The CHAI program was established by the South Carolina General Assembly Proviso 33.20 titled the Medicaid Accountability and Quality Improvement initiative 2023-2024 Appropriations Act in 2023 which authorized SCDHHS to contract with the Center for Community Health Alignment (CCHA) in a collaborative effort to expand the Community Health Worker (CHW) workforce with the goal of improving health outcomes for individuals without access to affordable health insurance by facilitating resource connections and access to safety net providers.

A basis for understanding why we will be focusing on increasing the CHW workforce to support people who are uninsured can be seen in the County Health Rankings Population Health Model below. We know that clinical care is important, but it only impacts about 20% of our health. However, health behaviors, social and economic factors and the physical environment where someone lives impacts the other 80%. These are the areas where CHWs, with support from their larger teams, organizations and partners, can assist

Individuals living in high priority ZCTAs (Zip Code Tabulation Area) who are uninsured, or at high risk of becoming uninsured, with priority given to communities with higher rates of chronic disease or chronic disease risk factors and lower access to primary care. To determine the higher needs ZCTAs, we utilized diabetes and high blood pressure data from the Centers for Disease Control and Prevention’s Interactive Atlas of Heart Disease and Stroke (2019). The uninsured rate was derived from the 2021 American Community Survey data. The standardized provider rate information is drawn from the SC Community Health Worker Prioritization Index (2021). Applications must indicate how CHWs will serve individuals living in these areas. CHWs may serve individuals from other areas as well, but the application must indicate how these ZCTAs will be prioritized.

The 40 highest-need ZCTAs include:

 CCHA shall maintain responsibility for the collaborative effort to expand the Community Health Worker  Program to meet the goal of improving health outcomes for individuals who do not have access to adequate health insurance by facilitating individuals’ connections to safety net providers and community resources.  

Specific Duties of CCHA

• Maintain responsibility for the Community Health Alignment Initiative (CHAI). 
• Determine how to expand the CHW Program to clinical and community-based settings in a way that remains consistent with CHW philosophy and best practices defined by field expertise.  
• Provide SCDHHS with a timeline for implementation of the CHAI.  
• Ensure that CHWs are properly trained in the tasks expected of them.  
• Provide guidance and expectations to funded subrecipients on how to maintain CHWs’ ties to the community.  
• Develop a process for and provide subcontracts of funding to clinical and community-based organizations for hiring and support qualified community health workers to achieve the CHAI goals.  
• Ensure that each site focuses on one/or more health condition and the social determinants of health factors that they determine to be most relevant to the needs of the individuals that are uninsured or underinsured that they serve.  

CCHA will submit quarterly reports and one final summary report to the SC Department of Health and Human Services. Data collected from funded organizations will be utilized to complete these reports and are essential:  

• Details on the CHAI structure, status, and workplan;  
• Project successes on hiring and incorporating CHWs to serve identified communities;  
• Barriers encountered throughout the project;  
• Narratives on how the Center for Community Health Alignment’s goals were met and the impact of the CHAI on the CHW workforce, individual South Carolina residents, and the hospitals affiliated with specific CHAI programs; 
• Summarization of metrics, as applicable, including health improvement indicators and the number of individuals reached;  
• Future directions and sustainability planning; and 
• A listing of CCHA partners as of each reporting quarter.  

To address access to care, appropriate healthcare utilization, social determinants of health, health education gaps, and other needed services so that individuals have more tools and support to be healthy. CHW roles include:

• Facilitating cultural mediation among individuals, communities, and health/social service systems 
• Providing culturally appropriate health education and information 
• Care coordination, case management and system navigation of healthcare and social service systems 
• Providing coaching and social support 
• Advocating for individuals and communities 
• Building individual and community capacity 
• Providing direct service 
• Implementing individual and community assessments 
• Conducting outreach 
• Participating in evaluation and research 

CHWs will need to do outreach and develop community partnerships with organizations serving the target communities to engage individuals without insurance, or at risk of becoming uninsured. At intake, the CHWs will conduct a screening of healthcare and social service needs, level of need, and individual’s strengths and challenges. The CHW will engage the individual and any other team members or partners to determine a plan for supporting the individual by utilizing any of the CHW roles above. CHWs will also engage in cultural mediation with providers, advocacy, and capacity building as applicable and needed to best serve the individuals and communities of focus.