Who reaches Medicaid patients before they lose coverage? with Colby Takeda of Pear Suite

Starting Jan. 1, most adults who got Medicaid through expansion will have to prove they're working, in school, in job training or doing community service to keep their coverage under the 2025 reconciliation law known as H.R. 1. A recent survey found 44% of Medicaid members unprepared.

Colby Takeda, M.P.H., MBA, co-founder and CEO of Pear Suite, says states and health plans are turning to community health workers to reach them.

Medical Economics Associate Editor Austin Littrell sat down with Takeda, whose company helps community health workers contract with health plans and get paid. Takeda explains what those workers can and can't do, where their nonclinical role ends on the medically frail exemption and whether Medicaid pays for redetermination outreach. He says that varies by state.

He also covers how a small practice can hire community health workers, contract with them or reach them through community care hubs, and what physicians should ask their state and health plans before January.

According to Takeda, one health plan reported that members who worked with a community health worker were three times more likely to see their primary care physician within six months.

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Don't miss our recent episodes on heart health habits, Medicare's 2027 fee schedule, the Medical Group Management Association's 100th annual conference and maternity care gaps.

Music Credits:

Ocean Calm by Cephas - stock.adobe.com

A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:25 | Cold open. Takeda on why community health workers shouldn't be expected to keep doing this work for free.

0:25 – 1:50 | Introduction. Austin Littrell introduces the episode and the guest and previews the Medical Economics Practice Academy on Nov. 19.

1:50 – 3:50 | Inside Pear Suite. Takeda on building the documentation, contracting and billing setup that community-based organizations need to get paid by health plans.

3:50 – 6:36 | Who community health workers are. From his start in senior care to the care coordinators, advocates and promotores who have done this work for decades without much connection to physicians.

6:36 – 8:45 | What early states are seeing. Takeda on confusion in states like Nebraska and the first questions to ask about who leads the outreach.

8:45 – 10:47 | Where coverage breaks down. Language barriers, tech literacy and fear of sharing personal information, and why trusted messengers matter.

10:47 – 12:24 | Does Medicaid pay for the outreach? Reimbursement varies by state, and Takeda says assuming community health workers will do it for free is misguided.

12:24 – 13:16 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

13:16 – 15:37 | The medically frail exemption. Community health workers can't diagnose or prescribe, and Takeda says one of their biggest jobs is connecting patients with a primary care physician.

15:37 – 18:31 | How a practice can work with them. Hiring in house, contracting, partnering with community organizations or working through a community care hub.

18:31 – 21:09 | The outcome data. Takeda on about 78% member engagement and one health plan's finding that members were three times more likely to see their primary care physician within six months.

21:09 – 22:23 | What to do before January. Learn your state's and health plans' strategies, and find the local organizations that can help patients with forms and work requirements.

22:23 – 23:20 | Final thoughts. Takeda urges physicians to look for the community health workers already working in their area.

23:20 – End | Outro. Littrell wraps the episode and reminds listeners about the Practice Academy.