Medicaid Provider Email 11/21/25

This communication came from Noreply-riproviderreps@gainwelltechnologies.com to Medicaid providers on 11/21/25. Scroll for Spanish.

EOHHS is sharing three important updates regarding the Community Health Worker (CHW) Program:

  1. CHW Manual Version 4.3 Now Posted

EOHHS has posted Version 4.3 of the CHW Program Manual on the EOHHS website. This version includes updated requirements and the compliance deadline of December 1. The manual is available in English and Spanish.

  1. New FAQ Released

EOHHS has released a Frequently Asked Questions (FAQ) document summarizing key questions from the fall information session, available in English and Spanish.

For additional guidance, providers may also review the information session slide deck (English and Spanish). Slides 17–26 include step-by-step enrollment instructions and troubleshooting tips. Please note the compliance date in the slides has been updated to December 1.

  1. Enrollment and Billing Requirements Effective December 1
    1. All CHWs must meet the updated enrollment requirements by December 1 to bill Medicaid for CHW services. Requirements include:
  • Obtaining an individual NPI
  • Being affiliated with an enrolled group provider
  • Completing enrollment with Gainwell
  • Completing the National Criminal Background Check (NCBC) through Gainwell
  • Completing the required EOHHS site visit
  1. Atypical Provider Terminations:
    Currently enrolled CHWs who remain listed as atypical providers will receive a termination notice from EOHHS and will be terminated on November 30. This aligns enrollment with the updated program structure.
  1. Billing Guidance:
  • Dates of service on or after December 1 will only be reimbursable for CHWs who have completed full enrollment as describe above in 3A.
  • Dates of service prior to November 30 may still be billed by CHWs registered as atypical providers. These claims must be submitted within 365 days from the date of service, consistent with Medicaid timely filing rules.

If you have questions about enrollment or NCBC processing, please contact Gainwell at rienrollment@gainwelltechnologies.com or the Customer Service Help Desk at (401) 784-3800 or 1-800-964-6211.

Thank you for your continued partnership in supporting Rhode Island Medicaid members.

Rhode Island Medicaid

Provider Services


EOHHS comparte tres actualizaciones importantes relacionadas con el Programa de Trabajadores Comunitarios de la Salud (CHW).

  1. Publicación del Manual de CHW Versión 4.3

EOHHS ha publicado la Versión 4.3 del Manual del Programa de CHW en el sitio web de EOHHS [protect.checkpoint.com]. Esta versión incluye requisitos actualizados y la fecha límite de cumplimiento del 1 de diciembre. El manual está disponible en inglés [protect.checkpoint.com] y español [protect.checkpoint.com].

  1. Nuevas Preguntas Frecuentes Publicadas

EOHHS ha publicado un documento de Preguntas Frecuentes (FAQ) que resume las preguntas principales de la sesión informativa de otoño, disponible en inglés [protect.checkpoint.com] y español [protect.checkpoint.com].

Para obtener orientación adicional, los proveedores también pueden revisar la presentación de la sesión informativa (en inglés [protect.checkpoint.com] y español [protect.checkpoint.com]). Las diapositivas 17–26 incluyen instrucciones paso a paso sobre la inscripción y consejos para la resolución de problemas. Tenga en cuenta que la fecha de cumplimiento en las diapositivas se ha actualizado al 1 de diciembre.

  1. Requisitos de Inscripción y Facturación Vigentes a partir del 1 de diciembre
  1. Todos los CHWs deben cumplir con los requisitos de inscripción actualizados antes del 1 de diciembre para poder facturar a Medicaid por los servicios de CHW. Los requisitos incluyen:
  • Obtener un NPI individual
  • Estar afiliado a un proveedor grupal inscrito
  • Completar la inscripción con Gainwell
  • Completar la Verificación Nacional de Antecedentes Penales (NCBC) a través de Gainwell
  • Completar la visita requerida al sitio por parte de EOHHS
  1. Terminación de proveedores atípicos

Los CHWs actualmente inscritos que sigan apareciendo como proveedores atípicos recibirán un aviso de terminación de EOHHS y serán dados de baja el 30 de noviembre. Esto alinea la inscripción con la estructura actualizada del programa.

  1. Guía de facturación
  • Las fechas de servicio el 1 de diciembre o después solo serán reembolsables para CHWs que hayan completado la inscripción completa descrita en la sección 3A.
  • Las fechas de servicio anteriores al 30 de noviembre aún pueden ser facturadas por CHWs registrados como proveedores atípicos. Estas reclamaciones deben presentarse dentro de los 365 días a partir de la fecha del servicio, conforme a las reglas de presentación oportuna de Medicaid.

Si tiene preguntas sobre la inscripción o el procesamiento de NCBC, comuníquese con Gainwell en rienrollment@gainwelltechnologies.com o con el Servicio de Atención al Cliente al (401) 784-3800 o al 1-800-964-6211.

Gracias por su continua colaboración para apoyar a los miembros de Medicaid de Rhode Island.

Rhode Island Medicaid

Provider Services

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This email inbox is not monitored.

For assistance call Medicaid Customer Service Help Desk at (401) 784-8100 for local and long distance or (800) 964-6211 for in-state toll calls and bordering communities.

RI Food Access Office Hours

*This meeting typically happens monthly, but in light of the current state of emergency, it has been moved to weekly, on Wednesdays from 9:30-10:15 am. *

RI Food Access Office Hours (monthly)

This monthly meeting creates space for community members and organizations to hear from—and ask questions of—state agencies and each other. Staff from state agencies and community organizations provide updates on food access programs and share information about any upcoming program changes. All are welcome to join us on the first Wednesday of each month from 9:30 to 10 a.m. on Zoom.

Zoom link: https://zoom.us/j/95157696130?pwd=HWzZNjEavJaH6TbXbsQQQuhOpIUcmM.1

Email Sarah Blau with any issues: Sarah.Blau@health.ri.gov

CISB Graduations & Endorsement!

¡Felicitaciones Centro de Innovación de Salud y Bienestar!

Finalización del Curso de Salud Mental y Trastorno por Uso de Sustancias – 26 de julio de 2025
El pasado sábado, 26 de julio de 2025, finalizó exitosamente la primera sección del Curso de Salud Mental y Trastorno por Uso de Sustancias. Esta capacitación de 30 horas es válida para el nuevo endoso en Salud Mental y Trastorno por el Uso de Sustancias del RI Certification Board. Un total de 8 Trabajadores Comunitarios de la Salud completaron el curso y ahora están listos para solicitar formalmente el endoso, ampliando sus competencias para apoyar mejor a las comunidades frente a los desafíos relacionados con la salud mental y el uso de sustancias.

Mental Health and Substance Use Disorders Course Completion – July 26, 2025
This past Saturday, July 26, 2025, the first section of the Mental Health and Substance Use Disorders Course was successfully completed. This 30-hour training is valid for the new Mental Health and Substance Use Disorders endorsement from the RI Certification Board. A total of 8 Community Health Workers completed the course and are now ready to formally apply for the endorsement, expanding their competencies to better support communities facing mental health and substance use challenges.

Graduación del Curso de Trabajador Comunitario de la Salud Mental – 28 de julio de 2025
El pasado lunes, 28 de julio de 2025, se celebraron en la Biblioteca de la Casa Estatal de Rhode Island los actos de graduación y recertificación del Curso de Trabajador Comunitario de la Salud Mental. Este curso representa la especialidad más avanzada en salud mental para los Trabajadores Comunitarios de la Salud. Un total de 13 TCSM completaron exitosamente la capacitación de 180 horas, reafirmando su compromiso con el bienestar emocional de sus comunidades. El evento contó con la participación de líderes políticos, socios comunitarios y familiares, quienes se reunieron para reconocer el esfuerzo, la dedicación y el trabajo transformador de estos profesionales esenciales en el sistema de salud pública.

Mental Health Community Health Worker Graduation – July 28, 2025
This past Monday, July 28, 2025, the Graduation and Recertification Ceremony for the Mental Health Community Health Worker Course was held at the Rhode Island State House Library. This course represents the most advanced specialization in mental health for Community Health Workers. A total of 13 CHWs successfully completed the 180-hour training, reaffirming their commitment to the emotional well-being of their communities. The event was attended by political leaders, community partners, and family members, who came together to recognize the effort, dedication, and transformative work of these essential professionals within the public health system.

Tuvieron el honor de estar acompañados por los siguientes líderes políticos y aliados de la comunidad en la graduación:/ They had the honor of being joined by the following political leaders and community allies at the graduation:

Political Leaders:

  • Governor Dan McKee, represented by Rosa De Castillo
  • Lieutenant Governor Sabina Matos
  • Mayor of Providence Brett Smiley, represented by Norelys Consuegra
  • Mayor of Central Falls Maria Rivera, represented by Zulaika Santana
  • Representative David Morales
  • Representative Enrique Sanchez
  • Providence City Councilor Miguel Sanchez
  • Central Falls City Councilor Tatiana Baena

Community Allies:

  • Rhode Island Foundation
  • Neighborhood Health Plan of Rhode Island
  • United Way of Rhode Island
  • Project Undercover
  • Central Providence HEZ / One Neighborhood Builders
  • Community Health Worker Association of Rhode Island (CHWARI)

EOHHS’s Response to Medicaid Comments

EOHHS Released Response to Comments 7/25/25
We would like to thank those of you who took the time to comment on the proposed changes to the State Plan Ammendment regarding CHW reimbursement by Medicaid. On Friday, EOHHS released their feedback to the commentary. The results are disheartening and we endeavor to remain hopeful for resilience through tumultuous times. Please view their responses here.  

While we are still digesting this information, we wanted to ensure it was made available to those most affected ASAP. 

Unfortunately, the critical role of CHWs and the opportunities to support their important work through Medicaid reimbursement has been adversely impacted by the fraudulent behavior of several bad actors who misappropriated Medicaid funding for their own purposes. In contrast to this behavior, countless times Rhode Island has been referenced on a national level as a glowing example of what a robust and advanced CHW workforce can accomplish. In our opinion, rather than narrowing eligibility or coverage, the state should provide adequate support for CHW services as a high-value strategy to reduce Medicaid’s overall cost of care, especially in light of the challenges and burdens our systems are currently facing. 

Dr. Tonya Glantz, Executive Director of RIC’s Institute for Education in Healthcare and CHWARI’s Administrator, stated her frustration, “It is unconscionable that after all of our hard work over multiple years that dishonest people have taken all of this effort and undone it. It is inexcusable.”

Over the past month, CHWARI, CHWs, and a variety of community-based organizations collaborated on a document to suggest specific changes and compromises in the Medicaid provider manual and to strongly recommend that EOHHS establish a comprehensive community consultation process. It was submitted to EOHHS, and while we hoped that the suggested changes would be implemented at this time, we now hope that the commentary will provide a foundation for future advocacy efforts. View it here

CHWARI has reached out to EOHHS multiple times, expressing the importance of collaborating with Medicaid to provide necessary training to CHWs and employers on Medicaid billing. Now that results of the commentary have been delivered, we will further advocate for training for those who still have questions on how to appropriately bill/operate under the new guidelines.  

Lastly, we know that many CHWs are scrambling to submit for certification before the October deadline. We have culled a list of upcoming trainings for those who still need education hours and posted it here. We have both a bilingual certification workshop and a re-certification/ specialties workshop this week. We will continue to offer one-on-one portfolio help to those who have completed CHW training and who have read the RICB CHW application completely. 

This is a tough beat. After we’ve all had time to carefully consider the current scenario, we would like to use this time as an opportunity to foster collaboration, connection, and support for each other. We are committed to supporting CHWs in RI going forward, no matter what. Thank you for your dedication and collaboration.  

In solidarity. 
The CHWARI

RI’s “Bridge to Better Health” CHW Marketing Campaign Earns Recognition and Awards!!!





We’re excited to share more campaign kudos!
RI’s “Bridge to Better Health” CHW Marketing Campaign Earns MORE Recognition and Awards!!!


The campaign “RI’s Community Health Workers: Your Bridge to Better Health” was recently recognized by the New England Society for Healthcare Communications (NESHCo) Lamplighter Awards with THREE awards:

  • Gold: Single Video – RI’s CHWs: Your Bridge to Better Health
  • Silver: Logo Design – RI’s CHWs: Your Bridge to Better Health
  • Bronze: Image/Branding – RI’s CHWs: Your Bridge to Better Health

All winners are listed at: https://lamplighter.awardsplatform.com/gallery.

This is the latest in many accolades the campaign has received since it was first launched in 2024 by the Rhode Island Department of Health (RIDOH) Community Health Worker (CHW) Program to elevate the roles and profiles of CHWs in public health. In December 2024, this same RIDOH CHW Program campaign received a Silver Award in theprestigious 2024 Davey Awards for the campaign’s visual identity development in marketing and advertising. Earlier this spring, the campaign also received an Award of Excellence for “Features – Art Direction” in the prestigious  2025 Communicator Awards

The campaign was produced by the RIDOH CHW Program and RIDOH Center for Public Health Communication with Communications Manager Angela Lemire leading this multi-media project at RIDOH from its initial planning stages through final executions. RIDOH contracted with Reach Consulting, with Meara Levezow leading the agency’s 2023-2024 evidence-based formative research, campaign development, production, and marketing phases. Throughout these steps, RIDOH and Reach engaged with the CHW Strategy Team, Roadmap groups, local CHWs, employers, and community partners to share insights, personal stories, and creative feedback. 

Congratulations to all RIDOH and Reach staff, CHWs, employers, and allied partners who were involved or shared their deep insights, personal stories, and creative feedback!

Access all award-winning campaign videos right here on YouTube! 

EOHHS Announcement

On Behalf of EOHHS,

Hello,

The Secretary of the Rhode Island Executive Office of Health and Human Services (EOHHS) has under consideration one (1) amendment to Medicaid regulation.  The regulation with proposed amendments and the reason for the amendments are summarized below.

Medicaid Payments and Providers, 210-RICR-20-00-1

In response to emerging concerns related to potential fraud, waste, and abuse (FWA) and the health and safety of Medicaid beneficiaries, the Rhode Island Executive Office of Health and Human Services (EOHHS) is proposing updates to the Community Health Worker (CHW) program to strengthen oversight, safeguard beneficiary health and safety and Medicaid funds, and ensure the continued integrity of the program.

EOHHS has identified a need to enhance provider screening and improve documentation and billing standards to better align with federal and state program integrity requirements . As part of this effort, CHW providers will be designated as high-risk provider for the purposes of enrollment, which will include additional screening measures to protect the health and safety of Medicaid members and promote the appropriate use of Medicaid resources.

These updates are necessary to maintain compliance with federal Medicaid standards and to preserve continued access to federal funding.

*Note: An emergency promulgation with the proposed changes is currently in effect and this promulgation is intended to supersede the emergency version when complete.

The proposed rule is accessible on the R.I. Secretary of State’s website: Welcome to the Rhode Island Code of Regulations – Rhode Island Department of State (ri.gov), the EOHHS website: www.eohhs.ri.gov, or available in hard copy upon request (401 462-2598 or RI Relay, dial 711). Interested persons should submit data, views, or written comments by July 25, 2025 to Katy Thomas, RI Executive Office of Health & Human Services, Virks Building, 3 West Rd, Cranston, RI 02920 or Kathryn.thomas@ohhs.ri.gov

In accordance with R.I. Gen. Laws 42-35-2.8, an oral hearing will be granted if requested by twenty-five (25) persons, by a governmental agency or by an association having at least twenty-five (25) members.  A request for an oral hearing must be made within ten (10) days of the publication of this notice.

Info on Changes to CHW Reimbursement by Medicaid

Things are happening fast! This page attempts to present the most updated shareable information from allies in one place – rather that waiting for the next newsletter to come out. Email updates to chwari@laurablackwell.com


Peer Specialist

Brown University Health
Charlestown
Full-time
2 Years Sobriety

Summary:

The Peer Recovery Specialist provides peer support and care coordination services to adults who have behavioral health needs (mental and substance use disorders. They are a member of a multi-disciplinary team designed to provide outreach engagement and system support. The function of the Peer Recovery Specialist is to serve as a role model mentor advocate and motivator to clients sharing their personal experiences to help motivate to seek treatment prevent relapse and promote long-term recovery.

Responsibilities:

Works with general outpatient and substance use disorder clients as assigned to support adults in their mental health and substance use challenges.

Provides opportunities for individuals receiving services to direct their own recovery process.

Coaches and supports the acquisition and use of skills needed to facilitate individual recovery.

Assists clients in identifying their personal strengths abilities and needs and articulating personal recovery goals and advocating for themselves during treatment.

Promotes the identification and use of natural resources and support systems within the community accompanying them to assist is accessing services.

Facilitates the development of a sense of wellness self-worth and personal control over one�s life and recovery journey.

Acts as a role model to clients in recovery to inspire hope; share life experiences and lessons learned as a person with lived experience.

Models/mentors recovery process and demonstrate coping skills.

Assists in the orientation process for persons who are new to receiving mental health and/or co-occurring treatment.

Demonstrates cultural sensitivity and competence in trauma informed care as relevant to the needs of individuals in recovery.

Supports the individual in seeking to connect/reconnect with family friends and significant others and in learning how to improve or eliminate unhealthy relationships.

Co-facilitates meetings to nurture a peer support culture.

As requested by client fosters spiritual connections with faith-based organizations and/or participation in self-help and mutual support groups.

Adheres to the policies and procedures for recovery-oriented treatment.

Participates in supervision team conferencing department and agency meetings.

Maintains detailed accurate and timely documentation in medical record.

Follows agency policies and standards for client rights and confidentiality.

Perform other duties as assigned.

Other information:

QUALIFICATION REQUIREMENTS:

Individual who is in personal recovery from a mental health and/or substance use condition and has used services related to that recover.

High school diploma or GED

Ability to complete certification as a peer recovery specialist.

Maintained at least 2 years of sobriety or absence of drug use.

NECESSARY SPECIAL REQUIREMENTS:

Be self-identified current or former user of mental health or co-occurring services who can relate to others who have not utilized those services.

Communication with supervisor to identify potential situations/concerns.

Have demonstrated proficiency in reading and writing.

Attended trainings on relevant topics such as behavioral health substance use and chronic health conditions.

JOB KNOWLEDGE SKILL AND ABILITY:

Valid driver’s license and use of car during normal working hours or other means of transportation to complete major functions of job.

Ability to establish trusting relationships with peers.

Ability to work independently and also as an integral part of multidisciplinary team.

Be able to recognize early triggers and signs of relapse. Be able to use computer to record services or be willing to learn.

SUPERVISORY RESPONSIBILITY:

None.

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Brown University Health is a VEVRAA Federal Contractor.

Location: GHI-Charlestown-4705 Old Post Road USA:RI:Charlestown

Bilingual Care Coordinator/Community Health Worker

Amos House
Providence, RI
Full-time, $22 – $24/hr
CHW Certified or close

Job Description

——————————————-

The Bilingual Care Coordinator/Community Health Worker (CHW) will act as a bridge between the Amos House Outreach team and the Amos House Clinic, supporting individuals who come into Amos House for emergency services. This role will connect them with behavioral health and medical services as needed. The Care Coordinator will assess needs, directly address issues related to benefits and housing, and facilitate connections with Amos House and other healthcare providers, including for evaluation of social security benefits. The Care Coordinator will also support clinic clients in consistently engaging in treatment, including assisting with transportation, locating individuals who have been lost to follow-up, and helping clients navigate pharmacy requests.

This position requires fluency in English and Spanish to provide direct, equitable care to the communities we serve.

Duties/Responsibilities:

Conduct assessments to identify health-related social needs, as well as basic physical and behavioral health screenings. 

Assist with benefits enrollment and obtaining identification (IDs, birth certificates, Social Security cards). 

Prepare clients for CES enrollment by completing required assessments and housing applications. 

Assist clients in scheduling and attending medical and behavioral health appointments; provide reminders and transportation as needed. 

Support clients in applying for SSI/SSDI, coordinating with medical providers and legal representatives. 

Conduct outreach to locate individuals who have fallen out of care or require medical follow-up.

Coordinate care with other service providers and case managers. 

Provide positive modeling in communication, punctuality, and accountability. 

Share lived experience with clients professionally, when appropriate. 

Document all case notes in AWARDS and complete all required Medicaid billing documentation.

Note: Duties/responsibilities may evolve based on organizational needs. 

Qualifications

Required:

Certification as a Community Health Worker (CHW) in Rhode Island or completion of the required training hours for certification.

Bilingual proficiency in English and Spanish—must be able to communicate effectively with clients in both languages.

Proficiency in Microsoft Office and the ability to enter written notes into an electronic medical record system.

Ability to maintain confidentiality in all aspects of the work environment.

Understanding and respect for each individual’s unique path to recovery.

Sensitivity to adults from diverse educational, socio-economic, and cultural backgrounds, including individuals who are experiencing homelessness, in recovery, or formerly incarcerated.

Working knowledge of behavioral health and health disparities affecting marginalized populations.

Demonstrated commitment to the recovery community.

Schedule & Physical Requirements:

Typical Schedule: Monday – Friday, 8:00 AM – 4:00 PM 

Prolonged periods of sitting and computer work 

Must be able to lift up to 15 pounds occasionally

Compensation & Benefits:

Pay Range: $22 – $24/ hour, commensurate with experience

Comprehensive benefits package (eligible after 60 days) including:

Health, dental, and vision insurance

401(k) with employer match

Generous PTO and paid holidays

Employee assistance program (EAP)

Opportunities for training and professional development

Why Amos House?

Amos House is more than a workplace—it’s a community. We are mission-driven, team-oriented, and committed to making a difference. Join us in building a more just and compassionate Rhode Island.

All people have a seat at our table. Join us.

Amos House is an Equal Opportunity Employer. We are committed to fostering a workplace where everyone feels valued and respected. Diverse perspectives and experiences make us stronger, and we encourage candidates of all backgrounds and abilities to join us in building a more just and equitable community.

How to Apply

——————————————-

Send your resume and a brief explanation of why you are interested in this role, with the position as the subject line, to hr@amoshouse.com