{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/community-health-workers/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Community Health Workers", "soc_code": "21-1094", "category": "Social Service", "us_employment": 61660, "median_annual_wage": 51850 }, "verdict": "EXPOSED", "risk_resistance": 58, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 13, "embodiment": 14, "liability_shield": 5, "trust_premium": 16, "judgment_accountability": 10 }, "reasoning": { "task_resistance": "At 13 rather than 16, the door-knocking, motivational-interviewing, and translating-a-discharge-plan-into-a-grandmother's-kitchen-Spanish half genuinely resists software, but the other half of a CHW's week — SDOH screening tools, entering encounters into the community-care platform, running a 211-style resource lookup, calling the no-show list — is already being handed to text-message bots and eligibility engines.", "embodiment": "14 reflects that the work happens in stairwells, encampments, food pantries, and unairconditioned apartments where you carry BP cuffs and glucometers, do home safety walk-throughs, and drive clients to appointments — uncontrolled environments, but with fewer clinical procedures on your hands than a home health aide, which is why it sits at 14 and not 18.", "liability_shield": "5 is the floor-plus-one for a role where most states offer only voluntary CHW certification (Texas, Indiana, Massachusetts credentials among them), no scope-of-practice statute protects your tasks, and the nurse or care manager above you signs off on anything clinical — the credential helps with Medicaid billing pathways, not with keeping the job.", "trust_premium": "16 because the entire reason payers hire CHWs is that you are from the ZIP code and the client will pick up your call after ignoring six from the clinic — that shared-language, shared-history credibility is the deliverable, though it is a bit below 20 since programs do reassign caseloads and clients transfer between workers.", "judgment_accountability": "10 sits mid-band because you decide in real time whether a home visit has become unsafe, whether the depression screen warrants an immediate warm handoff, and whether to report suspected neglect — but the protocols, escalation thresholds, and care plans are written by supervising RNs and program managers, so you carry the judgment call without owning the final clinical decision." }, "rationale": "The core of this job is showing up in people's homes, churches, shelters, and clinic waiting rooms to build enough trust that someone actually takes their meds, keeps the prenatal appointment, or accepts a referral — that cultural brokering and physical presence is not automatable. What is automatable is the paperwork half: intake forms, case notes, eligibility screening, resource directory lookups, appointment reminder calls, and the health-education handouts CHWs currently assemble by hand. Licensure is the weak spot — most states require only voluntary certification, so there is no legal barrier to a payer replacing outreach headcount with an app plus a smaller field team.", "outlook": "Demand grows as Medicaid and health systems keep paying for social-needs work, but documentation and referral-matching duties get absorbed by software, so the job shifts toward more visits per worker and more clinically embedded roles.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "CMS's 2024 Physician Fee Schedule made Community Health Integration services billable, but only when delivered by auxiliary personnel meeting state/certification standards under a billing practitioner. If more state Medicaid agencies follow Indiana, Minnesota, Rhode Island and Oregon in making a state-issued CHW certificate (with training hours and scope) a condition of payment, an app cannot be the billable entity — a certified named human must be attached to each billed encounter and to the supervising practitioner's attestation.", "plausibility": "already happening", "would_add": 5 }, { "dimension": "liability_shield", "change": "If state CHW scope-of-practice rules add named-worker documentation duties for specific reimbursable acts (blood pressure self-measurement coaching, home asthma trigger assessment, closed-loop referral confirmation) such that an audit clawback lands on the individual certificate holder rather than only the agency, personal accountability attaches.", "plausibility": "plausible", "would_add": 3 }, { "dimension": "task_resistance", "change": "Genuine two-tier job: if intake forms, eligibility screening, resource-directory lookup, reminder calls and handout generation are absorbed by payer platforms, the residual role is the tier AI cannot do — entering an unfamiliar home, reading whether someone is lying about food in the fridge, defusing distrust of clinics. Task mix shift alone raises measured resistance without any new law.", "plausibility": "already happening", "would_add": 4 }, { "dimension": "judgment_accountability", "change": "If health-plan contracts formalize CHW escalation authority — the worker's field judgment triggering an urgent clinician callback, a CPS or adult-protective report, or an ED-diversion decision under an accountable-care shared-savings arrangement — the role owns consequential calls under ambiguity with a documented trail. Some Medicaid managed-care Health-Related Social Needs contracts already assign escalation criteria to CHWs.", "plausibility": "plausible", "would_add": 4 }, { "dimension": "trust_premium", "change": "If payers or accreditors adopt language-and-community-concordance requirements (as some state Medicaid maternal-health and doula benefits now do), buyers are explicitly purchasing a specific human's community membership rather than an outreach function.", "plausibility": "plausible", "would_add": 2 } ], "ceiling_note": "Trust premium is already near its practical ceiling: the buyer is a payer or health system optimizing cost per engaged member, not the community member being served, and payers have repeatedly substituted app-plus-smaller-field-team when allowed. Certification-linked reimbursement is the only lever with real teeth, and it protects the certificate, not the headcount — a state could certify CHWs while plans still cut caseload-per-worker ratios." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 54760, "wage": 38370 }, { "y": 2018, "emp": 56130, "wage": 39540 }, { "y": 2019, "emp": 58950, "wage": 40360 }, { "y": 2020, "emp": 58670, "wage": 42000 }, { "y": 2021, "emp": 61010, "wage": 46590 }, { "y": 2022, "emp": 61300, "wage": 46190 }, { "y": 2023, "emp": 58550, "wage": 48200 }, { "y": 2024, "emp": 60730, "wage": 51030 }, { "y": 2025, "emp": 61660, "wage": 51850 } ], "from": 2017, "to": 2025, "change_pct": 12.6, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [ { "slug": "clinical-and-counseling-psychologists", "title": "Clinical and Counseling Psychologists", "verdict": "SAFE", "risk_resistance": 71, "median_wage": 100580, "overlap": 78, "skills_to_close": [ "Science", "Reading Comprehension", "Critical Thinking" ] }, { "slug": "occupational-therapy-assistants", "title": "Occupational Therapy Assistants", "verdict": "SAFE", "risk_resistance": 68, "median_wage": 72300, "overlap": 78, "skills_to_close": [ "Science", "Equipment Maintenance" ] }, { "slug": "child-family-and-school-social-workers", "title": "Child, Family, and School Social Workers", "verdict": "SAFE", "risk_resistance": 70, "median_wage": 59550, "overlap": 77, "skills_to_close": [ "Operations Analysis", "Science", "Active Listening", "Negotiation" ] } ], "license": "https://cookedindex.com/terms" }