Day 35 – Medicaid at 50: Health Homes

Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up to the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.

The fragmentation of our health care system can be challenging even for the savviest patient. Many of you may be familiar with the frustration of trying to get your various providers access to each other’s records and tests. For patients with complex needs, coordinated care is really important. Medicaid Health Homes are an optional State Plan benefit that encourage a “whole person” approach to care.

Health Homes are for Medicaid beneficiaries with two or more chronic conditions, or someone who has one chronic condition and is at risk for a second, and/or people with severe and persistent mental illness. The “Health Home” can be a designated provider, or a team of providers, and their role is to provide comprehensive care management, care coordination, health promotion, comprehensive transitional care/follow up, patient and family support, and referral to community/social services. The idea is that the Health Home will provide whatever their own specific services are (primary care, mental health, etc.), but also be aware of the big picture and make sure that the patient’s overall care plan is on track. States can receive an enhanced FMAP of 90% for the first 8 quarters of the initiative, and are required to be evaluated on quality measures, utilization, and expenditures. The ultimate goal of the program is to improve health outcomes, reduce emergency room visits and hospital admissions and readmissions, reduce overall costs, and to improve patient experience.

So far, 19 states have approved State Plan Amendments for a variety of Health Home models. It’s too soon for definitive results, but this will be an interesting program to watch.

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