Health Homes

Introduction

A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another to provide comprehensive services to patients based on their needs

It is an optional Medicaid State Plan program introduced part of Affordable Care Act of 2010, Section 2703. CMS expects states health home providers to operate under a “whole-person” philosophy.

Health homes are for the people with Medicaid who have chronic conditions. Health homes providers will integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person so that the services are not duplicated and neglected.

Who Is Eligible for a Health Home?

Health Homes are for people with Medicaid who:

• Have 2 or more chronic conditions
• Have one chronic condition and are at risk for a second
• Have one serious and persistent mental health condition

Chronic conditions include:

• Mental health disorder 
• Substance use disorder
• Asthma 
• Diabetes
• Heart disease 
• Obesity (BMI over 25) 
• HIV/AIDS
• Hypertension
• Certain types of cancer

Health Home Services

Below services should be covered in accordance with federal and State requirements:

• Comprehensive care management
• Care coordination
• Health promotion
• Comprehensive transitional care/follow-up (e.g., inpatient discharge, jail to community);
• Patient & family support
• Referral to community & social support services (e.g., housing, legal, food)

Health Home Goals
Below are few goals of health homes.

• Improve the experience of care
• Improve health outcomes for chronically ill clients
• Reduce Medicaid expenditures

Intended Outcome
The Health Homes Program will save money by reducing preventable hospitalizations, emergency room visits, and unnecessary care via the provision of a higher level of coordination among the patients’ various care providers

Eligibility for Health Home Providers
States have flexibility to determine eligible health home providers. Health home providers can be,

• A designated provider: May be a physician, clinical/group practice, rural health clinic, community health center, community mental health center, home health agency, pediatrician, OB/GYN, or other provider.
• A team of health professionals: May include physicians, nurse care coordinators, nutritionists, social workers, behavioral health professionals, and can be free-standing, virtual, hospital-based, or a community mental health center.
• A health team: Must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractic’s, licensed complementary and alternative practitioners.

How does a Health Home Work?

• Clients are either found in the community and meet eligibility criteria, or are assigned to us directly by the Health Home
• The client is outreached, located, engaged and enrolled
• Once enrolled, the Care Coordinator identifies areas of need and current providers in the client’s care team and referrals are given to fill gaps in service
• The Care Coordinator and client collaboratively build a care plan that outlines goals, barriers and strengths
• The Care Coordinator collaborates with the various treatment providers in the care team to ensure client compliance and continuity of care
• If the client is hospitalized or otherwise involved in a critical event the Care Coordinator takes the lead on transitional care planning and stabilization

Health Homes Flow

Assignment: State Department of Health (DOH) will send default and recommended member health home assignments to MCO/Payer.

Enrollment: After health home assignment, member has to confirm the assignment or select another health home on his choice.

Billing: MCOs bill state Medicaid for the services provided to the members. Once the MCO receives payments for the members, they will distribute the payment to its downstream/corresponding providers

Few more notes on Health homes

• Enrolling in the Health Home program is purely member choice.
• Department of health assigns all eligible members to a default health home center.
• Assignment is based on existing relationships with ambulatory, medical and behavioral health care providers or health care system relationships, geography, and/or qualifying condition.
• Members can accept and continue with the assigned health home or can request for member preferred health home center

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