Qualification Requirements

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:

1. Active Medicaid.
2. 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
     • Asthma
     • Diabetes
     • Heart Disease
     • Overweight as evidenced by a body mass index (BMI) of 25
     • Other Chronic Conditions
3. 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.