Pennsylvania Community Health Worker Guide

Pennsylvania’s Certified Community Health Worker credential is issued by the Pennsylvania Certification Board. Since April 18, 2026, qualified CHWs can enroll in Medical Assistance for specified managed care services. That enrollment does not authorize fee-for-service payment, and an MCO contract or provider-billed service pathway has its own requirements. DHS enrollment bulletin DHS managed care guidance PCB credential requirements

Pennsylvania CHW quick facts

What does a community health worker do in Pennsylvania?

DHS describes health education that closes gaps in care, connecting people with community resources, help enrolling in government services, health-system navigation and support managing a health condition. Someone who cannot reach a follow-up appointment may need help interpreting the appointment instructions and finding an available resource. Record which of those tasks the worker actually performed. DHS enrollment bulletin

For a new position, identify the community served, who can make referrals, the worker’s immediate supervisor and the person who can resolve an unanswered clinical question. This makes the job description more useful to staff and to the issuer reviewing the CCHW application. PCB credential requirements

Pennsylvania CCHW certification requirements

Applicants must live or work in Pennsylvania when applying. PCB requires approved education, qualifying work or volunteer experience, a current signed position description and documented on-the-job supervision. PCB awards this credential after it approves the application. Its CCHW instructions explicitly say there is no examination. PCB credential requirements PCB application

How to prepare a CCHW application

1. Choose a PCB-accredited CHW training provider and retain completion evidence.
2. Document qualifying paid or volunteer experience within the required lookback.
3. Obtain the current job or volunteer description with the necessary signatures.
4. Collect supervision documentation from the relevant supervisors.
5. Submit the application, supporting evidence and fee together.
6. Record the issued certification and expiration after approval.

For previous employment, obtain the organization’s verification of title, duties and dates. The application expressly says not to use a résumé as proof of previous experience. PCB application

Training, experience and supervision are separate requirements

Keep course hours, qualifying work time and supervision hours in separate records. A full workday does not automatically count as a full day of supervision. PCB permits more than one supervisor to document the qualifying supervision and does not impose a particular supervisor credential in its CCHW application. PCB application

That certification provision does not determine every employer’s clinical supervision or payer obligation. A program may need additional review arrangements under its contract. Identify which requirement each form or signature satisfies.

Pennsylvania CHW renewal

CCHW certification lasts two years from approval. Renewal requires 30 hours relevant to community health, including three hours in ethics, and the current fee is $75. PCB’s credential page states that since January 1, 2026, credentials are active or expired rather than using a separate “lapsed” status. PCB credential requirements PCB renewal table

Track education dates and evidence throughout the cycle. Keep the application-submitted date separate from renewed status. A manager should be able to see which worker needs education, which application is awaiting review and which credential has expired.

What changed for Pennsylvania Medicaid in 2026?

DHS’s March 19, 2026 bulletin opens CHW enrollment effective April 18, 2026. It assigns Provider Type 13, “Non-Traditional Provider,” and Specialty 139 for PCB-certified CHWs rendering services in the managed care delivery system. The bulletin explicitly says enrollment does not authorize CHW coverage or payment in fee-for-service. DHS enrollment bulletin

A CHW who will not be identified as a rendering provider on a PH-MCO claim does not need enrollment under the bulletin. That distinction should be reviewed against the actual payment route rather than turned into a rule that every employed CHW must enroll. DHS enrollment bulletin

The provider-recommended and billed pathway

The HealthChoices requirement covers three CHW encounters per year for a qualifying member when an MA-enrolled physician, physician assistant, certified registered nurse practitioner or certified nurse midwife recommends them. The bulletin lists asthma, chronic obstructive pulmonary disease, diabetes (excluding gestational diabetes) or prediabetes, heart disease, high cholesterol, hypertension, obesity, or prescribed use of multiple medications. Document the need in the care plan. DHS enrollment bulletin DHS managed care guidance

When a provider bills for the encounter and identifies the CHW as the rendering worker, DHS requires the CHW to be enrolled in Medical Assistance. For this pathway the CHW does not need separate credentialing into the MCO’s network. Check the billing provider’s network status, contract scope and the member’s plan instructions before sending a claim. DHS enrollment bulletin DHS managed care guidance

MCO employment and community-based contracts

DHS also describes MCO-employed CHWs and contracts with community-based organizations. These can use salary, invoiced or lump-sum payments rather than individual claims. The same condition and visit limits do not apply to that pathway, and the contract determines its operational details. DHS managed care guidance

Before accepting a referral, confirm which route your organization is using. A direct contract should identify staffing expectations, credential timing, covered work, deliverables, payment and reporting. Availability of a contracting model does not establish that a particular organization has received an award.

How to choose between a billed visit and a CBO agreement

Rates, codes and payer instructions

DHS directs organizations to the relevant MCO handbook, fee schedule or agreement. It says there is no CHW rate on the MA fee schedule and that rates may be negotiated. Its training identifies commonly used codes while directing providers to the plan’s billing guide. Do not translate that into one statewide rate or automatic code eligibility. DHS managed care guidance

For a budget, use the actual agreement and account for outreach attempts, travel, supervision, documentation and other work. Confirm what the contract funds and what must be supported elsewhere. Software should help organize the evidence, it cannot establish a payer’s approval.

What documentation should Pennsylvania CHW programs keep?

DHS’s training addresses care-plan evidence of the referral, precipitating assessment and recommended assistance. It also describes encounter details such as date, time, duration, location, modality and the assistance or education delivered. Use the current payer instructions for the complete record requirements. DHS managed care guidance

Operationally, connect each encounter to the participant’s needs and agreed next step. If a worker helps someone navigate a resource, preserve whether the participant accepted the referral and whether access was confirmed. A report should distinguish outreach, completed encounters and outcomes.

Before a Pennsylvania practice schedules an MA-paid encounter

1. Identify the member’s physical health MCO, qualifying condition and eligible recommending practitioner. Record how the member wants the CHW to help. DHS enrollment bulletin

2. Check the care plan, rendering CHW’s applicable enrollment and number of encounters already covered through the provider-billed route. DHS enrollment bulletin DHS managed care guidance

3. If the intended payer is a CBO agreement, locate the invoice and activity requirements in that agreement. Ask who handles the handoff if the referral arrived through a practice. DHS managed care guidance

4. Separate the worker’s PCB supervision and training documentation from the evidence supporting the member’s visit. PCB credential requirements PCB application

A referral example that reveals workflow quality

A participant with hypertension tells a practice that confusing appointment instructions are keeping them from returning. When a qualifying practitioner recommends CHW visits and the plan conditions are met, the CHW can help the participant navigate the health system. Write down the specific barrier, language or communication preference, the instruction the participant practiced, and the date of the return appointment. The provider should separately check the plan’s encounter history and billing requirements. DHS enrollment bulletin DHS managed care guidance

Suppose the next contact is solely a missed appointment, a ride or time spent driving. DHS’s managed-care training excludes missed appointments, transportation and travel time from this CHW claim pathway. The program can still track the unmet need and arrange follow-up. A service log and a claim-ready visit record serve different purposes. DHS managed care guidance

Questions a Pennsylvania CBO can resolve before accepting a referral

Ask the MCO which pathway it intends to use, who submits the encounter, what information it needs, and how it wants staff to report unsuccessful contacts. A CBO that receives a contract invoice payment should keep that agreement with its reporting instructions. A practice filing a claim should check its MCO’s current handbook and negotiated fee. DHS says there is no statewide Medical Assistance fee-schedule rate for these managed-care CHW services. DHS managed care guidance

For a staffing decision, compare the worker’s credential date with the date the plan expects them on a claim. For a referral decision, write down what the person wants help doing and who will confirm whether it happened. A community health workflow walkthrough can use the same fictional case with the two payment routes side by side.

Frequently asked questions

Does CCHW certification require an exam?

PCB’s current CCHW page says no. Approval depends on meeting and documenting the credential requirements. PCB credential requirements

Can volunteer experience count?

Yes, when it meets the qualifying role, duration and lookback requirements. Obtain proper organization verification. PCB application

Does MA enrollment authorize CHW fee-for-service payment?

No. The 2026 bulletin explicitly limits the enrollment purpose to managed care and does not authorize fee-for-service payment. DHS enrollment bulletin

Does the three-visit rule apply to an MCO’s salaried community health workers?

DHS describes a separate arrangement for MCO-employed staff and contracted community organizations. The provider-billed pathway’s visit and qualifying-condition limits do not automatically apply to that separate arrangement. Confirm the governing employment or CBO contract. DHS managed care guidance

Sources

• DHS enrollment bulletin
• DHS managed care guidance
• PCB credential requirements
• PCB application
• PCB renewal table