Follow the Testimony and the Money: A Stakeholder Map for a State Community Health Worker Coverage Bill
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP870: Health Policy, Advocacy, and Partnerships
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Month Day, Year
Follow the Testimony and the Money: A Stakeholder Map for a State Community Health Worker Coverage Bill
Advocates often know who supports their bill. They know less about who opposes it, why, and who pays for that opposition. A policy stakeholder map that includes funding helps advocates anticipate arguments, find potential allies among opponents, and understand the resources arrayed against them. This paper maps stakeholders for a composite state bill to cover community health worker services under Medicaid, using public testimony, lobbying registrations, and campaign finance disclosures.
Method
Varvasovszky and Brugha (2000) describe stakeholder analysis as a way to understand a policy by identifying the actors involved, their interests, their influence, and their positions, and they caution that analysts must be explicit about their own position and sources. This map drew on four public sources: written and oral testimony at the committee hearing; the state's lobbyist registration database, which lists clients and bills lobbied; lobbying expenditure reports filed quarterly; and campaign contribution records for members of the two committees that heard the bill. Each stakeholder was classified by position, influence, and resources. Where a group's position was unclear from the record, the map lists it as undecided rather than guessing, and the gap becomes a task for the next round of meetings.
Supporters
Supporters included the state nurses association, the community health worker association, the association of federally qualified health centers, two regional hospital systems, the state public health association, and several patient and anti-poverty organizations. Their interests vary: nurses and health centers see a way to address social needs they encounter daily, hospitals see potential reductions in avoidable readmissions, and community health worker organizations seek stable funding and professional recognition. Their influence is moderate: the nurses association and hospital systems have registered lobbyists and relationships with legislators, while community groups bring constituents and stories. The evidence base supports their position; a trial of community health worker support found fewer hospital days, and an analysis estimated a return of $2.47 per dollar to Medicaid (Kangovi et al., 2020).
Opponents
Opposition came from three sources. The state association of Medicaid managed care plans testified against the bill as written, arguing that a mandated fee-for-service benefit would reduce plans' flexibility. The state's business and taxpayer federation submitted written testimony opposing new Medicaid spending. And the state association of licensed social workers raised concerns about overlap between community health worker services and social work scope, seeking clear boundaries rather than outright defeat.
Who Funds the Opposition
Disclosure records show that the managed care association reported the largest lobbying expenditure on health bills in the session and employed two contract lobbyists; its members are the four plans holding Medicaid contracts, whose revenue depends on state capitation rates. The business and taxpayer federation is funded by member companies and reported spending on a general budget campaign rather than this bill specifically; several committee members received contributions from its political committee in the last election. The social workers' association has no paid lobbyist and relies on volunteer members. The loudest opposition was not the best funded, and the best funded opposition was the most negotiable. The managed care plans' objection was to the payment mechanism, not to community health workers themselves; several plans already fund small community health worker programs.
Neutral and Undecided Stakeholders
The Medicaid agency testified neutrally, raising implementation concerns about certification and timelines. The governor's budget office did not testify but signaled concern about cost. The state medical society took no position. These actors have substantial influence on whether the bill is funded and implemented, and their concerns can be addressed through amendments, such as a pilot structure and delayed effective date.
Comparing the Coalitions' Resources
Influence depends on resources, and the two sides hold different kinds. The opposition's advantage is money and access: paid lobbyists who meet legislators throughout the session, and campaign contributions that keep doors open. The supporters' advantage is numbers, credibility, and stories. The nurses association can mobilize members in every legislative district; community health workers and patients can describe what the work changes; and hospital systems carry weight with legislators whose districts depend on them as employers. Nurses are consistently rated among the most trusted professions, which gives their testimony a credibility that paid lobbyists lack. The supporters' task is to convert those assets into sustained contact with the members who will decide, especially the chairs of the health and appropriations committees and the members who received contributions from the opposition's political committee. A single hearing is not enough; the opposition's lobbyists will be in the building every week of the session.
Strategic Implications
The map suggests three strategies. First, negotiate with the managed care plans by letting them purchase services from community-based worker programs and credit that spending toward their quality incentive targets, turning the best-funded opponent into a partial ally. Second, address the social workers' concern with statutory language defining community health worker services as distinct from clinical social work and requiring referral pathways. Third, answer the fiscal opposition with a pilot limited in scope and cost, an evaluation requirement, and data on savings. Longest (2016) emphasizes that policy is shaped through interaction among interest groups, legislators, and agencies; understanding each group's interests, not only its position, opens room for negotiation.
Keeping the Map Current
Stakeholder positions change during a session. The map will be updated after each committee action, each quarterly lobbying report, and any public statement by a major actor. If the managed care plans accept the contracting amendment, they move from opponent to neutral or supporter; if the budget office's concerns harden, the pilot's scope may need to shrink further. A map that is not revised becomes a record of where things stood, not a guide to where they are going.
Conclusion
Mapping stakeholders by position, influence, and funding reveals that opposition to the community health worker bill is neither uniform nor fixed. The best-funded opponent objects to a mechanism, not a goal; another seeks boundaries, not defeat; and fiscal concerns can be met with a pilot. Following both the testimony and the money gives advocates a clearer picture of whom to persuade and how.
References
Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207-213. https://doi.org/10.1377/hlthaff.2019.00981
Longest, B. B., Jr. (2016). Health policymaking in the United States (6th ed.). Health Administration Press.
Varvasovszky, Z., & Brugha, R. (2000). How to do (or not to do) . . . A stakeholder analysis. Health Policy and Planning, 15(3), 338-345. https://doi.org/10.1093/heapol/15.3.338
How this DNP 870 Module 5 example is structured
DNP870 Module 5 samples usually map stakeholders, including the groups funding the opposition. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example states a method using public disclosures, maps supporters, opponents and neutral actors by interest and influence, analyzes who funds the opposition and derives strategies.
DNP870 Module 5 questions, answered
What does DNP870 Module 5 usually ask for?
The module usually asks you to map the stakeholders for a health policy, including opponents and the groups that fund them, and to consider what the map means for advocacy. Aspen does not publish module deliverables, so your classroom's instructions govern.
How can I find out who funds opposition to a bill?
Public sources include state lobbyist registration databases, lobbying expenditure reports, campaign contribution records and testimony at hearings, which together show who is lobbying, for whom and with what resources.
Why distinguish an opponent's position from its interests?
A group may oppose a bill as written while sharing its goal. Understanding the interest behind the position, such as flexibility for managed care plans, can reveal amendments that turn opponents into partial allies.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.