PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Sep 16, 2026
Community Health Worker Access Act
This bill provides for coverage of community health services under Medicare.
Community health services are services provided by a community health agency in accordance with an individual needs assessment, including preventive services (e.g., screenings) and services to address social determinants of health (e.g., educational home visits). Community health agencies include nonprofits, federally qualified health centers, and other organizations that employ health workers (in accordance with certain labor standards) who have lived experience in the communities served.
The bill also allows state Medicaid programs to cover these services and provides for an increased Medicaid federal matching rate, also known as the Federal Medical Assistance Percentage (FMAP), for these services.
People & committees
Rep. Adams, Alma S. [D-NC-12] · D–NC
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Oct 8, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-09-16 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Community Health Worker Access Act would add Medicare coverage for community health services, including preventive care and help connecting people to health and social services. It would also let states cover these services through a new Medicaid option and increase the federal share of qualifying costs. The coverage changes would begin January 1, 2027. Medicare services would require an individual needs assessment supervised by a qualified health care provider.
This Act may be cited as the Community Health Worker Access Act.
(KK) community health services (as defined in subsection (nnn)(1)) furnished on or after January 1, 2027;
in accordance with an individual needs assessment that meets requirements established by the Secretary and is conducted under the supervision of an applicable provider
beginning January 1, 2027, a State, at its option as a State plan amendment, may provide for medical assistance for preventive services and services to address the social determinants of health furnished by a community health worker, promotora, or community health representative.
the Federal medical assistance percentage determined under such section for a State shall be increased by 6 percentage points
The bill would add community health services to Medicare Part B for services furnished on or after January 1, 2027. Services would have to come from a qualifying community health agency and follow an individual needs assessment meeting the Secretary's requirements.
2. Coverage of community health services under part B of the Medicare program
(KK) community health services (as defined in subsection (nnn)(1)) furnished on or after January 1, 2027;
The term community health services means the services described in subparagraph (B) that are furnished— (i) by a community health agency (as defined in paragraph (2)); and (ii) in accordance with an individual needs assessment that meets requirements established by the Secretary and is conducted under the supervision of an applicable provider;
Covered preventive services would include diagnostic and screening services, infectious disease outreach, and direct screenings and basic health services recommended by an applicable provider.
Diagnostic, screening, and preventive services to prevent illness, disease, injury, or any other physical or mental health condition, reduce physical or mental disability, and restore an individual to the best possible functional level
(II) Containment of infectious disease outbreaks, including providing in-language, culturally specific, and trusted support services, such as public health outreach. (III) Direct provision of screenings and basic health services, as recommended by an applicable provider.
Covered services would also include coaching and social support, help managing health conditions, coordination with preventive care, arranging transportation to needed services, and promotion of healthy behaviors.
(IV) Provision of coaching and social support, such as support for individuals to obtain health care, support to reduce stress and social isolation, support for self-management of disease, and other support necessary for the prevention and management of health conditions. (V) Care coordination and connection to preventive care services, including for chronic conditions, such as diabetes, asthma, chronic obstructive pulmonary disease, congestive heart disease, autoimmune disease, or behavioral health conditions. (VI) Facilitation of transportation to needed services. (VII) Promotion of healthy behaviors, such as physical activity and smoking cessation.
Services could connect people with disabilities to assistive technology and home modifications, help people understand health information and communicate across cultures, and provide culturally and linguistically appropriate health education. The Secretary could include other services considered appropriate to preserve and improve individual and public health.
(VIII) Case management and linkage to resources that connect people with disabilities to assistive technology, home modifications, and other adaptations to increase their ability to live independently in the community. (IX) Provision of support for health literacy and cross-cultural communication. (X) Provision of culturally and linguistically appropriate health education. (XI) Other services, as the Secretary determines appropriate to preserve and improve individual and public health.
The bill would cover services addressing social conditions that affect health. These include needs assessments, insurance and service-system education, home visiting, referrals for underserved populations, and help connecting people to food, housing, child services, technology, education, and employment resources. This language covers assistance and connections to resources; it does not itself promise payment for those underlying resources.
(I) Assessment of individual and community needs and communicating identified needs to public health, health care, and social service agencies. (II) Provision of outreach and education regarding health insurance, and other health and social service systems. (III) Provision of education, assessment of needs, and social support through home visiting. (IV) Provision of case management (as defined in section 1915(g)(2)) and linkage to resources to alleviate financial strain, including food, housing, child services, technology, educational services, employment services, and other services. (V) Identification of underserved populations and referring them to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health and social services and to streamline care, including serving as a liaison between individuals and communities and health and social service organizations.
Providers authorized to supervise the needs assessment or recommend direct screenings and basic health services would include physicians, physician assistants, nurse practitioners, and clinical nurse specialists. The Secretary could also approve other practitioners within a referenced statutory category.
For purposes of subparagraphs (A)(ii) and (B)(i)(III), the term applicable provider means— (i) a physician (as defined in section 1861(r)); (ii) a physician assistant, a nurse practitioner; and a clinical nurse specialist (as such terms are defined in section 1861(aa)(5)); and (iii) any other practitioner described in section 1842(b)(18)(C) that the Secretary determines appropriate.
A community health agency could be a community organization, nonprofit, urban Indian organization, community health worker network, health center, rural clinic, public health department, academic institution, health care provider, or another organization approved by the Secretary. Each would have to meet requirements established by the Secretary.
The term community health agency means an entity, including a community-based organization, a nonprofit organization, an urban Indian organization, a community health worker network, a Federally qualified health center, a rural health clinic, a local or State public health department, an academic institution, a health care provider, and any other organization deemed appropriate by the Secretary, that meets requirements established by the Secretary
The Secretary's agency standards could include hiring workers with shared community experiences, reducing employment barriers, providing market wages and career development, and keeping caseloads manageable. These are possible requirements, not standards the bill would automatically impose on every agency.
which may include the following requirements: (A) The entity provides for the employment of health workers who share lived experiences with the community served and minimize barriers to employment, including formal educational requirements. (B) The entity provides for market wage compensation and professional development and career advancement opportunities for health workers, as well as training on core competencies. (C) The entity has established work practices and manageable caseloads that allow health workers to provide tailored, holistic, person-centered support.
Possible agency standards would also address worker safety, supervision, coaching, evaluation, and worker involvement in organizational decisions. Evaluation measures would be developed in consultation with the community health workforce.
which may include the following requirements:
(D) The entity ensures— (i) the safety of health workers, in accordance with applicable fair labor laws; (ii) the supervision, coaching, and evaluation of health workers, through the use of evidence-informed process and outcome indicators developed in consultation with community health workers, promotoras, and community health representatives (as such terms are defined in section 1903(cc)(4)); and (iii) leadership and engagement of health workers in organization- and program-level decision making, including decision making related to the improvement of processes and outcomes.
Medicare would pay 100 percent of the lower of the actual charge or the amount on a payment schedule established by the Secretary. The Medicare deductible—the amount a patient otherwise must pay before applicable coverage begins—would not apply to these services.
with respect to community health services under section 1861(s)(2)(KK), the amounts paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary for such services.
such deductible shall not apply with respect to community health services (as defined in section 1861(nnn)(1))
Beginning January 1, 2027, states could choose to amend their Medicaid plans to cover the specified preventive and social-support services furnished by community health workers, promotoras, or community health representatives. The option would operate notwithstanding Medicaid's statewideness and comparability requirements, and other provisions the Secretary determines must be waived to implement it.
Notwithstanding section 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B) (relating to comparability), and any other provision of this title that the Secretary determines is necessary to waive in order to implement this subsection, beginning January 1, 2027, a State, at its option as a State plan amendment, may provide for medical assistance for preventive services and services to address the social determinants of health furnished by a community health worker, promotora, or community health representative.
The Secretary would have to issue guidance explaining what states need for approval. It would cover recruiting agencies, making coverage available for each service category, responding to public health emergencies, reducing participation barriers, and coordinating with community health worker networks.
The Secretary shall issue guidance on the components that are necessary for a State plan amendment to receive approval under this subsection, including:
(A) Plans to recruit community health agencies for the provision of preventive services and services to address the social determinants of health that are furnished by a community health worker, promotora, or community health representative. (B) Plans to make medical assistance available for each category of preventive services and services to address the social determinants of health. (C) Plans to ensure that the preventive services furnished by community health workers, promotoras, or community health representatives under the amendment will respond to public health emergencies. (D) Plans to minimize barriers to community health worker, promotora, or community health representative program participation in the State plan, such as by providing guidance and technical assistance on requirements for participation. (E) Plans to coordinate with and build the capacity of community health worker networks within the state or region.
The guidance would also address participation barriers for agencies that do not otherwise bill insurance. This would include plans for a way to reimburse such agencies for the covered services.
(F) Plans to address barriers to participation experienced by community health agencies that do not bill insurance for other services, such as community-based and nonprofit organizations, academic institutions, faith-based organizations, tribal organizations, or other organizations that employ community health workers, promotoras, or community health representatives, including by implementing a mechanism to reimburse such community health agencies for preventive services and services to address the social determinants of health.
For calendar quarters beginning January 1, 2027, the federal share of qualifying Medicaid service costs would increase by six percentage points. This would apply to services provided under an approved amendment or otherwise in accordance with the Secretary's guidance, rather than to all Medicaid spending.
for calendar quarters beginning on or after January 1, 2027, the Federal medical assistance percentage determined under such section for a State shall be increased by 6 percentage points with respect to amounts expended by the State for medical assistance for preventive services and services to address the social determinants of health furnished by a community health worker, promotora, or community health representative that is provided in accordance with a State plan amendment approved under this subsection or otherwise provided in accordance with the guidance issued under paragraph (2).
For territories, the extra federal payments resulting from the increased matching rate would not count against the referenced territorial Medicaid payment limits. The exclusion would cover only the increase, not the entire payment.
With respect to payments made to a territory for expenditures for medical assistance described in subparagraph (A), the portion of such payment that exceeds the amount that would have been paid without regard to the increase in the Federal medical assistance percentage under such subparagraph shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.
The Medicaid definitions would distinguish three kinds of frontline workers: community health workers with trusted community ties or unusually close community knowledge; community health representatives with trusted ties to tribal communities; and promotoras who primarily work in Spanish-speaking communities and share the populations' experiences, language, and culture.
The term community health representative means a frontline health worker who is a trusted member of a tribal community with a close understanding of the community, language, and traditions
The term community health worker means a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served
The term promotora means a trusted frontline worker who primarily works in Spanish-speaking communities and who shares lived experiences, language, and culture with the populations served
A qualifying community health worker network would be a statewide, regional, or local association or coalition whose leadership and membership are composed of at least 50 percent community health workers, promotoras, or community health representatives. Its activities would include training, workforce development, mentoring, and other program support.
The term community health worker network means a statewide, regional, or local association or coalition with leadership and membership that is composed of at least 50 percent community health workers, promotoras, or community health representatives and whose activities include training, workforce development, mentoring, and other initiatives to support community health worker, promotora, and community health representative programs.
The new Medicaid option would use the same community health agency definition and preventive and social-support service categories established by the bill's Medicare provisions.
The term community health agency has the meaning given that term in section 1861(nnn).
The term preventive services means services described in clause (i) of section 1861(nnn)(1)(B).
The term services to address the social determinants of health means services described in clause (ii) of section 1861(nnn)(1)(B).
The supplied October 8, 2026 source snapshot records introduction in the House on September 16, 2026, and referral that day to the Energy and Commerce and Ways and Means committees for provisions within their respective jurisdictions.
Source snapshot updated 2026-10-08T19:26:00Z.
2026-09-16: Introduced in House
2026-09-16: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-09-16. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish what appears in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place outside general program or formula arrangements was identified in the complete supplied introduced text. This conclusion is limited to that version; accompanying materials could be relevant to formal earmark status.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied text contains a narrow exception to payment limits within the bill's main funding policy. This classification does not establish improper purpose or waste.
Territories would receive a specific exception from Medicaid payment limits: the additional federal payments attributable to the bill's six-percentage-point matching increase would not count toward those limits. This would favor territories' treatment of the additional funding while remaining directly related to the community health services policy.
the Federal medical assistance percentage determined under such section for a State shall be increased by 6 percentage points with respect to amounts expended by the State for medical assistance for preventive services and services to address the social determinants of health furnished by a community health worker, promotora, or community health representative
With respect to payments made to a territory for expenditures for medical assistance described in subparagraph (A), the portion of such payment that exceeds the amount that would have been paid without regard to the increase in the Federal medical assistance percentage under such subparagraph shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.
Full text preserved for this analysis. Legislative record snapshot: Oct 8, 2026. How PlainBill uses AI