As Heartland Forward has explored, rural America faces a shortage of practicing health professionals, from dentists and nurses to mental health practitioners and primary care physicians. These deficits leave gaps in the patient continuum of care, which is the delivery of coordinated health services over time. The continuum of care outlines why consistent and comprehensive health care matters—if a patient experiences gaps in care, like a lack of communication between different health professionals or several missed appointments without a follow-up, care worsens, outcomes decline, the strain of an individual on the system is higher and cost skyrockets.

Across the heartland, a different kind of health worker has emerged as a transformative force in shoring up evident gaps in the continuum of care: the Community Health Worker (CHW). 

Who Are Community Health Workers?

Community Health Workers (CHWs) are trusted, local health professionals who help individuals navigate the health care system. CHWs are vital not only because they address physical health, but because they also address social determinants of health, which are circumstantial factors, like access to housing, food and education, all of which impact a person’s well-being, quality of life and health outcomes. 

CHWs help patients navigate the health care system (in ways such as booking appointments and assisting with insurance claims), provide health education and bolster the health capacity of the region they serve. When CHWs are included in a patient’s care plan, they can help make health care more accessible and holistic, leading to a healthier and more productive population.

Why Community Health Workers Are Valuable Health Professionals

The value of CHWs is becoming increasingly clear in an era of health workforce shortages. The projected growth in CHW employment over the next 10 years is 13%—over three times the 4% national growth rate for all jobs. This meteoric growth trajectory can be linked to the favorable patient outcomes CHWs bring about as well as the measurable cost savings they provide to health systems. 

CHWs Support Favorable Patient Outcomes 

CHWs provide high-value, vital and preventative services intended to reduce emergency hospitalizations or costly care before these challenges arise:

• Comprehensive Health Screenings: Going beyond basic vitals, these screenings detect early-stage conditions and circumstantial risks which may benefit from early-intervention solutions. For example, a CHW-led comprehensive maternal health screening might assess postpartum depression, nutrition and home safety in addition to blood work and vital organ examinations.

• Psychosocial Intervention: CHWs can help identify early signs of mental health conditions and deliver low-cost, community based interventions. One teenager’s depression, for instance, might be addressed through individual therapy, group support and vocational engagement—tailored by a CHW who understands the teenager’s local and home context to help ensure that support is effective and long-lasting.

These interventions shift the health care system from reactive to preventive, curbing downstream health crises and costs.

CHWs Lead to Cost Savings  

CHWs offer a sizable economic return on investment: every $1 invested in a CHW-led intervention yields a $2.47 return, driven by reductions in emergency visits, hospitalizations and delayed treatments for more advanced conditions. CHWs help to decrease reliance on high-cost health care by catching and addressing issues earlier, like for “super-utilizers” of emergency rooms who rely on emergency medicine for care that could have been prevented by earlier and less expensive interventions or by aiding in preventative maternal health care leading to cost savings and better health outcomes.  

Heartland States Leading the Way 

Arkansas, Kentucky and Oklahoma are pioneering legislation to formalize and fund CHW programs, as they recognize the promise and sustainability of the CHW career path, the economic potential CHWs offer and the highly localized care CHWs provide which help drive long-term health outcomes. For CHWs to accomplish local community care at the highest level, state support of this workforce is critical.

Arkansas

• In April 2025, Arkansas passed HB 1258, establishing statewide CHW training and certification while authorizing Medicaid compensation for CHW services. The bill is a part of the broader Healthy Moms, Healthy Babies Act, which emphasizes maternal health care before, during and after pregnancy, and highlights the role of CHWs in maternal and child health. When speaking on the bill, Arkansas State Representative Lee Johnson (R-AR), the bill’s lead sponsor and Co-chair of the Heartland Health Caucus, said:

“Community Health Workers are a key part of our health care system here in Arkansas and I am proud to support these frontline professionals with HB 1258. In prioritizing Arkansas-informed training, we are cultivating a care environment that addresses the long-term health needs of Arkansans and provides savings to our budget.”

Keep an eye out for additional information around Heartland Forward’s Maternal and Child Health Center for Policy and Practice (MCH CPP), which aims to develop effective maternal health solutions by leveraging resources, like adding CHWs to the maternal care ecosystem, and data in Arkansas and across the heartland.

Kentucky 

• Kentucky has developed one of the most robust and bipartisan CHW networks in the nation, which was strengthened with the passage of HB 525 in April, 2022. This bill established a statewide CHW certification system and required Medicaid reimbursement for certain services provided by certified CHWs. Kentucky State Representative Kimberly Moser (R-KY), the primary sponsor of the bill and a member of the Heartland Health Caucus, spoke to the importance of CHWs in Kentucky’s health care system: 

“As a former health care professional, I understand first-hand the critical role of CHWs in our Kentucky health care system, especially when primary care physicians can be difficult to access. To support CHWs in our care systems, we need the financial backing to do so, which we achieved with HB 525. Now, in Kentucky, we are proud to have one of the strongest CHW networks in the country.”

Oklahoma

• In May 2025, Oklahoma enacted HB 1831, creating a voluntary CHW certification program and authorizing CHWs to act as liaisons in underserved communities, in coordination and consultation with Tribal governments and with faith-based organizations. Oklahoma State Representative Ellyn Hefner (D-OK), Co-chair of the Heartland Health Caucus and Co-author of the bill said:

“The Oklahoma Community Health Workers Act is a win for Oklahomans. Recognizing certified CHWs expands care capacity, improves access, supports healthy pregnancies and babies and helps families navigate behavioral health systems.”

Check out Heartland Forward’s Oklahoma PSA for Community Health Worker Awareness Week. 

CHWs: A Smart Investment for Heartland Health 

The case for CHWs is clear. These professionals:

• Close rural care gaps by extending the reach of traditional providers
• Improve health outcomes through early, preventative care 
• Generate cost savings by reducing reliance on emergency care systems 
• Strengthen communities by building local trust, resilience and educational capacity 

States like Arkansas, Kentucky and Oklahoma are showing what is possible with structured certification, sustainable funding and legislative support for CHWs. These models and the role of CHWs in the continuum of care are replicable across the heartland. 

As health care costs rise and rural access remains fragile, CHWs represent a high-impact, low-cost solution. By investing in this growing workforce, heartland states can improve lives, strengthen communities and build a more resilient, equitable health system.