Kyle Fischer, MD, MPH, Director, Policy & Advocacy, The Health Alliance for Violence Intervention
Princess Fortin, MPH, Senior Director, Organizational Growth & Equity, The Health Alliance for Violence Intervention
American cities are witnessing historic declines in gun violence. In recent years, cities like Baltimore, Philadelphia, and Chicago have all seen precipitous drops in homicides, with some reaching multi-decade record lows (Washington Post 2025). While there are many causes of this decline, experts in the field point to community violence intervention as driving the trend.
Community violence intervention (CVI) is a public health approach to prevent and intervene in gun violence. This strategy can be delivered in a variety of settings and includes program models such as hospital-based violence intervention programs (HVIPs), street outreach, transformational mentorship programs, and cognitive behavioral interventions. Oftentimes, cities will deploy multiple simultaneous models to create a CVI ecosystem, a comprehensive network of programs, people, and strategies working together to reduce violence in communities.
Although there are multiple distinct program models, all CVI strategies maintain a set of core components (US Department of Justice 2024). Programs work with individuals at the highest risk of either becoming a victim or perpetrator of gun violence. These interventions are delivered by trusted, credible messengers, referred to as violence prevention professionals. They deliver trauma-informed care interventions, while programs address the upstream social drivers of health.
Existing research demonstrates that CVI strategies are effective across multiple outcomes. One randomized control trial of an HVIP in Baltimore demonstrated a reduction in repeat hospitalizations for violent injuries from 36 percent to 5 percent (Cooper, Eslinger, & Stolley 2006). A study of street outreach programs reported a 32 percent reduction in homicides as well as a 23 percent reduction in nonfatal shootings (Webster, Tilchin, & Doucette 2023). Beyond repeat injuries, these approaches improve health outcomes across a variety of patient-centered outcomes, including increasing access to mental health care services (particularly for post-traumatic stress), and increased connections to critical social needs such as jobs, education, and housing (Juillard et al. 2016). Due to this success, CVI strategies were recommended as an evidence-informed approach for communities to address firearm violence in the 2024 Surgeon General’s Advisory, Firearm Violence: A Public Health Crisis in America (Office of the Surgeon General 2024).
Despite notable successes, the CVI field stands at a critical crossroad. Communities that implemented CVI ecosystems have seen record declines in homicides, yet the funding landscape is shifting dramatically. In the late 2010s, emerging programs were supported by city, state, and federal Victim of Crime Assistance (VOCA) dollars. When firearm violence surged during the COVID-19 pandemic, Congress acted and passed the American Rescue Plan Act (ARPA), sending a surge of funds to cities, counties, and states to address pandemic-related harms, including gun violence. As a result, individual cities and counties were able to invest millions of dollars across the country on new and existing CVI programs (Pattison-Gordon 2025). That funding boom, however, has ended. ARPA is in the process of distributing its final dollars. The federal Community Violence Intervention and Prevention Initiative experienced drastic DOGE cuts (Solomon & Pearl 2025), and the Crime Victims Fund contains a fraction of its balance from the late 2010s (Library of Congress 2025). Fortunately, one promising funding source remains: Medicaid.
How Medicaid can support CVI
Medicaid covers more than half of hospital costs for survivors of gun violence, making it the largest payer of gun violence (Royan et al. 2025). Fortunately, just as Medicaid has a role in paying for the costs of violence, it now has a role in paying for the prevention of violence.
These benefits vary from state to state, but in general, reimbursable activities cover a significant scope of the work CVI programs offer. For example, Maryland’s state-wide violence prevention Medicaid benefit covers mentorship, conflict mediation, crisis intervention, referrals to certified or licensed health care professionals or social service providers, patient education, and screening services.
Although there have been recent changes to the Medicaid program at the federal level, the opportunity to provide violence prevention and interventions services was largely unaffected by these changes. “The One Big Beautiful Bill Act,” or H.R.1, cut overall spending for the program in 2025, but mostly deferred to the states to determine how to balance their budgets (KFF 2025). As a result, states will spend significant efforts in 2026 balancing their budgets. For states looking to add a violence prevention benefit, they will likely need to use 2026 to plan and design a benefit before seeking approval in 2027.
Barriers to Medicaid reimbursement
We also know that using Medicaid to fund CVI can be complex as reimbursement requires medical billing expertise that many CVI programs lack, and state Medicaid administrators have limited familiarity with CVI. Medical billing is new for programs, and most need to perform an in-depth readiness assessment and staff training prior to launching reimbursement systems. Commonly encountered issues from programs include how to determine if billing should be done in-house vs outsourcing to a third-party processor, how to build accounting systems to avoid “double-dipping” with other funding sources, and training staff on medical records keeping, compliance, and HIPAA privacy policies.
Beyond knowledge, programs often must make up-front investments to begin the reimbursement process. Programs commonly need to upgrade documentation systems to HIPAA-compliant case management software. In addition, they may need to identify dedicated staff to manage the claims process. These gaps have slowed implementation, but they also highlight a clear opportunity for funders and policymakers to invest in capacity-building, technical assistance, and cross-sector partnerships to unlock Medicaid’s potential as a sustainable source for CVI.
Role for funders
These challenges present an opportunity for funders to make targeted investments that can create long-term financial sustainability of CVI programs, like HVIPs. While public funding through Medicaid is available in many states, it remains difficult to access. With proper support, however, these benefits can become fully usable and impactful. The support needed ranges from technical assistance for policymakers and programs, to practical infrastructure such as financial projection tools and HIPAA‑compliant documentation software.
Perhaps the most impactful moment to ensure easily accessible Medicaid benefits is through the initial policy planning and implementation process. As most Medicaid administrators are not familiar with CVI programming, the design of Medicaid violence prevention benefits is critical. Policymakers must make dozens of policy decisions, including the types of services covered, training and certification requirements for frontline violence prevention professionals, and a range of other technical details such as service limits which can drastically affect the accessibility of these benefits. These challenges can be addressed through the facilitation of robust stakeholder engagement processes, informational convenings with policymakers and programs, and the assistance of experts in the field to provide technical education. Funders can support these efforts by securing expert technical assistance for state-based Medicaid benefit design and direct funding for CVI organizations.
Programs benefit from direct assistance when adopting Medicaid reimbursement, since many encounter start‑up costs for billing software and must train staff on compliance, HIPAA, and reimbursement processes. The Health Alliance for Violence Intervention (HAVI), for example, provides hands-on technical assistance and works closely with both programs and state Medicaid administrators to ensure the benefits are accessible to patients and to ensure CVI programs remain financially sustainable. By engaging a broad range of stakeholders, HAVI has worked in nearly all states with a CVI benefit and provides technical assistance that has both improved the quality of violence prevention benefits in states and assisted programs in drawing down reimbursement. HAVI facilitates state-based learning communities to train and offer peer learning for numerous programs simultaneously. This allows programs to learn from national-level expertise while simultaneously working through similar issues among peers. These learning communities often serve as a venue for topic-based, expert-led sessions on challenging issues such as developing accounting systems for braided funding streams. In addition to group learning, HAVI provides targeted support for programs helping individual programs launch systems, project revenue, and decide between in‑house or outsourced billing.
Conclusion
Community Violence Intervention has become an increasing component of America’s community safety response. Despite its contribution to reductions in violence, the funding landscape is increasingly challenging, forcing programs to explore new opportunities. Though more technical support and education is needed, the recent development of Medicaid reimbursement for CVI programming offers the possibility of long-term funding for many programs. Targeted investments from funders can play a pivotal role in reducing gun violence by helping CVI programs implement and scale their work and by improving access to Medicaid reimbursement. These investments remove critical barriers, strengthen long‑term sustainability, and position programs to deliver consistent, high‑quality services. Ultimately, this support saves lives and helps communities build lasting safety.
References:
Cooper, Carnell; Eslinger, Dawn M. MS; Stolley, Paul D. “Hospital-Based Violence Intervention Programs Work.” The Journal of Trauma: Injury, Infection, and Critical Care 61(3):p 534-540, September 2006.
Juillard, Catherine; Cooperman, Laya; Allen, Isabel; Pirracchio, Romain; Henderson, Terrell; Marquez, Ruben; Orellana, Julia; Texada, Michael; Dicker, Rochelle A. “A decade of hospital-based violence intervention: Benefits and shortcomings.” J Trauma Acute Care Surg. 2016 Dec;81(6):1156-1161.
KFF. “Health Provisions in the 2025 Federal Budget Reconciliation Law.” KFF, August 2025. Health Provisions in the 2025 Federal Budget Reconciliation.
Library of Congress. “The Fluctuating Balance of the Crime Victims Fund,” April 2025.
Office of the Surgeon General (OSG). “Firearm Violence: A Public Health Crisis in America: The U.S. Surgeon General’s Advisory.” Washington (DC): US Department of Health and Human Services (US); 2024. Available from:
Pattison-Gordon, Jule. “ARPA reduced violence. Local governments to sustain the gains.” Governing, June 2025.
Royan, Regina; Lundberg, Alexander; Shan, Ying; Thomas, Arielle C.; Stey, Anne M. “Health Care Costs of Firearm Injury Hospital Visits in the US.” JAMA Health Forum. 2025;6(9):e253299. doi:10.1001/jamahealthforum.2025.3299
Solomon, Amy; & Pearl, Betsy. “DOJ Funding Update: A Deeper Look at the Cuts.” Council on Criminal Justice, May 2025.
US Department of Justice, Office of Justice Programs. “Community Violence Prevention: A Collaborative Approach to Addressing Community Violence,” March 2024.
Washington Post. “These five cities help explain why homicide rates are down across the US,” 2025.
Webster, Daniel W.; Tilchin, Carla G.; Doucette, Mitchell L. “Estimating the effects of Safe Streets Baltimore on Violence,” March 2023. Johns Hopskins Center for Gun Violence Solutions.