Health Homes - a Holistic Approach to Care

A Health Home is an added Medicaid benefit created to help manage all of the member’s health — physical, mental and social.

Benefits of a Health Home:

  • All the people who provide individual health care work together to provide services to meet the member’s needs. This includes the primary care provider, specialists and home health providers, as well as community-based service providers. A care manager who will coordinate all care among the providers
  • The care manager will ensure members get what they need when they need to stay healthy, out of the emergency room and out of the hospital
How it works

The care manager works with the member to complete the Health Home Patient Information Sharing Consent Form to ensure enrollment. By signing the form, they agree to share their health information with:

  • His or her primary care provider
  • Specialists
  • Home health providers
  • Other types of community based service providers
  • Empire Blue Cross Blue Shield HealthPlus

To ensure coordination of care, the member has one point of contact, the care manager will:

  • Schedule appointments
  • Coordinate transportation
  • Follow up to confirm appointments were kept
  • Track outcomes
Criteria for Health Home Eligibility

Health Home eligibility criteria require members to have one of the following:

  • Two or more chronic conditions (e.g., mental health condition, substance use disorder, asthma, diabetes, heart disease, BMI over 25 or other chronic conditions)
  • One qualifying chronic condition (HIV/AIDS) and the risk of developing another
  • One serious mental illness
How does a member join a Health Home?

A directory of participating Health Homes will be available on our provider website. This can help you identify a nearby or familiar entity for the member. Enrollment is conducted through the Health Home directly, and our Provider Relations team can assist you with the process.

Will the member be transferred to another provider if I am not in a Health Home?

No, the member won’t have to transfer, but it is more beneficial for you and the member to be in the same Health Home when an assignment is made to ensure continuity of care.

How can I join?

You can voluntarily join an existing entity or you can form a group with other providers. You must apply to the state to become a certified entity where one provider is identified as the lead applicant.