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Guide to Medicaid Health Home Design and Implementation

This Guide to Medicaid Health Home Design and Implementation includes resources to help states plan their health home programs and prepare a health home state plan amendment for submission. The guide includes resources from the Centers for Medicare & Medicaid Services, select external resources, as well as materials created by states that are currently implementing health home programs.

New resources will be continuously added to help states advance health home models.

 Health Home Background Resources

This section provides background information on the structure and purpose of Medicaid health homes and their regulatory authority.

Resources

Developing Health Home Population Criteria

Medicaid health homes must be targeted to beneficiaries with chronic conditions or serious mental illness.  States should carefully define their target population to maximize program impact. Questions to ask include:

  • How many beneficiaries would be eligible for the health home program?
  • Where do beneficiaries currently receive care?
  • Do eligible beneficiaries “cluster” in a certain geographic area, around certain providers, or among specific chronic conditions?
  • Do subsets of the population offer opportunities for reductions in avoidable emergency department and inpatient hospital use?

Resources

State-Developed Materials

Defining Health Home Services 

Medicaid health homes must provide six core services: (1) comprehensive care management; (2) care coordination and health promotion; (3) comprehensive transitional care/follow‐up; (4) patient and family support; (5) referral to community and social support services; and (6) use of health information technology to link services.

State-Developed Materials

Establishing Health Home Payment Methodologies 

States have considerable flexibility in establishing payment methodologies for Medicaid health homes. In selecting a payment method, considerations include:

  • What financial incentives will help ensure that providers will deliver health home services effectively and efficiently?
  • What reimbursement methods will promote accountability and flexibility?
  • Will the state use a tiered reimbursement methodology based on provider capability or patient acuity?

Resources

State-Developed Materials

Meeting Health Home Quality Measurement and Reporting Requirements 

Medicaid health home programs will need to meet federal and state quality and reporting requirements. Providers of health home services will be required to report quality measures to their state as a condition for receiving payment.

Resources

Using Managed Care for Health Home Implementation 

Some states may choose to create Medicaid health homes within or outside of managed care delivery systems. In developing their programs, states will need to consider the implications for health plan accreditation and non-duplication of care management services.

Resources

State-Developed Materials

Integrating Physical Health/Behavioral Health in Health Homes

Medicaid health homes provide states with an important opportunity to integrate physical and behavioral health care for beneficiaries with complex care needs. Although states have considerable flexibility to define health home services and provider qualification as they see fit, effective integration of physical and behavioral health services is a critical aspect of program design. 

Resources