Health Homes 101

New York's Medicaid program serves over 5 million enrollees with a broad array of health care needs and challenges. While the majority of Medicaid enrollees are relatively healthy and only require access to primary care practitioners to obtain episodic and preventive health care, the Medicaid program also has several population groups who have complex medical, behavioral, and long term care needs that drive a high volume of high cost services including inpatient and long term institutional care.

Navigating the current health care system can be difficult for relatively healthy Medicaid recipients and even more so for enrollees who have high-cost and complex chronic conditions that drive a high volume of high cost inpatient episodes. A significant percentage of Medicaid expenditures are utilized by this subset of the Medicaid population. Appropriately accessing and managing these services, through improved care coordination and service integration, is essential in controlling future health care costs and improving health outcomes for this population.

What is a Health Home?

A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that all of a patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital. Health records are shared among providers so that services are not duplicated or neglected. Health Home services are provided through a network of organizations – providers, health plans and community-based organizations. When all the services are considered collectively they become a virtual "Health Home."

Who is Eligible to be in a Children’s Health Home?

Children from birth through age 21 enrolled in Medicaid and have one or more of the following:

  1. At least two chronic conditions
  2. Diagnosed Severe Mental Illness (SMI) including Severe Emotional Disturbance (SED) or
  3. HIV

Pending approval from CMS, “trauma, and at risk for another chronic condition” will be added to these eligibility criteria.

What does a Health Home do?

A Health Home offers six core services:

  • Comprehensive Care Management
  • Care Coordination and Health Promotion
  • Comprehensive Transitional Care
  • Individual and Family Support
  • Referral to Community and Social Support Services
  • Health Information Technology