Medicaid Health Homes Presented by: Jayde Bumanglag, Quinne Custino & Sean Mackintosh

What is Medicaid? ❖ Medicaid is the nation’s largest public health insurance program and serves low income children and some adults, seniors, and individuals with disabilities

What is a Health Home? ❖ Care delivery model that offers coordinated care to Medicaid enrollees with multiple chronic health conditions ❖ Builds on the concept of the patient-centered medical home ❖ Promotes a patient-centered and “whole-person” approach to care

Policy Goals ❖ Expand the traditional medical home model ❖ Strengthen Medicaid provider networks ❖ Provide comprehensive care management, care coordination, health promotion, and comprehensive transitional care ❖ Improve healthcare quality and clinical outcomes ❖ Reduce healthcare spending

Enrollment & Eligibility ❖ Medicaid beneficiaries who: ➢ Have two or more chronic conditions ➢ Have one chronic condition and are at risk for a second, or ➢ Have one serious and persistent mental health condition ❖ States can target health home services geographically ❖ Cannot exclude people with both Medicare and Medicaid from health home services

Health Issues Addressed ❖ Mental health diagnosis ❖ Substance abuse disorder ❖ Asthma ❖ Diabetes ❖ Heart disease ❖ Obesity (BMI over 25)

Health Home Services ❖ Comprehensive care management ❖ Care coordination ❖ Health promotion ❖ Comprehensive transitional care/follow-up ❖ Patient and family support ❖ Referrals to community-based social services and supports

❖ States have flexibility to determine eligible providers. ➢ Designated provider - e.g. a physician, rural clinic, community health center, etc. ➢ Team of healthcare professionals - e.g. team may include physician, nutritionist, social worker, behavioral health professional, ect. ➢ Health team - e.g. a community-based interdisciplinary team, medical specialists, nurses, pharmacists, etc. Health Home Providers

Health Home Financing ❖ Through the Medicaid Health Home State Plan Option, authorized under the ACA, states can design their own health home programs with federal matching funds. ❖ States have flexibility in designing payment methods ❖ States receive a 90% enhanced Federal Medical Assistance Percentage (FMAP) for the specific health home services in Section 2703 ➢ Good for first eight quarters program is effective

Health Home Capabilities ❖ Must provide cost-effective and culturally appropriate person and family-centered services ❖ Must develop a care plan for each person that coordinates and integrates all clinical and non-clinical services ❖ Must also have a continuous quality improvement program, and report data to support the evaluation of health homes

Implications for Social Work ❖ The Health Home option presents states with opportunities to develop more person-centered models of care for Medicaid beneficiaries ➢ This helps reduces fragmentation of services ➢ Improves care coordination and integration ➢ Sustainable - reduces costs

Recap / Additional Knowledge Check States will receive a ___% enhanced Federal Medical Assistance Percentage. Will states be allowed to limit provision of health home services to a specific geographic area or must they be provided statewide? Are the US Pacific Territories eligible? Who is eligible to receive health home services? 1) 2) 3) What populations are eligible to be enrolled in a health home?

Questions?

References ❖ Centers for Medicare and Medicaid Services. Health Homes. Retrieved from Supports/Integrating-Care/Health-Homes/Health-Homes.html ❖ Centers for Medicare and Medicaid Services. (2014). Medicaid Health Homes: An Overview. Retrieved from Technical-Assistance/Downloads/Medicaid-Health-Homes-Overview.pdf ❖ Kaiser Commission on Medicaid and the Uninsured. (2012). Medicaid Health Homes for Beneficiaries with Chronic Conditions. Retrieved from ❖ The Hawaii Healthcare Project. (2014). Healthcare Innovation Plan. Retrieved from HeaCareTransformation/SW722_ACA_Hawaii%20Healthcare%20Innovation%20Plan_FINAL.pdf