Expanded Eligibility for Community Health Worker Services

TO: ALL PROVIDERS

Currently, MetroPlusHealth provides coverage of Community Health Worker (CHW) services to our Medicaid members during pregnancy and up to 12 months after the end of pregnancy, regardless of the pregnancy outcome.

RETROACTIVE: Effective January 1, 2024, MetroPlusHealth will expand coverage to include members eligible for CHW services beyond pregnant and postpartum populations as follows:

• Children under 21 years of age,
• Adults with chronic conditions,
• Individuals with justice system involvement within the past 12 months,
• Those with unmet health-related social care needs, and
• Those experiencing community violence.

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