To receive community health worker (CHW) services, a person must:

1. (1) Be eligible for one of the Washington apple health programs listed in the table in WAC 182-501-0060, except for the medical care services (MCS) programs; and

2. (2) Be recommended by a physician or other licensed practitioner of the healing arts, as specified in 42 C.F.R. 440.130, following an initiating visit with one of the following criteria:

   1. (a) An unmet health-related social need (HRSN) that limits the ability to engage in health care services;
   2. (b) A positive adverse childhood experiences (ACEs) screening;

   3. (c) One serious, high-risk condition that places the client at risk of any of the following:

      1. (i) Hospitalization;
      2. (ii) Institutionalization/out-of-home placement;
      3. (iii) Acute exacerbation or decompensation; or
      4. (iv) Functional health decline or death;
   4. (d) Two or more missed health care appointments within the previous six months;
   5. (e) The client, client's spouse, or client's family member expressed a need for support in health system navigation or resource coordination services;
   6. (f) A need for recommended preventive services; or
   7. (g) A condition that requires monitoring or revision of a disease-specific care plan and may require frequent adjustment of the medication or treatment regimen or substantial assistance from a caregiver.

[Statutory Authority: RCW 41.05.021, 41.05.160, and 2024 c 376 s 211(43). WSR 25-06-056, s 182-562-0200, filed 2/28/25, effective 7/1/25.]