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Resources and Background on Health Homes

There are many ways that states can modify their Medicaid programs to provide more targeted and coordinated care to their beneficiaries. One important option available to states is to develop a "health home" model for specific beneficiaries.

Health homes are a formal Medicaid state plan option. States must pro-actively opt to do adopt this program. There is a 90 percent federal match rate for two years to provide for specific services that are provided through the health home authority: comprehensive care management, care coordination, transitions from inpatient to other settings, family supports, and referrals to community and support services.

The goal of a health home is to provide comprehensive and coordinated care for specific populations. Health Homes are established by a designated provider or by a team of providers.

The benefit is for "eligible individuals with chronic conditions" and does not allow the state to narrow that to a subcategory of individuals. For example, a state that chooses to cover "obesity" as a chronic condition must offer the benefit to all beneficiaries who meet the criteria for obesity; they cannot limit the benefit to just adolescents with obesity. However, the specific treatment and coverage protocols may be different for different cohorts. In other words, all patients who present with a serious chronic condition would be eligible-but children and adults could be eligible for different services.

To date, thirteen states have been approved for health home state plan amendments. Many other states have been approved for planning grants and plan to submit a state plan amendment.

Click here for more resources on health homes


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