New York State Health Home Requirements

Section 2703 of the federal Patient Protection and Affordable Care Act (ACA) establishes authority for states to develop and receive federal reimbursement for a set of health home services for their state's Medicaid populations with chronic illness. Health home services support the provision of coordinated, comprehensive medical and behavioral health care to patients with chronic conditions through care coordination and integration that assures access to appropriate services, improves health outcomes, reduces preventable hospitalizations and emergency room visits, promotes use of health information technology (HIT), and avoids unnecessary care.

Health Home services include:

  • comprehensive care management,
  • health promotion; transitional care including appropriate follow-up from inpatient to other settings,
  • patient and family support,
  • referral to community and social support services,
  • use of health information technology to link services.

New York State's Health Home eligibility definition is as follows:

  • Two (2) chronic conditions; or
  • One (1) single qualifying condition (HIV/AIDS or SMI)

If an individual has HIV or SMI, they do not have to be determined to be at risk of another condition to be eligible for Health Home services. Substance use disorders (SUDS) are considered chronic conditions and do not by themselves qualify an individual for Health Home services. Individuals with SUDS must have another chronic condition to qualify.