Community Health Worker Certification by Jurisdiction

March 19, 2024

Updated February/March 2025

Approximately half of U.S. jurisdictions have or are developing a certification program for community health workers (CHWs). Certification can be employed as a tool to define a clear scope of practice and competencies within the CHW workforce, create a more simplified path to recruitment, and create a shared vision for integrating CHWs into health care teams. A certification program may also chart a path to a more defined and stable career ladder for CHWs.

At its core, certification is a declaration by an issuing authority that a CHW has met a standard set of qualifications (e.g., skills, education, work/volunteer experience, or training). Each jurisdiction that has developed a CHW certification program, however, has taken its own approach to setting requirements for certification and determining how to administer the program. 

Authorizing and administrative bodies vary between jurisdictions. In the majority of jurisdictions with CHW certification, the state/territorial health department (or an equivalent) is the credentialing authority or administrative home. However, associations, certification boards, or other state agencies can perform those functions. Currently, 12 states operate certification programs (AZ, CA, CT, KY, MA, MD, MO, NM, OH, OR, TX, and UT), five states’ programs are privately run by independent credentialing boards (FL, NV, PA, RI, and VA), and six states run their program through CHW association or CHW association-led committee (AR, IN, KS, NC, SC, and SD). At the time of publication, at least eight additional states are actively developing a CHW certification program (CO, IL, ME, MI, MS, NH, ND, and TN).  

Certification can be voluntary or mandatory. Typically, states, territories, and freely associated states have not required certification to practice as a CHW, since this would essentially serve as licensure. Instead, certification may be required to practice under the title of “certified CHW.” In addition, some states require certification for CHWs to be reimbursed for services through Medicaid or to operate in certain settings. Certification does not necessarily regulate the CHW practice, nor does it in most cases exclude non-certified CHWs from practicing within their communities. 

CHW certification programs are typically rooted in a core set of competencies. A consistent theme across certification programs is eleven competencies outlined in the Core Consensus (C3) Project—the closest approach to a national benchmark. Some states have outlined their own competencies in statute (e.g., Arizona, California, Maryland), but they often closely mirror the standards set forth in C3.

Certification does not necessarily equal training completion. CHW certification programs typically have additional requirements aside from training completion, such as work experience and continuing education requirements (see below).  For that reason, certification is not necessarily the same as “certificates of completion” often associated with higher education-based programs, unless the state or another entity declares it to be so. For example, Minnesota Department of Health considers completion of a foundational CHW certificate program to meet the certification requirement for Medicaid reimbursement.  

Common Components of CHW Certification Programs

Multiple pathways to CHW certification. Many CHW certification programs (e.g., Arizona, Arkansas, Connecticut, Kansas, Kentucky, Maryland, Massachusetts, New Mexico, North Carolina, and Texas) have multiple pathways to certification, which offer CHW applicants a range of eligibility criteria. Typically, there is at least one pathway rooted in training completion and a secondary pathway for CHWs with practical work experience. A jurisdiction may also offer a temporary “legacy” pathway for CHWs to apply for certification based on work experience for a limited duration of time  (e.g., Oregon).  

Initial certification and recertification requirements.

• Work or volunteer experience: The majority of CHW certification programs have at least one pathway for CHWs to become certified if they can demonstrate a certain number of paid or volunteer hours working as a CHW. Across jurisdictions that offer an experience-based pathway to certification, CHWs commonly must demonstrate six months (1,000 hours) to two years (4,000 hours) of experience working as a CHW. Those hours may have a recency requirement, often with CHWs required to demonstrate that the hours were completed within the past three to five years.  
• Training requirements: Typically, CHW certification programs have at least one pathway based in a CHW completing a core competencies-based training. A certification body may also be responsible for accrediting or approving the CHW trainings/curriculums (e.g., Missouri). In some jurisdictions, a CHW may be eligible for certification based on the training alone (e.g., Indiana), but most CHW certification programs require training coupled with a set number of experiential hours.  
• Professional recommendations: CHW applicants may be required to provide professional references (e.g., Florida, Massachusetts, New Mexico, Utah) or a reference from community members with direct knowledge of their work as CHWs (e.g., Connecticut).
• Educational requirements: The majority of CHW certification programs do not require CHWs to have a high school diploma or equivalency. However, an employer or CHW training program may have their own policies requiring certain educational attainment for employment/enrollment.  
• Age requirements: Typically, if a CHW certification program has an age requirement at all, applicants must be at least 16 or 18 years old.  
• Location requirements: A certifying body may require applicants to demonstrate ties to that jurisdiction. Kentucky requires applicants to live in or be employed as a CHW in the state at the time of certification. Nevada certification requires a CHW to validate they live in the state at least 51 percent of the time. Arkansas applicants must be currently working in the state or submit evidence to demonstrate a “good faith intention” to work in the state.  
• Agreement to a code of ethics: Certified CHWs may be required to adhere to a specific code of ethics (e.g., Kansas, Kentucky, Nevada, South Dakota, Utah).  

Tiered certification. At least four states have developed a tiered certification system designed to support professional advancement opportunities for CHWs. Nevada and New Mexico have two certification tiers, with the second tier requiring additional hours of specialty training. North Carolina has four certification tiers and South Carolina has three, each based on higher tiers requiring increased levels of lived and professional experience.  
 
Reciprocity between jurisdictions. Six states’ CHW certification programs have a component of reciprocity:  

• Arizona, New Mexico, and South Dakota allow applicants to demonstrate that they were certified in another jurisdiction.
• Kansas and Oregon honor work experience from specific neighboring states.
• Arkansas and Kentucky indicate they may review applications with out-of-state experience on a case-by-case basis.  

Fees for applicants. Certification fees for individual CHW applicants range from no-cost (Maryland, Oregon, Texas) up to $200 (Arizona), with the majority of programs charging an initial certification fee of $35-100. The certification fees are often determined in consultation with CHWs in the state to ensure costs do not present a barrier to entry into the workforce. The generated certification fees may go to support the administrative costs of program maintenance or could be directed to the state CHW association. Certification programs could also choose to allow certain applicants to be exempt from fees, such as exemptions based on income or veteran status.  
 
Recertification requirements. Almost all CHW certification programs require applicants to renew their certification on a two- or three-year cycle. CHWs may have to pay a recertification fee (typically $25-$100) and demonstrate completion of a certain number of continuing education credits (on average 10-15 hours of continuing education per year).  

Determining Whether and How to Pursue Certification

While some jurisdictions may choose to write their CHW certification requirements into statute via the legislature, others have taken a more collaborative approach by creating advisory committees to research and recommend CHW certification policies. In the latter model, a variety of stakeholders ranging from public health officials to current CHWs already working in their communities come together to assess necessary competencies, education and background requirements, and other elements of a certification program. And, although not required, jurisdictions may choose to formalize their recommendations through rules and regulations or legislative action. 
 
Certification is not the only path to support CHWs. Some jurisdictions, such as Louisiana, in consultation with CHWs in their respective jurisdictions, have chosen not to create a certification program and instead invested in developing robust training programs that build core competencies among the CHW workforce. 
 
Whichever pathway a jurisdiction takes, the public health community has widely endorsed working directly with CHWs and associations to ensure certification policies are responsive to the needs of the workforce. For example, the American Public Health Association has highlighted certain action steps for health departments, such as composing any advisory workgroups so at least half of its membership comprises self-identified CHWs.  

Conclusion

When assessing which policies are most impactful for strengthening and developing the CHW workforce in their communities, states should work in partnership with CHWs. One popular avenue to achieve this goal is certification. States, territories, and freely associated states continue to make meaningful inroads in developing certification programs that match the needs of public health, the communities they serve, and the CHWs providing services. As the landscape of CHW certification continues to change, ASTHO will update our Certification Map. 

The development of this product is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under grant number 2 UD3OA22890-10-00. The Centers for Disease Control and Prevention (CDC) awarded funds to ASTHO, which supported the update of this product, through the Strengthening Public Health Systems and Services through National Partnerships (CDC-RFA-OT18-1802) cooperative agreement. Information, content, and conclusions will be those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, CDC, or the U.S. Government. This document builds upon research completed by Carl Rush, Geoffrey Wilkinson, and Theresa Mason.