Medicaid Health Homes - Comprehensive Care Management¶
Generated from the delivery-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.
A 'Health Home' is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. Once you are enrolled in a Health Home, you will have a care manager that works with you to develop a care plan. A care plan maps out the services you need, to put you on the road to better health. Some of the services may include connecting to health care providers, mental health and substance abuse providers, needed medications, help with housing, social services such as food, benefits, and transportation, or other community programs that can support and assist you.
- Owner record:
ny/medicaid-health-home - Jurisdiction code:
NY - Frame:
care_recipient - Review by: 2026-11-28
- Authority: New York State Department of Health
- Also called: New York State Health Home Program
Offering 1: Health Home Serving Children or Adults care management services¶
A Health Home is a group of health care and service providers working together, with a care manager who develops a care plan. Eligibility requires Medicaid enrollment and either two or more chronic conditions or one single qualifying chronic condition: HIV/AIDS; Serious Mental Illness (SMI) for adults; sickle cell disease for adults and children; or Serious Emotional Disturbance (SED) or Complex Trauma for children. SUDs alone do not qualify; an individual with SUDs must have another chronic condition. HIV or SMI does not require a determination of risk of another condition. The Medicaid member must also be appropriate for the intensive level of care management. The agency's guidance requires diagnostic eligibility to be verified and maintained, and an assessment to determine appropriateness, including significant behavioral, medical, or social risk factors requiring that intensive care management. Developmental-disability and SED pathways have additional clinical criteria described in the cited guidance.
- Availability (owner codes):
{"intake": "unknown", "type": "unknown"}
Conditions:
- The owner record does not yet state this offering's conditions. Check them with the program.
Access route 1.1¶
- Where: New York State Health Homes
- How: Visit the Find a Health Home page to find a Health Home that serves your county.
- Url: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm
Offering 2: Care Coordination Organization/Health Home (CCO/HH) care management services¶
The CCO/HH model provides person-centered holistic service planning and integrated care for individuals with intellectual and/or developmental disabilities. To be eligible for CCO/HH enrollment, Medicaid-enrolled individuals need a diagnosis in the Major Category of Developmental Disabilities that results in a functional limitation constituting a handicap under New York State Mental Hygiene Law Section 1.03(22), and must meet the other criteria outlined in the guidance as determined by OPWDD. If an eligible individual chooses to receive OPWDD/HCBS services, they need to enroll in a CCO/HH. An individual who is not eligible, declines, or chooses not to pursue OPWDD services may enroll in a Health Home Serving Children or Adults if they meet that program's eligibility and appropriateness criteria.
- Availability (owner codes):
{"intake": "unknown", "type": "unknown"}
Conditions:
- The owner record does not yet state this offering's conditions. Check them with the program.
Access route 2.1¶
- Where: OPWDD Care Coordination Organizations
- How: OPWDD lists seven Care Coordination Organizations and links to a coverage chart for county coverage.
- Url: https://opwdd.ny.gov/find-care-manager
Owner confirmations¶
/authority:sha256:7f27da89770415c50c4aca7fd36f5889b8ab7666adc3434c7513e94149583902
Evidence¶
/name: "# Medicaid Health Homes - Comprehensive Care Management" (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/authority: "# Department of Health" (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/caregiving_effect: "A 'Health Home' is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. Once you are enrolled in a Health Home, you will have a care manager that works with you to develop a care plan. A care plan maps out the services you need, to put you on the road to better health. Some of the services may include:" (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/caregiving_effect: "* Connecting to health care providers,\n* Connecting to mental health and substance abuse providers,\n* Connecting to needed medications,\n* Help with housing,\n* Social services (such as food, benefits, and transportation) or,\n* Other community programs that can support and assist you." (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/offerings/0/summary: "A 'Health Home' is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. Once you are enrolled in a Health Home, you will have a care manager that works with you to develop a care plan. A care plan maps out the services you need, to put you on the road to better health. Some of the services may include:" (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/offerings/0/summary: "> #### +Eligibility\n> \n> \n> \n> In order to be eligible for Health Home services, the individual must be enrolled in Medicaid and must have:\n> \n> \n> * Two or more chronic conditions (e.g., Substance Use Disorder, Asthma, Diabetes*) OR\n> * One single qualifying chronic condition: \n> * HIV/AIDS or\n> * Serious Mental Illness (SMI) (Adults) or\n> * Sickle Cell Disease (both Adults and Children) or\n> * Serious Emotional Disturbance (SED) or Complex Trauma (Children)\n> \n> \n> \n> If an individual has HIV or SMI, they do not have to be determined to be at risk of another condition to be eligible for Health Home services. Substance use disorders (SUDS) are considered chronic conditions and do not by themselves qualify an individual for Health Home services. Individuals with SUDS must have another chronic condition to qualify. Chronic Condition Criteria is not population specific (e.g., being in foster care, under 21, in juvenile justice, etc.), and does not automatically make a child eligible for Health Home. In addition, the Medicaid member must be appropriate for the intensive level of care management services provided by the Health Home (i.e., satisfy the appropriateness criteria). The Health Home Chronic Conditions document outlines guidance for the Health Home Serving Children eligibility, appropriateness, enrollment prioritization, and Health Home Six Core Services.\n> \n> \n> * Health Home Program Chronic Condition Update with Developmental Disabilities Conditions\n> * Developmental Disabilities Condition Eligibility for a CCO/HH or Health Home Serving Children or Adults\n> * Health Home Chronic Conditions and Billing Questionnaire/HML Selection Guidance\n> \n> \n> #### +Is a Health Home Right for Me?\n> \n> \n> \n> Ask yourself these questions if you are a Medicaid recipient and believe that you may qualify for the Health Home Program:\n> \n> \n> * Do you have chronic or mental health conditions for which you need regular doctor's care?\n> * Do you have a doctor you can see when you need to?\n> * Do you have a safe place to live?\n> * Do you have someone in your life to help you whenever you need help?\n> * Do you have difficulty keeping and making it to your medical appointments?\n> * Have you visited an emergency room or hospital more than once in the past six months? Twelve months?\n> \n> \n> #### +How to Enroll\n> \n> \n> \n> You can talk to your Managed Care Plan, doctor, specialist, hospital emergency room, discharge planner or your Department of Social Services, or you can contact a Health Home at any time to find out if you are eligible to enroll." (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/offerings/0/summary: "Diagnostic eligibility criteria verifying the individual’s current condition(s) must be confirmed " (source, capturea4bca3e52f5406fd882ad25b1084196b7ca74cd1c63f97caf7df99004cd07a68)/offerings/0/summary: "Qualifying chronic conditions are any of those included in the “Major” categories of the " (source, capturea4bca3e52f5406fd882ad25b1084196b7ca74cd1c63f97caf7df99004cd07a68)/offerings/0/summary: "Step three is to determine appropriateness for Health Home services . Individuals who are " (source, capturea4bca3e52f5406fd882ad25b1084196b7ca74cd1c63f97caf7df99004cd07a68)/offerings/0/summary: "Referral Portal referrals, as well as community or bottom up referrals. An assessment must " (source, capturea4bca3e52f5406fd882ad25b1084196b7ca74cd1c63f97caf7df99004cd07a68)/offerings/0/summary: "HHSC Serious Emotional Disturbance (SED) Definition and Determination Process: \nSED is a single qualifying chronic condition for Health Home and is defined as a child or adolescent (under the age of 21) that has a designated mental illness diagnosis in the following Diagnostic and Statistical Manual (DSM) categories below* as defined by the most recent version of the DSM of Mental Health Disorders ANDhas experienced the following functional limitations due to emotional disturbance over the past 12 months (from the date of assessment) on a continuous or intermittent basis as determined by a licensed mental health professional." (source, capture5d36b1e3e9c3e3beb83a237b595b6c5547d27d7f51131561fd973d792ed5f350)/offerings/0/summary: "For an SED determination to be utilized as a Health Home single qualifying condition, a mental health diagnosis alone is not sufficient to meet the SED definition for Health Home enrollment. The mental health diagnosis accompanied by documentation from an appropriate assessment outlining the required functional limitation determination is necessary to meet the SED single qualifying condition for enrollment." (source, capture5d36b1e3e9c3e3beb83a237b595b6c5547d27d7f51131561fd973d792ed5f350)/offerings/0/summary: "If an individual has one of the above diagnoses in the Developmental Disabilities Major Category and one or more of the other diagnoses included on the Health Home Chronic Conditions List, the individual may be eligible for enrollment in a Health Home Serving Children or Adults. Specifically, the individual’s developmental disability diagnosis must be in the Developmental Disabilities Category, originate before the age of twenty–two and be expected to continue indefinitely to qualify as a diagnosis in the Developmental Disabilities Category, and the individual must be Medicaid eligible and meet the other appropriateness and enrollment criteria. For more information on the Health Home Chronic Conditions List and appropriateness, please visit the following link: Eligibility Requirements: Identifying Potential Members for Health Home Services." (source, capture0b3a40e105d88e550f84cacabd07a31e6735d75aebf57625a9382948c39a0a3c)/offerings/0/access/0: "There is a total of 23 designated Health Homes located throughout New York State. Out of the 23 designated Health Homes: 10 serve both adults and children; 2 are designated to serve children only; and, 11 are designated to serve adults only. To find a Health Home that serves your county, visit our Find a Health Home page." (source, capture69d9e2dde4d5fa9ceb54920173b2ae7b7406f954098cf9cea54b8a00712aec27)/offerings/1/summary: "The expansion, tailoring, and implementation of the Health Home Care Management model was the first phase and foundation for OPWDD's transition to Managed Care. OPWDD is committed to helping individuals with I/DD live richer lives, and creating stronger person-centered services, now and in the future. The CCO/HH model provides a strong, stable, person-centered approach to holistic service planning and ensures the delivery of integrated quality care that supports the needs of individuals with I/DD." (source, capture2d9b044acdc90af382ce52cf2566331f9b5bb4c46df0610a9b1ccb34b96c63bb)/offerings/1/summary: "To be eligible for enrollment in a CCO/HH, Medicaid–enrolled individuals will need to present with a diagnosis of one of the above conditions in the Major Category of Developmental Disabilities, which results in a functional limitation that constitutes a handicap per the New York State Mental Hygiene Law Section 1.03(22), and meet the other criteria outlined in the section as determined by the Office of People With Developmental Disabilities. Individuals who meet these criteria, as determined by the New York State Office for People With Developmental Disabilities, may be eligible to enroll in a CCO/HH." (source, capture0b3a40e105d88e550f84cacabd07a31e6735d75aebf57625a9382948c39a0a3c)/offerings/1/summary: "If an eligible individual chooses to receive OPWDD/HCBS services, the individual will need to enroll in a CCO/HH. If an individual is not eligible, declines, or chooses not to pursue OPWDD services, the individual may enroll in a Health Home Serving Children or Adults provided they meet the Health Home Serving Children or Adults eligibility and appropriateness criteria (see below)." (source, capture0b3a40e105d88e550f84cacabd07a31e6735d75aebf57625a9382948c39a0a3c)/offerings/1/access/0: "\n \nVIEW THE CARE COORDINATION COVERAGE CHART" (source, capture61fe0adcabe00e6d296e07ff9222a450d4441c1fa5035fc61e714f0ef125f1d3)/offerings/1/access/0: "# OPWDD’s seven Care Coordination Organizations are listed below." (source, capture61fe0adcabe00e6d296e07ff9222a450d4441c1fa5035fc61e714f0ef125f1d3)