The Affordable Care Act gives states the right for Medicaid to establish health homes to help manage beneficiaries with chronic illnesses. However, an individual must be a Medicaid beneficiary diagnosed with two chronic conditions or one chronic condition and risk for a second, or a serious mental illness.
Medicaid Health Homes www.medicaid.gov integrate physical and behavioral health and long term services for the Medicaid population with high need, high cost medical services. In contrast to patient-centered medical homes, health homes specifically for Medicaid beneficiaries offer person-centered team-based care coordination with a strong focus on behavioral healthcare and social supports.
The team providing health home services may include physicians, nurse care coordinators, nutritionists, social workers, behavioral health professionals, or any professional the state deems appropriate for the health home model.
Some states are building health home models on a medical home framework by expanding links to providers and increasing the breadth of available support services. States must submit a Medicaid State Plan Amendment (SPA) to CMS for review and approval if states want to request program changes or update information.
As of July 2016, 19 states and the District of Columbia have approved SPAs. Some states are submitting multiple SPAs to target different populations or to phase-in SPAs regionally. More than one million Medicaid beneficiaries have been enrolled in health homes.
For more information, email healthhomes@cms.gov.