Legal Considerations for Community Health Worker Programs

Rural programs utilizing community health workers (CHWs) may need to navigate legal considerations related to CHWs, the program, and the people served by the program. Key legal considerations include patient privacy, liability, certification, and other policy considerations.

Patient Privacy

In some programs, CHWs handle protected health information (PHI), such as a patient's medical history, diagnosis, and treatment plans. Programs should ensure policies are in place to address procedures for safeguarding PHI, in accordance with regulations under the Health Insurance Portability and Accountability Act (HIPAA).

Liability

When CHWs offer direct health services, there can be liability concerns regarding any mistakes, negligence, or injury that may occur. In some states there is a Good Samaritan statute addressing civil liability issues for CHWs. For example, people voluntarily performing certain types of care in good faith are immune from civil liability for acts or omissions resulting from that care. However, if a volunteer or paid CHW is negligent, the organization or employer may still be liable.

Many CHW programs recognize these liability issues, but few have formal policies. Programs should explore whether their state has relevant laws to understand the broader context of their activities. Programs should also assess liabilities, including:

• Do CHWs drive their own vehicles to appointments and/or transport patients in their vehicles?
• Is the employer responsible for a CHW who is injured on the job?
• Does the employer's liability change if the CHW is a paid versus volunteer employee?

Organizations hiring CHWs may consider whether acquiring malpractice insurance is appropriate, given the activities and services performed by CHWs, and they should educate CHWs about their scope of practice and responsibilities.

State Certification Programs

Some states require community health workers (CHWs) to complete training or obtain certification to demonstrate they meet certain qualifications or established standards. Within states that have state-operated CHW certification programs, the state health department is often the entity that provides credentialing oversight. In other states, certification boards or other state agencies provide oversight of CHW certification programs.

Resources describing how different states approach CHW training and certification include:

• State Approaches to CHW Certification. This map depicts the status of CHW certification among states, including state-operated programs, privately operated programs, programs under development, and no certification program. The map is maintained by the Association of State and Territorial Health Officials (ASTHO) and up to date as of March 2025.
• State Community Health Worker Policies. The National Academy for State Health Policy (NASHP) maintains this resource, which includes a map and chart depicting how each state defines, trains, certifies, and pays CHWs.

Certification programs may help support the CHW workforce by clarifying competencies and scope of practice. Research has found that some CHWs view certification and continuing education as a tool to help advance their careers and the CHW field as a whole. In some states, credentialing may be mandatory for the CHW workforce, and in some states, credentialing is necessary to participate in reimbursement for services provided by CHWs.

Policy Approaches

In some instances, policy changes may help support community health worker (CHW) involvement in rural programs. Policy approaches may address CHWs' provision of services, involvement in care delivery teams, certification, training, scope of practice, and payment. The National Academy for State Health Policy's State Community Health Worker Policies webpage tracks CHW legislation and policy approaches at the state level, including CHW models, state definitions, funding mechanisms, partnerships, and more. For additional policy considerations related to sustainability, see Module 6.