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Medicaid Health Home Program Begins

Under the federal Patient Protection and Affordable Care Act (PPACA), New York has developed a set of services for Medicaid and Family Health Plus (FHPLus) members with chronic illnesses.

As of March 1, 2012, Medicaid recipients eligible for the Health Home program in both Medicaid Fee-For-Service and Managed Care plans are being invited to participate in designated Provider-Led Health Home (PLHH) services in their county of residence. Counties included in the phase one rollout are:

• Bronx
• Kings (Brooklyn)
• Nassau

Provider-Led Health Home (PLHH) services are available to eligible Medicaid and FHPlus members who meet the following criteria:

• Have two or more conditions, such as asthma, diabetes, high blood pressure, heart disease
• Are HIV-positive or have AIDS
• Are in treatment for serious mental illness or substance abuse

What Is a Provider-Led Health Home?
A Provider-Led Health Home is a care management service model in which all of an individual's caregivers communicate with one another to comprehensively address a patient’s needs. This is done primarily through a community-based “care manager” who oversees and provides access to all services Medicaid patients need to ensure they stay healthy and avoid emergency room visits or in-patient care.

The Health Home program is offered at no cost to all eligible Medicaid and FHPlus members. Once a member is assigned to a PLHH in their county, the patient’s Health Home care manager will contact the primary care physician (PCP) to make sure the PCP’s treatment plan is included in the comprehensive care plan developed for the eligible patient.

Services Available to Eligible Members
Members will receive the following services through the Health Home program:

• Comprehensive case management with an assigned, personal case manager
• Encouragement and help in getting necessary tests and screenings
• Help when transitioning from a hospital to another setting
• Personal support and support for their caregiver(s) or family
• Referrals and access to community and social support services