Community Health Worker Enrollment Criteria and Forms

Revised: October 2, 2025

To enroll as a community health worker (CHW) with Minnesota Health Care Programs (MHCP), a CHW must complete a Minnesota State Colleges and Universities (MnSCU) certified curriculum program recognized by the Healthcare Education Industry Partnership Community Health Worker Project policy committee. The following schools currently offer the certificate program:

· Minnesota West Community & Technical College

· Normandale Community College, Bloomington

· Northwest Technical College, Bemidji (primarily online; meet in person as needed)

· Rochester Community and Technical College, Rochester (as needed)

· St. Catherine University, St. Paul (hybrid: online or in person)

These schools are no longer offering the Community Health Worker Program but may enroll with certificate issued by:

· Minneapolis Community and Technical College

· Summit Academy OIC

· South Central Community College

· St. Mary’s University of Minnesota

· Inver Hills Community College

Tribal community health representatives (CHRs) may enroll as CHWs if they complete the MnSCU certification, the Federal Indian Health Services (IHS) training or meet the five years of supervised experience with an MHCP-enrolled physician or advanced practice registered nurse (APRN) providing educational services. MHCP and MnSCU will work with the tribes and IHS to determine how CHR training might be used to meet CHW requirements.

How to Enroll

Providers wanting to enroll with MHCP or make enrollment requests can do so in one of the following two ways:

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. Also, upload the following in the MPSE Portal:

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Community Health Worker (CHW) Provider Assurance Statement (DHS-5308) (PDF) signed by both the applicant and supervising professional

· A copy of the certification from one of the MnSCU approved programs

or

· Complete the following documents required to enroll as a community health care worker and fax your materials to MHCP Provider Eligibility and Compliance at 651-431-7462

· Individual Provider Enrollment Application (DHS-4016) (PDF)

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Community Health Worker (CHW) Provider Assurance Statement (DHS-5308) (PDF) signed by both the applicant and supervising professional

· Copy of the certification from one of the MnSCU approved programs

Review and keep a copy of the MHCP Data Privacy Notice (DHS-6287) (PDF).

We process forms in the order they are received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. If we need more information, we will send a request for more information letter to your MN–ITS mailbox (if you have an account) or via the U.S. Postal Service telling you what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services final federal provider screening regulations.

Refer to Revalidation in Provider Screening Requirements under Provider Basics in the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Enrollment. Refer to Changes to Enrollment in Enrollment with Minnesota Health Care Program (MHCP) under Provider Basics in the MHCP Provider Manual for details.

Legal References

Minnesota Statutes, 256B.0625, subdivision 49 (Covered Services; Community health worker)