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Health Homes Program:
Care Coordination 

The goal of the Health Home program is to make sure its members get the care and services they need. This may mean fewer trips to the emergency room or less time spent in the hospitals, getting regular care and services from doctors and providers, finding a safe place to live, and finding a way to get to medical appointments. Medicaid recipients who have chronic health problems are eligible for comprehensive care coordination. Referrals are required for enrollment into the program.

Care coordination eligibility 

In order to be eligible for Health Home services, the individual must be enrolled in Medicaid and must have:

  • Two or more chronic conditions (e.g., Substance Use Disorder, Asthma, Diabetes*) or

  • One single qualifying chronic condition: HIV/AIDS or

  • Serious Mental Illness (SMI) (Adults) or

  • Serious Emotional Disturbance (SED) or Complex Trauma (Children)

Doctor's Visit