The Affordable Care Act of 2010, Section 2703 (1945 of the Social Security Act), created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions. The Centers for Medicare & Medicaid Services (CMS) expects states health home providers to operate under a “whole-person” philosophy. Health Homes providers will integrate and coordinate all primary, acute, behavioral health, and long term services and supports to treat the whole person.
Who Is Eligible for a Health Home?
Health Homes are for people with Medicaid who:
- Have two 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 listed in the statute include mental health, substance abuse, asthma, diabetes, heart disease, and being overweight. Additional chronic conditions, such as HIV/AIDS, may be considered by CMS for approval.
- States can target health home services geographically
- States cannot exclude people with both Medicaid and Medicare from health home services
Health Home Services
Services incude the following:
- Comprehensive care management
- Care coordination
- Health promotion
- Comprehensive transitional care/follow-up
- Patient & family support
- Referral to community & social support services
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, chiropractics, licensed complementary and alternative practitioners
Health Home service providers must report quality measures to the state. States are also required to report utilization, expenditure and quality data for an interim survey and an independent evaluation.
Health Home Financing
States have the flexibility in designing their payment methodologies and may propose alternatives.
States receive a 90% enhanced Federal Medical Assistance Percentage (FMAP) for the specific health home services in Section 2703. The enhanced match doesn’t apply to the underlying Medicaid services also provided to people enrolled in a health home.
The 90% enhanced FMAP is good for the first eight quarters the program is effective. A state can get more than one period of enhanced FMAP, but can only claim the enhanced FMAP for a total of eight quarters for one enrollee.
The Health Home Information Resource Center (HHIRC) located on Medicaid.gov provides useful information to States considering the health home Medicaid State Plan option. Technical assistance is available to support state Medicaid agencies in developing and implementing health home programs under Section 2703 of the Affordable Care Act.