How Navigators and Community Health Workers Increase Access to Care
December 8, 2025 | By Heather Bates, MSW, ACC, and Ahana Singh, EdD, MPH
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Accessing and paying for health care is one of the most complex experiences Americans face in their lifetime. Two key workforces are critical to supporting access to care: health insurance Navigators and community health workers (CHWs). These community-based roles are important for local economies and play a pivotal role in keeping people healthy by assisting with finding and enrolling in coverage and accessing care after enrollment.
Navigators: Facilitating enrollment into health coverage, providing health insurance literacy, and promoting access to care
Navigators are central to the process of finding and enrolling in a health plan. Funded through grants, certified Navigators provides free, unbiased information to help consumers, small businesses, and families their annual health insurance plans through state and federal marketplaces made possible by the Patient Protection and Affordable Care Act (ACA).
Navigators work to increase both health insurance coverage — which pays for care — and health insurance literacy — which demonstrates the value of having coverage — by conducting outreach and consumer education year-round. Using an array of outreach and in-reach educational strategies and tactics, Navigators also help to meet the needs of their communities by providing education that is culturally and linguistically appropriate.
The Daily Work of Navigators
Navigators play an important role in the national effort to ensure consumers enroll in health coverage. During both Open Enrollment (November 1 – January 15) and Special Enrollment Periods (SEP) throughout the year due to life-changing events, Navigators have several key responsibilities:
- Provide information in a culturally and linguistically appropriate manner for populations served.
- Inform people about their new insurance options.
- Conduct public education activities about which enrollment options are available.
- Distribute impartial information about plan enrollment and availability of tax credits.
- Help people enroll in qualified health plans.
- Provide referrals for people with complaints and questions about their health plan.
- Help people keep their coverage and stay enrolled.
Community Health Workers (CHWs): Health promotion education, adoption, and behavior change to stay healthy once enrolled
CHWs help individuals navigate complex systems, manage chronic conditions, and access essential services such as food, housing, and transportation. A toolkit released this November by the Millbank Memorial Fund explains further that CHWs “address health-related social needs through resource navigation, peer social support, health coaching, and advocacy. A large body of research suggests that well-designed [CHW] programs improve chronic disease control and mental health, promote healthy behaviors, reduce hospitalizations, and increase participation in primary care.”
By meeting people where they are, CHWs help transform health care from a distant concept into something personal, accessible, and practical. Their presence builds trust and helps individuals feel truly seen, heard, and supported. This diverse workforce includes promotores, peers, and community health representatives who serve across homes, clinics, schools, and community settings. CHWs are funded in various ways, including grant funding, health plans, providers, and .
The Daily Work of CHWs
CHWs contribute to healthier, more connected communities through consistent, person-centered support that meets people where they are:
- Engage in daily activities that strengthen the health, stability, and well-being of individuals, families, and entire communities. Their presence makes health care more accessible, understandable, and culturally aligned.
- Support individuals across the lifespan, whether assisting a new parent in navigating postpartum care, helping an older adult organize and manage medications, or leading group workshops focused on preventing chronic diseases such as diabetes or hypertension.
- Bridge communication gaps by translating medical information into clear, relatable language. In doing so, they offer guidance, encouragement, and practical steps that help individuals understand their conditions, follow care plans, and stay connected to the care they need.
- Play an essential role in addressing social drivers of health. They advocate for safer environments, improved community conditions, and policies that support healthier living. They also connect individuals to food assistance, housing supports, transportation services, and other community resources that influence health outcomes.
Before Coverage, After Coverage
Navigators and CHWs play distinct yet complementary roles. While real-world workflows are rarely linear, Navigators generally assist before individuals access care. They explain payment and insurance options and help individuals enroll in coverage and stay enrolled so they can obtain preventive and specialty care. Once individuals are insured and able to access care, CHWs provide ongoing, person-centered support by helping people understand their health conditions, connect to essential resources, build self-management skills, and navigate the broader health and social care landscape with confidence.
The roles of Navigators and CHWs may be integrated into a single position depending on program design and funding sources. Both are trained to meet people where they are, provide education that connects coverage to care, and guide individuals through complex health care systems. Whether helping someone enroll in health coverage, connecting a family to food or housing support, or offering guidance during a vulnerable moment, Navigators and CHWs bring compassion and clarity to the front lines of care. They support individuals both before they enter the health care delivery system and as they experience health services. Together, they bridge connections, build trust, strengthen local communities, and help transform health care by ensuring that enrollment leads to access and access leads to better health.
Bottom line: Both Navigators and CHWs maintain and perform essential roles in the community, and they each require sustainable investment to deliver long-term impact.
Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.