid Member Services: 1-866-211-0950

DCH Maternal Health Initiative: 404-657-7117

Georgia Department of Public Health: 404-657-2700

Georgia DPH Maternal and Child Health: 404-657-2850

Healthy Mothers, Healthy Babies Coalition: 1-800-822-2229

Georgia Family Connection Partnership: 404-572-0090

Georgia Crisis and Access Line (GCAL): 1-800-715-4225

HRSA Maternal and Child Health Bureau: 301-443-2170

Georgia ADRC: 1-866-552-4464

211 Georgia (community resources): dial 211

Georgia Legal Services: 1-833-457-7529

Disability Rights Georgia: 1-800-537-2329

Mercer School of Medicine (training programs): 478-301-2542

Morehouse School of Medicine: 404-752-1500

Augusta University Medical College of Georgia: 706-721-0211

CMS Region IV: 404-562-7150

For comprehensive information on Medicaid in Georgia, including community health workers, doulas, peer support, maternal health, and how to access CHW services in your community, visit brevy.com.

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This guide provides general information about Georgia Medicaid community health workers, doulas, peer support specialists, and related programs. Individual circumstances vary. For application assistance, eligibility determination, and care coordination, contact DCH Medicaid Member Services at 1-866-211-0950, your CMO's care management line, or visit brevy.com. This is not legal advice. For legal questions about Medicaid eligibility, appeals, or rights, consult Georgia Legal Services (1-833-457-7529) or Disability Rights Georgia (1-800-537-2329).

Find personalized help understanding community health worker benefits in Georgia at brevy.com.