Medicaid Health Homes
Presented by: Jayde Bumanglag, Quinne Custino & Sean
Mackintosh
What is Medicaid?
❖ Medicaid is the nation’s largest public health insurance
program and serves low income children and some
adults, seniors, and individuals with disabilities
What is a Health Home?
❖ Care delivery model that offers coordinated care to
Medicaid enrollees with multiple chronic health
conditions
❖ Builds on the concept of the patient-centered medical
home
❖ Promotes a patient-centered and “whole-person”
approach to care
Policy Goals
❖ Expand the traditional medical home model
❖ Strengthen Medicaid provider networks
❖ Provide comprehensive care management, care
coordination, health promotion, and comprehensive
transitional care
❖ Improve healthcare quality and clinical outcomes
❖ Reduce healthcare spending
Enrollment & Eligibility
❖ Medicaid beneficiaries who:
➢ Have two or more chronic conditions
➢ Have one chronic condition and are at risk for a
second, or
➢ Have one serious and persistent mental health
condition
❖ States can target health home services geographically
❖ Cannot exclude people with both Medicare and
Medicaid from health home services
Health Issues Addressed
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Mental health diagnosis
Substance abuse disorder
Asthma
Diabetes
Heart disease
Obesity (BMI over 25)
Health Home Services
❖ Comprehensive care management
❖ Care coordination
❖ Health promotion
❖ Comprehensive transitional care/follow-up
❖ Patient and family support
❖ Referrals to community-based social services and supports
Health Home Providers
❖ States have flexibility to determine eligible providers.
➢ Designated provider - e.g. a physician, rural clinic, community
health center, etc.
➢ Team of healthcare professionals - e.g. team may include
physician, nutritionist, social worker, behavioral health professional,
ect.
➢ Health team - e.g. a community-based interdisciplinary team,
medical specialists, nurses, pharmacists, etc.
Health Home Financing
❖ Through the Medicaid Health Home State Plan Option,
authorized under the ACA, states can design their own
health home programs with federal matching funds.
❖ States have flexibility in designing payment methods
❖ States receive a 90% enhanced Federal Medical
Assistance Percentage (FMAP) for the specific health
home services in Section 2703
➢ Good for first eight quarters program is effective
Health Home Capabilities
❖ Must provide cost-effective and culturally appropriate
person and family-centered services
❖ Must develop a care plan for each person that
coordinates and integrates all clinical and non-clinical
services
❖ Must also have a continuous quality improvement
program, and report data to support the evaluation of
health homes
Implications for Social Work
❖ The Health Home option presents states with
opportunities to develop more person-centered models
of care for Medicaid beneficiaries
➢ This helps reduces fragmentation of services
➢ Improves care coordination and integration
➢ Sustainable - reduces costs
Recap / Additional
Knowledge Check
States will receive a ___% enhanced Federal Medical Assistance Percentage.
Will states be allowed to limit provision of health home services to a specific geographic
area or must they be provided statewide?
Are the US Pacific Territories eligible?
Who is eligible to receive health home services?
1)
2)
3)
What populations are eligible to be enrolled in a health home?
Questions?
References
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Centers for Medicare and Medicaid Services. Health Homes. Retrieved from
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-andSupports/Integrating-Care/Health-Homes/Health-Homes.html
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Centers for Medicare and Medicaid Services. (2014). Medicaid Health Homes: An Overview.
Retrieved from http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-HomesTechnical-Assistance/Downloads/Medicaid-Health-Homes-Overview.pdf
❖
Kaiser Commission on Medicaid and the Uninsured. (2012). Medicaid Health Homes for
Beneficiaries with Chronic Conditions. Retrieved from
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8340.pdf
❖
The Hawaii Healthcare Project. (2014). Healthcare Innovation Plan. Retrieved from
https://laulima.hawaii.edu/access/content/group/MAN.72844.201510/RecommendedReadingsSelected/ACAHeaCareTransformation/SW722_ACA_Hawaii%20Healthcare%20Innovation%20Plan_FINAL.pdf