Community Health Worker Pilot and Cost Control Act

Congress may act only under its listed powers, with limits on spending, respect for states, and fair process for those it pays. Article I, Section 8, Clause 1 allows spending for the general welfare but demands responsible limits. The Tenth Amendment leaves health regulation to states unless they choose to join a federal program. Fifth Amendment Due Process requires clear rules and fair review before payment is denied. This proposal follows those limits. The strongest objection is that prevention needs a permanent open-ended benefit to work. The answer is that an uncapped promise risks waste and state control, while a capped voluntary test would prove what helps patients before Congress commits more funds. The Community Health Worker Pilot Act would create a five-year voluntary pilot to test coverage of community health services. The official summary states the original would cover these services under Medicare and open a state option under Medicaid with a higher federal match. This proposal keeps that goal but makes it narrower, capped, and measured before Congress decides whether to continue it. Under the pilot, Medicare would cover preventive visits, health screenings, home education visits, and referrals to care when given by a qualified community health agency under a written needs plan. Qualified agencies would include nonprofits, federally qualified health centers, and similar groups that hire workers with lived ties to the areas served and meet clear training, background check, and supervision standards. Payment would be tied to documented visits and results, not open-ended claims. State participation in Medicaid would be fully voluntary. A participating state could cover the same defined services and receive a temporarily higher federal matching rate of five percentage points for those services only, within the overall five-year cap. States would keep control over which agencies qualify, how workers are supervised, and how services fit state health plans. Strong taxpayer protections would apply. Total federal spending for the pilot would be capped, with yearly public reports on costs, health results, and improper payments. The Inspector General would audit claims. Agencies could seek fair and prompt review of denied payments. After five years the pilot and the added match would end unless Congress reviews the results and passes a new law.