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Community health workers don’t need licensing, auditor says; is Legislature listening?

A proposed certification scheme for community health workers would burden the workers and raise prices for everyone, according to a new report by Hawaii Office of the State Auditor.[1]

The document, “Sunrise Analysis: Regulation of Community Health Workers,” issued in September, follows a long string of state auditor reports that show Hawaii’s occupational licensing laws do more harm than good.

Between 1985 and 2017, the state auditor conducted 44 reviews on various occupations — from mixed martial arts timekeepers to social workers — and 73% of them recommended that new regulations were unnecessary.

Nevertheless, state lawmakers rarely listened to the auditor: In 46% of the cases, they created a new license or kept the existing one anyway.[2]

Occupational licensing has been around for decades in Hawaii. In fact, Hawaii has the strictest occupational licensing laws in the country, according to a 2017 study from the Institute for Justice.[3]

Moreover, proposals to extend licensing to additional occupations continue to be put forth, despite a growing body of research showing that it does little to enhance the quality of work or protect consumers.[4]

Little wonder that so many Hawaii residents find it hard to get a good job in the islands and leave for greater job opportunities elsewhere.

In the case of community health workers, of which there are more than 200 in Hawaii, the state auditor’s office examined the trade in response to a licensing proposal considered during the 2022 legislative session.

State law requires the Office of the Auditor to review bills that would create new occupational licenses, so the Legislature passed a resolution directing the auditor to do that,[5] and the bill, SB2882, was shelved for the time being.[6]

There is no agreed-upon definition of a community health worker, but the federal Centers for Disease Control and Prevention defines them as individuals who are “effective at connecting the community to needed health and social services and improving the quality and cultural competence of health service delivery.”[7]

The proposed certification would have mandated that all people trying to get a job as a community health worker pay a $1,000 fee and complete a university community health worker program, or work 3,000 hours under supervision.[8]

The auditor wrote that the burdensome requirements of mandatory certification “could inadvertently force existing community health workers out of the field and make recruitment from underserved communities a greater challenge.”[9]

The auditor noted that a CDC report that such certification also does not necessarily benefit those in need of care.

“There is no empirical evidence showing that [community health workers] with certification perform their job better than CHWs without certification,” the CDC reported.[10]

In lieu of mandatory certification, the Hawaii Public Health Institute, a nonprofit focused on improving health and preventing disease, testified before lawmakers in March that there be some sort of optional certification program.

“At this time we would prefer the certification program be optional for [community health workers] and for employers to decide if they will require certification,” the Institute said in written comments to the House Committee on Health, Human Services and Homelessness.[11]

Optional certification, the Institute said, would allow individuals and businesses flexibility. A mandatory certification or license would deny flexibility, and could be too rigid to adapt to the cultural differences of many community health workers.

For example, three health policy researchers writing in Health Affairs, a national peer-reviewed health policy journal, noted in July that “the CHW workforce is largely composed of women of color, [and] this racial diversity also brings linguistic diversity, which may prove to be a barrier in seeking CHW certification.”[12]

Considering all the evidence against occupational licensure laws, probably the best tactic for state lawmakers in the coming legislative session would be to heed the state auditor’s findings and fully reject mandatory certifications for Hawaii’s community health workers.

Then they could perhaps go back and reconsider their decisions regarding those other licensing laws that the Office of the Auditor recommended against.
____________

[1]Sunrise Analysis: Regulation of Community Health Workers,” A Report to the Governor and the Legislature of the State of Hawai‘i, Report No. 22-08, Sept. 2022.

[2]Hawaii’s Auditor Produces Some of the Nation’s Strongest Sunrise Reports,” Institute for Justice, accessed Oct. 28, 2022.

[3]License to Work: Hawaii,” Institute for Justice, accessed Oct. 28, 2022.

[4] Joe Kent, “Permission to Work in Hawaii,” Grassroot Institute of Hawaii, Sept. 14, 2017.

[5]SCR2 SD1,” Hawaii State Legislature 2022 Session, accessed Oct. 28, 2022.

[6]SB2882 SD2,” Hawaii State Legislature 2022 Session, accessed Oct. 28, 2022.

[7] “Sunrise Analysis,” p. 3.

[8]  Ibid, p 11.

[9] Ibid, p. 9.

[10] Ibid, p. 12.

[11] Testimony before the House Committee on Health, Human Services, & Homelessness, Hawaii Public Health Institute, March 15, 2022, p. 8.

[12] Megan Coffinbargar, April Joy Damian and John M. Westfall, “Risks And Benefits To Community Health Worker Certification,” Health Affairs, July 7, 2022.

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