HELENA, Mont. \u2014 Mark Nay\u2019s first client had lost the van she was living in and was struggling with substance use and medical conditions that had led to multiple emergency room visits.<\/p>\n
Nay helped her apply for Medicaid and food assistance and obtain copies of her birth certificate and other identification documents needed to apply for housing assistance. He also advocated for her in the housing process and in the health care system, helping her find a provider and get to appointments.<\/p>\n
After a year of \u201csteady engagement,\u201d Nay said, the client has a place to live, is insured, is connected to the health care system, and has the resources needed to \u201creally start to be successful and stable\u201d in her life.<\/p>\n
Nay is one of two community health workers in a program<\/a> that St. Peter\u2019s Health of Helena started in 2022, focusing on people experiencing or at risk of homelessness who had five or more ER visits in a year. Nay and his colleague, Colette Murley, link their clients to services to meet basic needs, whether it\u2019s health care, food, housing, or insurance. The goal is to provide stability and, ultimately, to improve health outcomes.<\/p>\n Similar work is done in hospitals, community health centers, and other settings across Montana by people with titles such as case manager, outreach worker, navigator, and care manager. State Rep. Ed Buttrey, a Great Falls Republican, is sponsoring a bill in Montana\u2019s legislative session to put a common title \u2014 community health worker \u2014 to the type of work they do and define in law what the role entails. The bill also would provide for licensure and allow, but not require, Medicaid to cover the service.<\/p>\n \u201cHealth care is just a very difficult system to navigate, especially when you\u2019re trying to sign up for service and you\u2019re trying to get access to coverage for service,\u201d Buttrey said. \u201cSo that\u2019s where I see the biggest benefit.\u201d<\/p>\n Buttrey\u2019s HB 850<\/a> is one of several bills still alive this session that are related to Montana\u2019s health care workforce, which is stretched thin throughout the state, the fourth-largest by land area. According to the U.S. Health Resources and Services Administration, more than one-fourth of the state\u2019s residents live in an area with a shortage of primary care health professionals.<\/p>\n Other pending workforce bills include three interstate compact bills, to recognize licenses issued in other states for physician assistants<\/a>, psychologists<\/a>, and respiratory therapists<\/a>. Then there are bills to prohibit noncompete clauses for physicians<\/a> and some categories of mid-level practitioners<\/a>. Other measures would allow more unsupervised activities by certain aides<\/a> and assistants<\/a>, let nurses provide low-cost home visits<\/a> to low-income patients, allow licensure of doulas<\/a>, and let physician assistants<\/a> and physical therapists<\/a> be considered \u201ctreating physicians\u201d for workers\u2019 compensation purposes.<\/p>\n State Rep. Jodee Etchart, a Billings Republican and a physician assistant, is sponsoring two of the interstate compact licensure bills and one of the bills to limit noncompete clauses.<\/p>\n Etchart termed the compact bills \u201ca no-brainer\u201d because they allow people to get licensed, get a job, and start working in Montana right away.<\/p>\n In 2023, Etchart sponsored successful bills to allow physician assistants to practice without physician supervision and to expand the scope of practice for direct-entry midwives<\/a>. Those bills, she said, helped pave the way for the progress this year\u2019s workforce bills have made this session.<\/p>\n \u201cIt opened a lot of people\u2019s eyes about how we can increase access to health care all over Montana,\u201d she said.<\/p>\n The 2023 bill<\/a> allowing independent practice by physician assistants drew opposition from physicians, with the Montana Medical Association saying it extended their scope of practice without requiring additional training. This session, the MMA has supported the bills to remove noncompete provisions but opposed bills on expanding the scope of practice for chiropractors and optometrists. MMA CEO Jean Branscum said the group generally believes scope-of-practice changes don\u2019t fix workforce problems if the expanded practice isn\u2019t supported by evidence or training.<\/p>\n Buttrey said this session\u2019s bills to extend unsupervised practice and enact licensure compacts are an acknowledgment of the difficulty that small, rural communities have in attracting doctors. Physician assistants and nurse practitioners have been filling those gaps, he said.<\/p>\n Community health workers fill a different type of gap. They don\u2019t provide direct medical care, instead helping people find the health care and support services they need to become and remain healthy.<\/p>\n Many states<\/a> have already adopted definitions for community health workers and started providing Medicaid reimbursement for their services.<\/p>\n The requests to add to the list of Medicaid-covered services come at a time when Congress is considering significant budget cuts that could affect the amount of funding the federal government contributes to the Medicaid program. Although the legislature this session continued Montana\u2019s Medicaid expansion program for low-income adults without disabilities, some legislators expressed concern about potential federal changes that could lower the amount of federal funds available for the program.<\/p>\n State Sen. Carl Glimm, a Kila Republican, was one of those legislators. He said he has similar concerns about increasing the types of services covered by Medicaid.<\/p>\n \u201cThe more stuff we add,\u201d he said, \u201cthe more responsibility the state has\u201d if the federal government shifts more of the program\u2019s costs to the states.<\/p>\n Buttrey\u2019s bill would define a community health worker as a \u201cfrontline public health worker\u201d who helps people obtain medical and social services, advocates for their health, and educates individuals, providers, and the community about health care needs. Workers could be licensed after completing training and supervision requirements.<\/p>\n Most medical providers don\u2019t have time to delve into all the outside factors influencing a patient\u2019s health, said Cindy Stergar, CEO of the Montana Primary Care Association, which is supporting Buttrey\u2019s bill. Community health workers can assist with that, she said, adding that research shows people with complex needs become healthier faster when their basic nonmedical needs, such as food and housing, are met.<\/p>\n \u201cAt the end of the day, the patient is better,\u201d Stergar said. \u201cThat\u2019s first and foremost.\u201d<\/p>\n The Area Health Education Center at Montana State University has been offering community health worker training<\/a> since 2018, and the University of Montana\u2019s Center for Children, Families and Workforce Development began a training program<\/a> in 2023. Together, the programs have trained nearly 500 people in how to identify the medical and social factors influencing a person\u2019s health and in strategies for connecting the person with the right community resources.<\/p>\n \u201cIdeally, what community health workers are doing is getting out of the clinic walls, meeting people where they are, and addressing the priorities of the client to get to the root cause of their health conditions and health needs,\u201d said Mackenzie Petersen, project director for the training program at the University of Montana.<\/p>\n Supporters of the community health worker role say the workers are uniquely positioned to observe, understand, and address the barriers preventing a person from getting and staying healthy.<\/p>\n The barriers might be a lack of transportation or insurance or, for a homeless person, the inability to refrigerate a prescribed medication. A community health worker can arrange rides to appointments, help with insurance applications, or make sure a health care provider prescribes a medication that doesn\u2019t need refrigeration.<\/p>\n Murley, with the St. Peter\u2019s Health program, recalled that one of her clients was making frequent trips to the ER with suicidal ideation. Murley learned that he faced bullying in his apartment building and helped him relocate. The ER visits dropped off.<\/p>\n As Nay put it: \u201cIt\u2019s really about helping the people that we work with create a path to their health.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n