Community Violence Intervention State Medicaid Resource Technical Hub (CVI SMART Hub)
The Community Violence Intervention State Medicaid Resource Technical Hub (CVI SMART Hub) is a comprehensive tool designed to help advocates, government administrators, and community violence practitioners understand the current status of Medicaid funding for violence prevention efforts nationwide.
Current Status of Medicaid Reimbursement for Violence Prevention Services
State | Authorizing Year | Authorizing Legislation | Authority of Benefit | Training or Certification Requirements | Reimbursement Rates | CPT Codes | Reimbursable Activities | Patient Eligibility | Medicaid Reimbursement Pathway | Provider Requirements | Provider Resources | State Plan Amendment |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| California | 2022 | AB1929 | Preventive Services | Completion of HAVI’s Violence Prevention Professional (VPP) Certification... Read more | $53.32/Hour | 98960, 98961, 98962 | Health education, health navigation, screening and assessment, individual... Read more | Individuals who either have been violently injured, are at... Read more | Services are reimbursed through MCOs and fee-for... Read more | A Community Health Work (CHW) must be supervised by a licensed... Read more | Provider Manual | State Plan Amendment (SPA) #: 22-0001 |
| Colorado | 2023 | SB23-002 | Physician Services | TBD | $95.00/Hour | 99401, 99402, 99403, 99404 | Preventive services, group and individual health education and... Read more | Individuals with a history of violent injury sustained because... Read more | Services are reimbursed through fee-for-service managed care... Read more | TBD | Provider Guide | TBD |
| Connecticut | 2021 | HB5677 | Preventive Services | HAVI Violence Prevention Professional (VPP) | $50.60/Hour | H0046 | Conflict mediation, crisis intervention, mentorship, peer support and... Read more | Individuals who have received medical treatment for injuries... Read more | Department of Social Services (DSS) has added coverage and reimbursement... Read more | Affiliation with a trauma center (level I or II) or children’s hospital | Provider Bulletin | State plan amendment (SPA)#: 22-AD |
| Illinois | 2021 | Reimagine Public Safety Act (430 ILCS 69) | Mental Health Rehabilitative Services | Violence Prevention Community Support Team (VP-CST) must include... Read more | $152 (off site) $139.36 (on site)/Hour | H0037 | Integrated assessment and treatment planning; crisis intervention, stabilization... Read more | Individuals who have experienced chronic exposure... Read more | Violence Prevention Community Support Team (VP-CST) services are... Read more | Community mental health centers (CMHC) or behavioral health clinics (BHC) | Provider Notice | State Plan Amendment (SPA) 22-0003 |
| Maryland | 2022 | SB0350/HB1005 | Preventive Services | HAVI Violence Prevention Professional (VPP) Certification | $65.52/Hour | 99402, 99402 GT | Covered services include mentorship, conflict mediation, crisis intervention... Read more | Individuals who have been exposed to community violence or received... Read more | Services are reimbursed through MCOs and Medicaid fee-for-service | HAVI Violence Prevention Professional (VPP) Certification | Provider Guide | State Plan Amendment (SPA) #: 22-0004 |
| New York | 2024 | S580A | Preventive Services | Violence prevention training program provided by entities... Read more | $70.00/Hour | 98960 U3 U1, 98961 U3 U1, or 98962 U3U1 | Peer support and counseling, mentorship, conflict mediation and... Read more | Individuals who have either been exposed to community... Read more | Services are reimbursed through MCOs and Medicaid Fee-for-Service | Clinic or hospital affiliation or a community-based... Read more | Provider Manual | TBD |
| North Carolina | 2022 | - | 1115 Waiver | - | $168.94/ Per Member Per Month (PMPM) | - | - | Individual must be at risk of witnessing or experiencing... Read more | - | - | - | - |
| Oregon | 2023 | HB4045 | Preventive Services | HAVI Violence Prevention Professional (VPP) Certification + Oregon Health... Read more | $99.12/Hour | H2015 | Mentorship; conflict mediation; crisis intervention; peer support and... Read more | Individuals who have received treatment for an injury which includes both... Read more | Services are reimbursed through MCOs and fee-for-service (FFS) | VPP must be employed by a community-based organization... Read more | Provider Rules | State plan amendment (SPA) #23-0009 |
Why Medicaid for Violence Prevention
In the United States, nearly two-thirds of violently injured patients are either on Medicaid or uninsured, making Medicaid the largest payer of the costs associated with violent injuries. Before the Affordable Care Act (ACA) expanded Medicaid coverage beyond low-income mothers and children, these patients often could not access the critical follow-up care necessary for long-term recovery, resulting in long-term disability, poor quality of life, and costly medical bills. Currently, 41 states and the District of Columbia have adopted the ACA’s Medicaid expansion.
In 2021, the Centers for Medicare & Medicaid Services announced several pathways states can take to provide reimbursement for community violence prevention services. Through Medicaid, survivors of violence can receive the necessary medical care to support their physical recovery and access programs and services that mitigate trauma, reduce future injuries, and disrupt cycles of violence. These services, provided by violence prevention professionals (VPPs), serve as a vital bridge between the hospital and an individual's return to the community.
The Role of Violence Prevention Professionals
Since 2015, VPPs have been recognized as health professionals by the National Uniform Claim Committee (NUCC), making their services eligible for reimbursement. Violence prevention professionals are trained public health professionals who provide services in both clinical and community-based settings, offering health navigation and support to the most vulnerable populations. By doing so, they reduce the burden on health care facilities and lower medical costs for both victims and health care providers. Violence prevention professionals offer trauma-informed care to survivors of violence through various means, such as hospital-based violence intervention programs (HVIPs), street outreach/violence interruption, and other community violence intervention services.
How the benefit works
Medicaid is state-based, meaning each state establishes and administers its own Medicaid program. Therefore, each state must take action to add VPP services to its existing Medicaid benefits package. These benefits are often added under the ACA’s "preventive services" authority (although other routes to coverage are also available). The ACA’s preventive service rule authorizes states to reimburse non-physician providers who deliver preventive services. Since violently injured patients are at high risk of death from reinjury, and VPPs work to prevent reinjury, their services qualify as preventive under existing law.
Additional Resources
Join our monthly Medicaid Implementation Working Group to learn more about advocacy strategies and the implementation of violence prevention benefits in your state. Our website offers a range of resources on public funding for community violence intervention (CVI). To see which states have adopted the ACA’s Medicaid expansion, visit KFF’s Status of State Medicaid Expansion Decisions: Interactive Map.
Frequently Asked Questions
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Organizations receiving Victims of Crime Act (VOCA) funding are still eligible for Medicaid reimbursement. However, they must comply with the specific requirements of each funding source. Generally, service providers aren’t allowed to be reimbursed for the same service by two separate funders — in other words, no “double-dipping.” Organizations that utilize both funding streams must ensure a clear delineation and accounting of which activities and/or personnel are covered by each source.
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For existing violence prevention programs to obtain funding through Medicaid, they must first enroll as a Medicaid provider. To do so, the program applies through either the state’s Medicaid Office or Department of Health. Each state has its own process and timeline for provider enrollment, so it’s important to follow your state's guidelines carefully and complete all required steps to become an authorized Medicaid provider.
Glossary
CBO – Community-based organization.
CHW – Community Health Worker. A public health worker that connects individuals to health care and social services.
CMS – Centers for Medicare & Medicaid Services, the federal agency that runs the Medicare and Medicaid programs and the Children's Health Insurance Program (CHIP).
CPT codes – Current procedural terminology. A code used to document medical procedures and services for the purposes of billing.
CVI – Community violence intervention (CVI) is an approach that uses evidence-informed strategies to reduce near-term violence through tailored community-centered initiatives. These multidisciplinary strategies engage very high-risk individuals and groups to disrupt cycles of violence and retaliation.
Fee-for-service (FFS)– A payment model in which a health care provider is paid directly for each individual service provided.
MCO – Managed care organization. A health insurance organization that coordinates care and services for enrolled members.
Provider bulletin/manual – A comprehensive guide that outlines policies, procedures, and billing information for health care providers.
SPA – State plan amendment. An agreement between a state and the federal government describing how that state will administer its Medicaid program. When a state is planning to make a change to its program policies or operational approach, states send a state plan amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) for review and approval.
VPP – Violence prevention professional. A frontline worker in a community violence intervention program.