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.
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