Health Home Eligibility

What are the requirements for Health Home Eligibility?

The Health Home program requires the following criteria for eligibility:
1. Applicant must be actively enrolled in Medicaid;
2. Applicant must have a diagnosis of two or more chronic health conditions such asthma, diabetes, heart disease; or a single qualifying chronic condition such as HIV/AIDS, Serious Emotional Disturbance (adults), or Complex Trauma (children);
3. Applicant must demonstrate a social/emotional need, such as lack of adequate family or housing support; learning or cognition issues; or recent psychiatric hospitalization.

HH Eligibility and Appropriateness Criteria

HH Eligibility: (ONE of the following. Must be diagnosed, documented and current)
-Two or more chronic conditions
-Serious Emotional Disturbance
-HIV/AIDS
-Sickle Cell Disease
-Complex Trauma

HH Appropriateness: (ONE of the following)
• Currently involved with ACS/CPS/DSS, Direct referral from school
(specific situations- suspension, truancy, grade failure etc)
• Referral from SPOA, DSS, LGU
• Inpatient admission in past 6 months
• Out of home placement in past 6 months (foster care, relative, residential facility)
• Recent diagnosis of terminal illness
• SSI/Disability Certification in past 6 months
• Unable to schedule appointments in past 3 months (unaware who their provider(s) is
and how to contact their provider(s)
• Doesn't have providers to treat HH qualifying diagnosis
• Has not seen providers in a year
• Current violence in home of member
• Food insecurity
• Currently homeless (in a shelter or living with different friends/family)
• Caregiver enrolled in a Health Home
• Member needs housing supports, Medicaid transportation/Access-a-ride, SSI, HEAP,
TANF, EI, HS, SPED
• Non adherent to medication or treatment
• Guardianship change in past 6 months