State Health Department Accepting Applications for Medicaid Health Homes

Initiative Will Improve Care Management for Medicaid Enrollees with Multiple Chronic Conditions and Reduce Medicaid Costs

ALBANY, N.Y (August 04, 2011) - The New York State Department of Health (DOH) is now accepting applications from health care providers to participate in New York's Medicaid Health Homes program, a new initiative to provide more coordinated, cost-effective services to Medicaid enrollees with complex medical, behavioral and long-term care needs.

"The Medicaid Health Homes program is an innovative plan to achieve Governor Cuomo's vision of improving the quality of care and controlling costs in Medicaid," Health Commissioner Nirav R. Shah, M.D., M.P.H. said. "Health homes will provide comprehensive care to Medicaid enrollees who need multiple services, while reducing the number of avoidable hospitalizations and visits to emergency rooms to manage costs."

Resulting from an initiative of the State's Medicaid Redesign Team (MRT), the Health Homes for Individuals with Chronic Medical and Behavioral Health Conditions program will better manage the care of Medicaid enrollees with multiple chronic conditions, while also controlling future health care costs associated with services for this population. In 2009, enrollees with two or more chronic conditions or HIV/AIDS accounted for $6.9 billion in State Medicaid expenditures.

Phase One Health Home applications will be accepted from August 1, 2011 until September 1, 2011. Other phases of Health Home development will follow as the program matures. Eligible providers include managed care plans; hospitals; medical, mental and chemical dependency treatment clinics; federally qualified health centers (FQHCs); targeted case management programs; primary care practitioners; patient-centered medical homes; and other Medicaid enrolled entities. DOH will prioritize patient assignment to health homes with comprehensive service delivery and care management capability, including both medical and behavioral health capacity.

DOH has submitted the Health Home plan to the federal Centers for Medicare and Medicaid Services (CMS) for approval. The goal is to have successful applicants assigned beneficiaries and be eligible to bill for health home services starting October 1, 2011. Additional application opportunities are expected to be offered at a later date based on geographic need.

The Medicaid Home Health program is projected to achieve state Medicaid savings of $33.2 million in fiscal year 2011-12.

The federal Patient Protection and Affordable Care Act established the authority for states to develop health home services for Medicaid populations with chronic illness and receive federal reimbursement for the health homes. State programs are eligible for a 90 percent federal matching funds.

To qualify for health home services, Medicaid eligible enrollees must have two chronic conditions; one chronic condition and be at risk for a second chronic condition; or one serious, persistent mental health condition. Chronic conditions include: mental health conditions, substance abuse disorders, diabetes, asthma, heart disease, HIV/AIDS, overweight (BMI>25), and hypertension.

Under the program, each enrolled patient will be assigned a single care manager who is responsible for the overall management and coordination of the patient's care. All members of the health home team will report back to the care manager on the patient's status, treatment options, actions taken, and outcomes.

Health home services will include: comprehensive care management; care coordination and health promotion; transitional care, including follow-up care when an patient leaves an inpatient setting; patient and family support; referral to community and social support services; and the use of health information technology to link services.

Additional information and the health home application, which is a web-based application available to applicants via the DOH website, can be found at: