1945A Health Homes Background
Section 1945A of the Social Security Act provides an opportunity for states to cover health home services, including care coordination, care management, patient and family support, and similar services, that are expected to support a family-centered system of care for children with medically complex conditions, and that could help to improve health outcomes for these children. Often, children with medically complex conditions require specialized diagnostic or treatment services that may not always be readily available from providers within their state of permanent residence. By implementing the section 1945A health home option, states can cover coordination of care for children with medically complex conditions, including coordination of the full range of pediatric specialty and subspecialty medical services and coordination of care and services from out-of-state providers (see discussion below of CMS’s October 20, 2021 guidance on best practices for using out-of-state providers to provide care to children with medically complex conditions). CMS expects state implementation of the new health home state plan option under section 1945A of the Act to improve care coordination for children with medically complex conditions.
General health home information can be found at the Health Home Information Resource Center home page.
1945A Health Homes Guidance
This State Medicaid Directors letter provides guidance on the implementation of section 1945A of the Social Security Act (“the Act”), enacted as part of the Medicaid Services Investment and Accountability Act of 2019, which authorizes states to cover an optional health home state plan benefit for Medicaid-eligible children with medically complex conditions.
Coordinating Care from Out-of-State Providers for Children with Medically-Complex Conditions
- Request for Information
- Fact Sheet
- 1945A SPA Template and IG Reference Materials
- Guidance on Coordinating Care Provided by Out-of-State Providers for Children with Medically Complex Conditions
Proposed 1945A Health Home Core Set Measures
- This State Medicaid Directors letter outlines provider reporting requirements as outlined in Section 1945A(g)(1) of the Social Security Act.
- Proposed 2024 Core Set of Health Care Quality Measures for 1945A Health Home Program (1945A Health Home Core Set)
1945A Health Home Planning Funds
Please refer to the Request Health Home Planning Funds section.
1945A Health Home SPA Submission Resources
States interested in establishing Medicaid health home programs will need to submit a state plan amendment (SPA) via an online template for approval by CMS.
- Use this web based portal for SPA submission.