Medicaid Health Homes Program Operation

Posted by IntegrityM | | Medicaid, Medicare

Section 2703 of the Affordable Care Act created an optional Medicaid State Plan benefit – Health Homes – to coordinate care for individuals who have Medicaid and have:

  • 2 or more chronic conditions;
  • 1 chronic condition and are at risk for a second; or
  • 1 serious and persistent mental health condition.

Chronic conditions include substance abuse, diabetes, heart disease, asthma, mental health, and being overweight. Health Home services include comprehensive care management, care coordination, health promotion, comprehensive transitional care and follow-up, patient and family support, and referrals to community and social support services.

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State Health Home Program & Providers

States have flexibility in determining eligible Health Home providers. Health Home providers can include:

  • A designated provider, such as a physician, pediatrician, OB/GYN, clinical/group practice, rural health clinic, community health center, community mental health center, or home health agency.
  • A team of health professionals, such as physicians, nurse care coordinators, nutritionists, social workers, or behavioral health professionals. These teams can be free-standing, virtual, hospital-based, or a community mental health center.
  • A health team, which must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractors, and licensed complementary and alternative practitioners.

Federal Medical Assistance Percentage (FMAP) for Medicaid Health Homes Services

States receive a 90 percent enhanced Federal Medical Assistance Percentage (FMAP) for the specific Health Home services detailed in Section 2703 of the Affordable Care Act. The enhanced FMAP for the first eight quarters the program is in effect.

Twenty States have approved State Plan Amendments to operate one or more Health Home programs. An additional eight States received Health Home planning grants, but do not yet have approved State Plan Amendments.

Health Home Program Medicaid Eligibility Requirements

To operate a successful Health Home program, a State must first identify members who meet Medicaid eligibility requirements to participate in the Health Home program. Then, they must match those determined eligible to Health Home providers.

Integrity Management Services has experience determining Health Home eligibility and assigning members to Health Home providers. Our approach yields consistent results taking into account States’ unique needs. Our approach even is tested and ready to use ICD-10 codes.

If you are looking to start a Health Home program, or looking for a new way to identify and assign Health Home participants, contact us here, or call us at (703) 535-1400, and we will be happy to help.

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