Health Homes

A Health Home is a care management service model whereby all of an individual’s caregivers communicate with one another so that all of a patient’s needs are addressed in a comprehensive manner. This is done primarily through a “care manager” who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital.

The Department of Health includes a full web site on Health Homes online here.


July 1, 2020

The New York State Department of Health has issued guidance as a reminder to Mainstream Medicaid Managed Care Organizations, Health and Recovery Plans, and HIV Special Needs Plans about the termination of reimbursement for outreach activities under the NYS Medicaid Health Home Program, effective July 1, 2020.

May 14, 2020

Due to the feedback provided on the Health Home Conflict Free Case Management Policy (HH0012), the following clarity and revisions have been made as outlined in the attached chart. The updated policy can be found on the DOH website at:

May 14, 2020

Guidance has been released to assist Children’s Health Home care managers and Home and Community Based providers to understand how to provide services to a child/youth who has Medicaid Spend-Down Coverage.  This guidance can be located on the NYSDOH Children’s Medicaid Transformation 1915(c) Children’s Waiver webpage:

February 24, 2020

The Health Home Care Management Activities and Billing Protocols for Managing Newly Referred Individuals from Excluded Settings Policy is posted to the Health Home Policy and Standards webpage under: General Health Home.

Direct link to policy:

This policy specifically addresses steps that must be taken to manage new referrals from excluded settings of potentially eligible Health Home or HCBS (for children/youth) individuals.


IMPORTANT:  There is a difference in the way Health Homes/Health Home Care Management Agencies must handle an individual in an excluded setting who is newly referred for enrollment in the Health Home program versus an already enrolled Health Home member who enters an excluded setting.

For already enrolled Health Home (HH) members who enter an excluded setting, Care Management Agencies (CMA)/Health Home Care Managers (HHCM) must follow requirements in the Continuity of Care and Re-engagement for Enrolled Health Home Members HH0006 policy, which can be accessed on the Health Home Policy and Updates webpage at:  under: General Health Home

Additionally, the HCBS Determination for Children Discharging from OMH Residential Treatment Facility or Psychiatric Center Guidance is posted to the 1915(c) Children’s Waiver and 1115 Waiver Amendments webpage under Children’s HCBS Waiver Provider Information/Guidance: HCBS Determination for RTF and State PC Discharge Guidance and Patient Resources Administration List

This guidance describes procedures for making 1915(c) Children’s Waiver Home and Community Based Services (HCBS) referrals for children prior to or after being discharged from OMH Licensed Residential Treatment Facilities (RTFs) or OMH State Operated Psychiatric Centers Serving Children (State PCs).


The Commonwealth Fund has issued a new brief: Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?  In the brief, they compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management.

Seizing the Opportunity: Early Medicaid Health Home Lessons

Medicaid health homes, made possible through the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. States implementing health homes receive enhanced federal support for a limited time period. As of March 2014, 15 states have 22 approved state plan amendments to implement Medicaid health homes. Six “early adopter” states — Iowa, Missouri, New York, North Carolina, Oregon, and Rhode Island — have collectively enrolled more than 875,000 Medicaid beneficiaries in health homes.

This CHCS brief, supported by the New York State Health Foundation and the Missouri Foundation for Health, draws from the experiences of early health home adopter states to outline elements critical to implementation and sustainability of this new model. The brief informs other states looking to develop effective health home programs. See also a fact sheet and infographic that summarize key points in establishing Medicaid health homes.

Read the brief
Read the fact sheet
View the infographic