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Rural Health Information Hub

Health Homes Model

The Medicaid Health Home program is designed to coordinate healthcare and social services for Medicaid and Medicare-Medicaid dual eligible individuals with chronic conditions, including mental and behavioral health.

A Health Home provides comprehensive coordinated care to Medicaid and Medicare-Medicaid dual eligible enrollees with chronic conditions. The Health Homes model integrates primary, acute, and behavioral health services and links patients and families to non-medical services. Like the PCMH model, Health Homes seek to reduce costs and improve care quality by reducing emergency department use, hospital admissions and re-admissions, and reliance on long-term care facilities.

The key components of the Health Home model are:

  • Comprehensive care management
  • Care coordination
  • Health promotion
  • Comprehensive transitional care including follow-up from inpatient and other settings
  • Patient and family support
  • Referral to community and support services

Health Home models are strongly encouraged by CMS to use health information technology to coordinate care.

More about this model:

Resources to Learn More

Health Home Information Resource Center
This website provides information and resources for states that are interested in establishing a Health Homes program.
Organization(s): Centers for Medicare and Medicaid Services

Medicaid Health Homes: Implementation Update
Explains the health home model's core service and eligibility requirements, and includes a map showing which states have health home models in operation.
Organization(s): Center for Health Care Strategies, Inc.
Date: 3/2011

Initial Considerations to Guide the Development of Medicaid Health Homes
This hands-on checklist is designed to walk states through the decision points in designing a health home program.
Organization(s): Center for Health Care Strategies, Inc.
Date: 6/2011

Medicaid Health Home Program Design Strategies
This website is an archive of calls for selected states focused on Medicaid health home program design.
Organization(s): Center for Health Care Strategies, Inc.

Medicaid's New “Health Home” Option
This document gives an overview of Medicaid's Health Home program.
Organization(s): Kaiser Family Foundation
Date: 1/2011