Primary Care

Project Title

Integrating Community Health Workers Into Primary Care Teams

Grant Amount


Priority Area

Primary Care

Date Awarded

September 22, 2023


Long Island


In Progress


New York State’s approximately 7,000 community health workers (CHWs) are frontline public health workers who are trusted members of their communities.

More than half of them are people of color. CHWs have been proven to improve access to care and health outcomes, address housing and healthy food access, and lower health care costs. Increasing support for these workers in the primary care setting is one way to expand patients’ access to primary care, advance team-based care, and enhance health equity for CHWs themselves through career ladders. With a recent increase in State and federal support, primary care practices are looking to recruit more CHWs but require assistance to integrate them into care teams. Practices also need support in designing updated clinical workflows and supervisory models to help these workers productively contribute to patient care. In 2023, NYHealth awarded the Health and Welfare Council of Long Island (HWCLI) a grant to integrate community health workers into primary care practice teams by providing technical assistance to clinicians across Long Island. NYHealth is also supporting a complementary initiative with Montefiore Medical Center.

Under this grant, HWCLI will create a repository of resources to support practices across Long Island in hiring and integrating CHWs. These resources will be informed by national best practices; interviews with primary care practices and CHWs; and engagement of a workgroup that includes community health centers, hospital outpatient practices, and Medicaid managed care plans. Resources will include job descriptions, interview guides, onboarding materials, and professional development options for community health workers. Tools will also provide guidance on effective referral mechanisms between primary care and community-based organizations. Additionally, HWCLI will engage 12 primary care practices, covering a broad swath of Long Island, to help them put the tools into practice by conducting group training sessions and one-on-one technical assistance. To ensure proper implementation, HWCLI will track outcomes including successful hiring and retention; integration into care teams; and effective referrals between clinicians, CHWs, and social services. Finally, HWCLI and workgroup members will develop a regional CHW policy advocacy agenda in response to on-the-ground needs.