MedicaidCoverageMedium impact
Community Health Worker Services for Medicaid and HARP Members
EmblemHealth·Family Medicine, General Practice, Internal Medicine +1 more·Provider News
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
EmblemHealth expanded Community Health Worker (CHW) services eligibility for Medicaid and HARP members effective January 1, 2024. Previously limited to pregnant and postpartum populations, CHW services are now available to all children under 21, adults with chronic conditions, justice-involved individuals, those with unmet health-related social care needs, and individuals experiencing community violence.
Action Required
Immediately: Billing team should verify current CHW service billing procedures for expanded eligible populations. Contact EmblemHealth for specific CPT/HCPCS codes used for CHW services and update patient eligibility verification processes to include new qualifying populations (children under 21, adults with chronic conditions, justice-involved individuals, those with unmet social care needs, and community violence victims).