Community Health Alignment Initiative (CHAI)

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Why Does South Carolina Need the Community Health Alignment Initiative
(CHAI)?

According to the American Community Survey (ACS) approximately 521,147 South Carolinians, or 10.04% of the total population, were uninsured in 2021. This number is likely currently higher since the federal government has ordered states to restart reviewing the eligibility status of Medicaid members and removing those who do not qualify beginning April 1, 2023. South Carolina needs community health workers to support community members in navigating access to insurance and address other social determinants of health (SDOH) that impact their quality of life. CHAI is designed to support these community members. 

    CHAI is Designed to Meet the Needs of Communities Across the Palmetto State

    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 program 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. Click on the questions below to learn more.

    Why was CHAI Established?

    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

    What are the target populations for the CHAI program?

    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:

    Aiken

    29801 

    Allendale

    29810

    Anderson

    29624

    Barnwell

    29817

    Berkeley

    29436

    Charleston

    29406

    Charleston

    29405

    Chester

    29706

    Clarendon

    29148

    Clarendon

    29102

    Darlington

    29550

    Darlington

    29532

    Dillon

    29536

    Florence

    29501

    Florence

    29505

    Florence

    29506

    Georgetown

    29440

    Greenville

    29611

    Greenville

    29605

    Horry

    29576

    Lancaster

    29720

    Lee

    29080

    Marlboro

    29512

    Marlboro

    29525

    Orangeburg

    29048

    Orangeburg

    29163

    Orangeburg

    29115

    Orangeburg

    29118

    Richland

    29203

    Richland

    29204

    Richland

    29201

    Spartanburg

    29302 

    Spartanburg

    29301

    Spartanburg

    29306

    Sumter

    29150

    Williamsburg

    29590

    Williamsburg

    29554

    Williamsburg

    29556

    Williamsburg

    29056

    York

    29730

     

    What is the Center for Community Health Alignment’s role?

     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.  
    How does CCHA have to account for the funds spent?

    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.  
    What are the duties of the CHWs that will be funded through CHAI?

    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.

    The CHAI Advisory Committee

    Upon notification of funding from SCDHHS, CCHA coalesced an advisory committee of CHWs, AccessHealth initiatives, hospital networks, and other stakeholders to provide input and direction on the development of CHAI for the Palmetto State. This advisory committee consists of several subcommittees that focus on Data and Evaluation, Funding Priorities, and CHW Program Fidelity. Following the guidance provided by these individuals, CCHA is planning to implement CHAI starting in January 2024.

    The CHAI Advisory Committee consists of the following individuals. Click on their photos to learn more about their work in the Palmetto State and beyond.

    Wilma Moore, CHW

    Wilma Moore, CHW

    Community Engagement Coordinator at United Way of the Piedmont

    Dara Brown, CHW

    Dara Brown, CHW

    Senior Community Health Coordinator at Brookland-Lakeview Empowerment Center

    Jodi Rodgers, CHW

    Jodi Rodgers, CHW

    Community Health Worker at Access Kershaw

    Victoria Adewumi, CHW

    Victoria Adewumi, CHW

    Community Health Worker at the City of Manchester, NH

    Mayra Lubov, CHW

    Mayra Lubov, CHW

    PASOs Deputy Director

    Terri Jowers, CHW

    Terri Jowers, CHW

    SCCHWA Interim Executive Director

    Pennie Jewell, CHW

    Pennie Jewell, CHW

    Community Health Worker at CHW Center for Research and Evaluation

    Marek Calhoun, CHW

    Marek Calhoun, CHW

    Director of Social and Community Services at CareSouth Carolina

    Reeshemah McKelvey, CHW

    Reeshemah McKelvey, CHW

    Director of Access Health Tri-County Network

    Carey Rothschild, CHW

    Carey Rothschild, CHW

    System Director of Community Health Policy and Strategy at Spartanburg Regional Healthcare System

    Sonya Del Rio, CHW

    Sonya Del Rio, CHW

    Director of Enabling Services at Tandem Health

    Karen Nichols

    Karen Nichols

    Executive Director for the Upper Midlands Rural Health Network (UMRHN)

    Zack King

    Zack King

    Community Health Development Consultant

    Holly Pope

    Holly Pope

    Research Associate at C.A.R.E.

    Angel Bourdon

    Angel Bourdon

    Director of Community Health & Innovation with the SC Hospital Association (SCHA)

    Mary Jones, PhD, MPH

    Mary Jones, PhD, MPH

    Director of Workforce Development at the Arnold School of Public Health

    Pam Gilliam

    Pam Gilliam

    Director at C.A.R.E.

    Suzie Foley

    Suzie Foley

    Executive Director at Greenville Free Medical Clinic

    Noelle Wiggins

    Noelle Wiggins

    Co-Principal Investigator at the CHW Center for Research and Evaluation

    Cyndi New

    Cyndi New

    Self Regional's Director of Community Health & Health Equity

    Acronym Glossary 

    • CCHA: Center for Community Health Alignment 
    • CHAI: Community Health Alignment Initiative 
    • CHW(s): Community health worker(s)  
    • SCCHWA: South Carolina Community Health Worker Association
    • SCDDHS: South Carolina Department of Health and Human Services

    CHAI Mailing List

    To sign up for the CHAI mailing list, please complete this form.

    CHAI Frequently Asked Questions

    Why were only 40 ZCTAs used to determine eligibility for the program?

    We are committed to a bold and equitable approach to expanding the CHW workforce in the Palmetto State by using our limited resources wisely. Our decision to fund the identified ZCTAs (Zip Code Tabulation Area) was data driven. There is a need to serve people in all of South Carolina’s 424 ZCTAs. However, we prioritized funding based on evidence-based inequities and are starting with the 40 highest need ZCTAs. Prioritizing these ZCTAs provides an opportunity to build on what we do in future years of this program and to garner additional resources to support more individuals in these identified communities in the years to come. This is only the beginning.

    In some communities, there are incredible income and health disparities. This means that CHAI may focus on communities that appear to be high-income, but also are home to low-income community members. We don’t intend to leave these people behind. To begin closing these gaps, we will take a closer look at health disparities in our state and embrace a more equitable approach to serving those that need the most assistance.

    This program focuses on individuals living in high priority ZCTAs  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.

    Contact Us

    For additional information about the Community Health Alignment Initiative (CHAI) please send an email to chai@mailbox.sc.edu .