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
- HIV/AIDS; 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
Please visit the Health Home provider page to find a Health Home in your member’s community.