Medicaid Health Home

Acronym: Medicaid

The Medicaid health home model builds on the traditional patient-centered medical home concept, but goes further by requiring integration of physical and behavioral health services. It also extends care coordination beyond medical services to include social and community supports. The Health Home model is also aimed at specific high-risk populations (e.g., patients with multiple chronic conditions and/or severe and persistent mental illness). Unlike other Medicaid benefits, states can limit Health Home benefits to geographic areas, and can vary the scope of benefits offered to different types of Medicaid beneficiaries without requiring a waiver. Targeted to individuals with multiple chronic conditions, health homes are designed to be person- centered systems of care that facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care, and community-based health and social service supports. Health homes establish a care plan for each beneficiary, and coordinate and integrate his or her clinical and non-clinical services. The following health homes services are reimbursable: comprehensive care management, care coordination and health promotion, transitional care, referrals to community and social services, patient and family support, and use of health information technology. The ACA includes incentives for states to adopt Health Homes by creating a new Medicaid state plan option, and provides 90 percent federal matching funds for the first eight quarters of program implementation. Relevant Federal Legislation or Regulation: State Option to Provide Coordinated Care through Health Homes for Individuals with Chronic Conditions, Social Security Act §1945. States may pay for home health services for eligible individuals with chronic conditions who select a designated provider. The Secretary will establish qualification standards for designated home health providers. The federal matching rate for state spending is 90% for the first two years that the initiative is in effect. After two years, the federal government will match health home spending at the regular rate, which ranges from 50% to 74% across the states.22 CMS State Medicaid Director Letter regarding implementation of the ACA provision on health homes for enrollees with chronic conditions. November 16, 2010. [http://www.cms.gov/smdl/downloads/SMD10024.pdf](http://www.cms.gov/smdl/downloads/SMD10024.pdf)