NY Health Insurance Introduces Medicaid Health Home Option

The Health Care Reform has added the new Medicaid health home option. This program is aimed at addressing the medical and insurance needs of people with chronic conditions that require long-term care. The program wants to address the difficulty that low-income individuals with chronic conditions face about the cost and coordination of care.

Medicaid Health Homes are designed to give easy access and coordination of health care services such as physical health services, behavioral health care, and long-term community-based services and supports. Through this design patients with chronic illnesses should be able to have improved quality of care and health insurance coverage costs are also expected to be reduced.

The federal government through the health care reform provides states with funding to adapt their own health care services for residents who are enrolled in Medicaid and who have chronic conditions. Health home services should provide coordinated care that will give patients access to comprehensive health and behavioral care services. The following are the benefits that can be expected from the Medicare health home services:

• comprehensive care management,
• health promotion; transitional care including appropriate follow-up from inpatient to other settings,
• patient and family support,
• referral to community and social support services,
• use of health information technology to link services.

This program is open to both children and adults. To qualify for this New York health insurance-administered program the resident should have at least two chronic conditions

• • or one chronic condition with another one developing
  • or one recurring mental illness

Examples of chronic illnesses include: obesity/overweight, asthma, diabetes, substance abuse, heart disease, mental conditions, and HIV/AIDS.

Enrollees will be assigned a primary care manager who will be in charge of managing and coordinating the patient’s care. All the participating care providers in the enrollee’s health home team forwards all medical report/record including patient progress to the primary care manager.

Governor Cuomo’s Medicaid Redesign Team has adopted this program into law. Development of the program is still in progress. The NY Health Insurance Department is now accepting applicants for the Medicaid health homes program. Application will be accepted from August 1, 2011 until October 3rd of this year (deadline extended from September 1st). This program is expected to yield Medicaid savings for as much as $33.2 million from 2011-2012.

Interested applicants should submit a letter of intent as an attachment. Send it to [email protected] with a subject line that begins with  “LOI for HH”.  The letter of intent should include the following:

• The name of the primary applicant,
• A preliminary list of the proposed Health Home network/partners including direct care providers, TCM, COBRA, MATS, CIDP programs, and community based organizations;
• Proposed service area;
• Initial capacity; should specifically identify the number of current TCM, MATS, COBRA, or CIDP slots that will become part of the proposed health home, as well as the number of new (not already in any care management) health home slots by service intensity (low, intermediate, high) the proposed Health Home is prepared to accept as assignments this fall.

More of this information is available at the New York State State of Health Department of Health website.