How to refer a member

Make a clinically informed, presumptive assessment about eligibility:

Step 1: Ensure the member is eligible for Medicaid and the Medicaid is active

Step 2: Assess Diagnostic Eligibility

  • At least TWO chronic conditions including, but not limited to: mental health condition, substance use disorder, asthma, diabetes, heart disease, BMI>25 or other chronic conditions. Full list of conditions. OR
  • A Serious Mental Illness OR SED (for children)


Step 3: Assess Health Home Appropriateness

The person has significant behavioral, medical, or social risk factors and can benefit from comprehensive care management services:

  • Inadequate connectivity to the healthcare system for example no primary care provider, no connection to specialty doctor, does not keep appointments, etc.
  • Non-adherence to treatment/medications or difficulty managing medications
  • Inappropriate ED use
  • Repeated hospitalizations for preventable conditions either medical or psychiatric
  • Recent release from incarceration
  • Deficits in activities of daily living such as dressing & eating
  • Lack of or inadequate social/family/housing support (including homelessness) or serious disruptions in family relationship

Next Steps

Please visit the Health Home provider page to find a Health Home in your member’s community.