An OPEN MINDS Market Intelligence Report

The health home model is an outgrowth of the medical home model that became a new Medicaid state plan option under the 2010 health care reform legislation, Patient Protection and Affordable Care Act (PPACA). The health home option, which is population-based and integrates care for individuals with chronic conditions, was included in the PPACA as a Medicaid quality initiative aimed at controlling health care cost growth by enabling individuals with chronic care illnesses to manage their conditions better, reduce the need for hospitalizations, and avoid costly emergency department visits. States are managing Medicaid health homes through three different models:

State contracts directly with a provider
State contracts with a lead entity
State contracts with providers and a care coordination entity

The health home model builds on the medical home model’s focus on acute care by including linkages to other community and social supports and enhancing integration and coordination of medical and behavioral health care to better meet the needs of people with multiple chronic illnesses. The health home model is independent of the delivery system. It can be incorporated into fee-for-service, managed care, or integrated Medicaid-Medicare demonstration projects for dual eligible beneficiaries.

Currently, there are 18 states that have health homes with 25 approved state plan amendments (states can submit different SPAs to implement different health home delivery models for different populations). Two states have either ended their health home program or are in the process of ending the health home program. Additionally, there are at least eight states in various stages of planning and implementing health homes.

OPEN MINDS gives readers answers to a number of questions related to health homes, including:

  • What is a health home?
  • What populations are served by Medicaid health homes?
  • How do states contract with health homes & what are the current payment rates?
  • A state-by-state guide to current Medicaid health homes – populations served, providers, & payment rates
  • What states have plans to implement health homes?

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