The Medicaid health home model supports integrated, coordinated care for individuals with chronic conditions, including behavioral health conditions. Established by the Affordable Care Act, health homes are an optional Medicaid benefit that states may elect to provide. States have flexibility to customize their health home approaches to meet state-specific goals and population needs. This resource specifically focuses on implementation and impact of Medicaid heath homes designed to support individuals with behavioral health conditions (sometimes referred to as “behavioral health homes”).
How do Medicaid Health Homes Work?
The Medicaid health home model includes six core services that participating states must provide: comprehensive care management, care coordination, health promotion, comprehensive transitional care and follow-up, individual and family support, and referral to community and social services. To be eligible for health home services, Medicaid members must have: 1) two or more chronic conditions; (2) one chronic condition and are at risk for a second; or (3) a serious and persistent mental health condition. As an incentive to provide health home services, states receive an enhanced federal funding match (90% Federal Medical Assistance Percentage) for the first eight quarters of health home program implementation (states with a health home focused on substance use disorder may receive an enhanced match for the first 10 quarters).
What Flexibilities Do States Have in Designing Medicaid Health Homes for Individuals with Behavioral Health Conditions?
Within the above parameters, states have significant flexibility to customize heath home programs, including for populations with behavioral health conditions. For example, states may determine which specific chronic conditions to target through health home programs. Fifteen states have health home programs for individuals with serious mental illness or substance use disorders, and additional states have heath homes with broader eligibility criteria that include but do not exclusively serve individuals with behavioral health conditions. States also determine the type of providers, or teams of providers, who may provide health homes services (e.g., physicians, interdisciplinary teams of providers, community mental health centers) and may develop definitions for the six core health home services. States also have flexibility to determine the payment methodology for health homes (e.g., fee-for-service versus per-member-per-month payments, tiering or other adjustment to payments based on member risk or acuity level).
What is the Evidence on the Impact of Health Homes for Individuals with Behavioral Health Conditions?
Medicaid health homes are associated with increased behavioral health treatment, outpatient utilization, medication utilization, and follow up post-hospitalization, as well as decreased emergency department utilization for individuals with behavioral health conditions. Evidence on the impact of health homes on reducing inpatient utilization is mixed. Health homes have been found to be especially beneficial to individuals with co-occurring SUD and diabetes diagnoses.
- Integrated Care Models and Behavioral Health Care Utilization: Quasi-Experimental Evidence from Medicaid Health Homes: Using national data, this population-level analysis assessed the effect of state implementation of Medicaid behavioral health homes between 2010-2016. Adoption of behavioral health homes was associated with increased behavioral health treatment use and better self-reported health for non-elderly Medicaid enrollees.
- Impact of New York State’s Health Home Model on Health Care Utilization: This study assessed the impact of New York Medicaid Health Homes on inpatient utilization among adults with at least one mental health visit. Over two years, health homes decreased rates of inpatient utilization for mental health, substance use, and medical conditions. At the same time, outpatient mental health visits and medication utilization increased.
- Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes: This analysis assessed the impact of New York Medicaid Health Homes on receipt of diabetes care, including for individuals with co-occurring diabetes and SUD diagnoses. Individuals with co-occurring diabetes and SUD had more substantial improvements in diabetes process of care measures than individuals without a co-occurring SUD diagnosis.
- The Effects of the Maryland Medicaid Health Home Waiver on Emergency Department and Inpatient Utilization Among Individuals with Serious Mental Illness, Behavioral Health Home Impact on Transitional Care and Readmissions Among Adults with Serious Mental Illness, and Association Between Enrollment in Maryland's Behavioral Health Homes and Use of Outpatient Mental Health Services: This group of studies evaluates the impact of Maryland Medicaid behavioral health homes on different aspects of health care services utilization. Behavioral health homes were associated with reduced emergency department visits, increased outpatient mental health visits, and increased follow up post-hospitalization for adults with serious mental illness. The studies did not find a statistically significant impact on inpatient admissions or readmissions.
What do Medicaid Behavioral Health Homes Look Like in Practice?
The following resources offer insights into how behavioral health homes are designed and implemented.
- Experiences of Three States Implementing the Medicaid Health Home Model to Address Opioid Use Disorder—Case Studies in Maryland, Rhode Island, and Vermont: Drawing on discussions with health home stakeholders, this resource explores state approaches to designing health home programs to address opioid use disorder and facilitators and barriers to implementation.
- Medicaid Behavioral Health Homes: Lessons Learned and Early Findings from Maine: Drawing from interviews and focus groups, this study describes implementation lessons from Maine’s behavioral health homes. Quantitative analysis showed no significant program impact of utilization measures but that it resulted in increased total Medicaid expenditures.
- Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Evaluation of Outcomes of Selected Health Home Programs, Annual Report - Year Five: This final report of a five-year evaluation includes a summary of findings from qualitative interviews with health home sites across multiple states as well as quantitative data on Missouri health homes.
- State-by-State Health Home State Plan Amendment Matrix: This table from the Centers for Medicare & Medicaid Services’ Health Home Information Resource Center outlines key design features of existing state health home programs, including populations of focus, health home providers, and payment methods.
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