The Impact of State Certification and Medicaid Reimbursement on Community Health Worker Place of Employment and Wages: United States, 2012-2023.

Abstract

<b>Objectives.</b> To describe trends in US community health worker (CHW) place of employment and wages and the impact of state certification programs and Medicaid reimbursement. <b>Methods.</b> Using 2012 to 2023 Bureau of Labor Statistics data, we performed tests of proportions to describe CHWs' changes in employment in different industries, linear regression to compare their wages between industries, and staggered difference-in-differences to evaluate the impact of certification and Medicaid reimbursement on the proportion of CHWs in each industry and wages. <b>Results.</b> CHW employment in health care and government has increased (<i>P</i> < .001), and CHWs are paid the least in social assistance agencies (<i>P</i> < .001). Certification was associated with a decreased proportion of government and public health CHWs (-9.4%; <i>P</i> = .003) but was not associated with wages. Medicaid reimbursement was not associated with place of employment or wages. <b>Conclusions.</b> Substantial wage differences exist across industries employing CHWs, and neither Medicaid reimbursement nor certification was associated with higher wages. Certification may influence workforce distribution, particularly in government settings. <b>Public Health Implications.</b> Improved Medicaid reimbursement rates and billing procedures and optimized payment models could grow and sustain the CHW workforce. Decreases in government employment after certification warrant further research. (<i>Am J Public Health</i>. 2026;116(8):1198-1209. https://doi.org/10.2105/AJPH.2025.308416).