As Medicaid cuts loom, are Michigan’s community health workers in jeopardy?

Read our entire series on Community Health Workers here>>>

Shanon Seymore had given up. Diagnosed with a rare bleeding disorder called von Willebrand disease, she was in constant pain, unable to work, and on the verge of eviction from her Pontiac home. “Nobody was listening,” she said. “I didn’t care anymore.”

Then she got a call from Regina Gully, a community health worker (CHW) at Trinity Health, where she was being treated for her condition. What followed were months of tireless advocacy: helping navigate the health care system, securing emergency rent assistance, and eventually finding a safer place to live.

“She became my lifeline,” Seymore said about Gully. “I really don’t know where I’d be without her.”

Community health workers aren’t doctors or nurses. They’re peers, often from the same neighborhoods or communities as the people they serve. They’ve gone through many of the same challenges as their clients.

They work by helping to connect patients to the care, services, and support they need to stay healthy — playing a crucial role in making Medicaid-funded health systems work more efficiently, especially for those with complex needs.

Whether it’s managing diabetes, avoiding eviction, getting to the clinic, or simply understanding what a doctor said in a rushed appointment, CHWs act as a bridge between the health care system and people struggling to manage chronic disease on top of poverty.

In January 2024, Michigan took a significant step toward institutionalizing this work: a new Medicaid policy now allows for reimbursement of certified CHW services. Reimbursement rates were low, and health systems struggled to navigate the administrative requirements. Still, the potential for Medicaid to provide a consistent source of funding for programs that had often relied on short-term grants was a promising development.

Those gains face new threats. President Donald Trump recently signed the “One Big Beautiful Bill Act” into law, which will slash approximately $1 trillion from federal Medicaid over the next decade, resulting in an estimated $863 billion in Medicaid cuts nationwide through 2034.

Those historic Medicaid cuts will likely significantly reduce funding and destabilize community health worker programs, such as Michigan’s.

“Community Health Workers are on the frontlines, serving as the bridge between Michigan families and the care they need. Weakening Medicaid not only severs that bridge but also erodes decades of progress toward health equity, access, and economic stability,” Kareem J. Baig, executive director of the Michigan Community Health Worker Alliance, said in a statement opposing the cut.

“These proposed cuts are not just numbers on a spreadsheet. They represent lives interrupted, health care denied, and communities left behind.”

Baig noted that since Michigan’s Medicaid expansion in 2014, uncompensated hospital care has fallen by 50%, and the uninsured rate has dropped to 5.4%.

The Citizens’ Research Council of Michigan warns the cuts could result in at least 200,000 Michiganders losing Medicaid coverage. It also warns that federal policy changes, including frequent eligibility checks and new work requirements, could result in coverage loss for nearly 40% of eligible adults, largely due to bureaucratic barriers.

The cuts would not only increase the number of uninsured residents but also put rural hospitals and clinics at risk of closure — institutions that increasingly rely on CHWs to manage patient care.

What is a community health worker?

Community health workers wear many hats: case managers, advocates, educators, and peers. But ask one what they do, and the answer often sounds simpler: “I help people.”

CHWs are frontline public health workers who serve as a bridge between individuals and various systems, including health care, housing, food assistance, insurance, and other essential services. Unlike clinicians, they are not licensed to provide medical care.Yet they often establish the kind of long-term, trusted relationships that can significantly impact health outcomes.

“People will talk to us when they won’t talk to anyone else,” said Trinity Health’s Gully, who works with the hospital system’s Community Health and Well-Being team. Many CHWs, like Gully, come to the role through lived experience. They’ve navigated poverty, chronic illness, or the social safety net themselves, and bring that understanding to others in crisis.

In Michigan, CHWs are trained through programs aligned with national standards, emphasizing communication, service coordination, health education, and social support. Once trained, CHWs may work in hospitals, clinics, schools, nonprofit agencies, or local governments. Some specialize in specific populations, like pregnant moms, older adults, or individuals with chronic diseases.

The Michigan Community Health Worker Alliance (MiCHWA) trains, credentials, and advocates on behalf of CHWs. Formed in 2011 by a coalition of stakeholders across the state, MiCHWA has evolved into a professional association supporting over 1,100 CHWs and their employers. It also maintains the official state registry for CHWs participating in Medicaid reimbursement programs.

“Our mission is to promote and sustain the integration of community health workers into the health and human services organizations throughout Michigan,” said Kareem Baig, MiCHWA’s executive director. “We do that through coordinated changes in policy as well as workforce development.”

Medicaid reimbursement arrives, but looming cuts present a threat

Michigan began reimbursing certified CHWs through its Medicaid fee-for-service program on Jan.1, 2024, a major milestone. That change followed a 2022 legislative win that included $26 million in state funding to support CHW services.

Medicaid now covers nearly a quarter of Michigan residents, including 39% of children and 65% of nursing home residents, according to CRC data.

Anthony Provenzano, who completed his doctoral research at the University of Michigan Medical School and Department of Learning Health Sciences, played a key role in the early policy development behind Michigan’s Medicaid reimbursement for community health workers. He conducted research and engaged with stakeholders to inform the state’s approach.

“The language in the state budget gave the policy a backbone,” Provenzano said. “It created a mandate and provided funding, which allowed the department to move forward with confidence and stakeholder input.”

The change also allowed CHWs to be recognized as credentialed providers with National Provider Identifier numbers and to submit claims directly.

“We worked with Michigan Medicaid to refine what the policy was going to look like,” Baig said, “so that organizations would be able to work with it and drive forward toward implementation.”

Still, the rollout was in early stages.

“Many health systems, federally qualified health centers, and local health departments are still working through it,” Baig said. Billing systems need updating, workflows must be retooled, and reimbursement rates often don’t cover the full cost of employing and supervising a CHW, especially for community-based organizations.

“We want to ensure that as organizations are investing time, admin staff … they’re able to recoup the cost of their investment and support CHW services moving forward,” Baig said.

In March, more than 130 community health workers from across the state traveled to the Michigan capital to meet one-on-one and in small groups with state legislators on ways to improve infrastructure for CHWs.

One top ask: increase Medicaid reimbursement rates and expand the eligible services. Currently, Medicaid only reimburses face-to-face or patient-initiated telephonic visits. “A lot of the work that CHWs do is coordination of care,” Baig said. “Those services aren’t covered.”

But advocates now warn that federal budget cuts could make such coverage less likely.

“We’ve seen a growing number of CHWs employed in settings such as health systems, federally qualified health centers, health departments, health plans, behavioral health organizations, and community-based organizations,” Baig said.

“For CHWs, whose work often depends on consistent reimbursements and stable infrastructure, such uncertainty threatens to undo hard-won progress.”

A workforce taking on a bigger role

Michigan is not alone in recognizing the value of community health workers. Across the U.S., CHWs are increasingly seen as essential partners in addressing persistent health disparities and improving outcomes for people with complex social and medical needs.

Their impact is backed by growing evidence. CHW programs have been shown to improve chronic disease outcomes, increase access to preventive care, and reduce avoidable emergency department visits and hospitalizations.

In Philadelphia, a pooled analysis of three randomized controlled trials found that CHW support resulted in a 34% reduction in total hospital days. Other studies showed improvements in blood sugar control, medication adherence, and mental health outcomes, especially for patients managing diabetes, cardiovascular disease, HIV, and asthma.

The financial argument is equally compelling. Research shows that CHW programs can generate substantial cost savings for Medicaid and other payers. One study found a return on investment of $2.47 for every dollar spent on CHW support for low-income adults with multiple chronic conditions. Another found a 23.8% reduction in Medicaid spending among participants compared to a matched control.

CRC analysts warn that cuts would not only increase the number of uninsured residents, but also put rural hospitals and clinics at risk of closure — institutions that increasingly rely on CHWs to manage patient care.

Because CHWs often share lived experiences with their communities, CHWs help bridge cultural and linguistic divides, build trust in health systems, and provide support in ways that traditional providers often cannot.

“We tend to treat everyone with kindness and respect,” Gully said, “because we know that there is sometimes a stigma that comes with people needing assistance.”

This reporting series from Planet Detroit examines the growing role of community health workers (CHWs) in Michigan—trusted professionals who assist residents in navigating housing, food access, managing chronic illnesses, and the healthcare system. Medicaid cuts could undermine funding for these workers, who often come from the same communities they serve. By building trust and drawing on lived experience, CHWs are addressing critical gaps in care that traditional health systems often overlook. This project was made possible with support from the Michigan Health Endowment Fund.

View the entire series here>>>