Our Health Home services are provided to a subset of the Medicaid population with complex chronic health and/or behavioral health needs. This population includes medically-needy beneficiaries served by Medicaid managed care or fee-for-service and Medicare/Medicaid dually eligible beneficiaries who meet Health Home criteria.
All of the below conditions must be met for the person to be Health Home eligible:
- Active Medicaid.
- A person served in a Health Home must have:
- A Serious Persistent Mental Illness or
- HIV/AIDS or
- At least two chronic conditions including, but not limited to:
- Mental Health Condition
- Substance Use Disorder
- Heart Disease
- Overweight as evidenced by a body mass index (BMI) of 25
- Other Chronic Conditions
- A person must be looked at and found to have significant behavioral, medical, or social risk factors to be considered for Health Home services.
Causes of medical, behavioral, and/or social risk can include:
- Probable risk for harmful events (e.g., death, disability, inpatient or nursing home admission);
- Lack of or poor social/family/housing support;
- Lack of or poor relationship with the health care system;
- Non-adherence to treatments or taking medication(s), or a hard time managing medications;
- Recent release from incarceration or psychiatric hospitalization;
- Difficulties in activities of daily living such as dressing or eating;
- Learning or cognition issues.