Ohio Medicaid Health Home Plan Taking Shape
 Over the summer months, the Academy of Medicine of Cleveland & Northern Ohio (AMCNO) executive staff and physician leadership have participated in a series of meetings with representatives from the Ohio Department of Health and the Ohio Department of Job and Family Services to continue discussions on the development of Ohio Medicaid Health Homes.


The Accountable Care Act 2703 provided for a state option to provide health homes for enrollees with chronic conditions. The health home concept is related to, but not the same as the medical home since the intent is to have Medicaid health homes expand on the traditional medical home model by focusing on patients with multiple chronic and complex conditions, coordinating across medical, behavioral, and long-term care, building linkages to community and social supports and recovery services, and focusing on health information technology. Medicaid health home services would be available to Medicaid consumers with two or more of the following conditions: mental health; substance abuse; asthma, diabetes; heart disease; being overweight (BMI>25); one chronic condition and at risk for a second, or a serious and persistent mental health condition. State participation in this concept is optional and timing is flexible and certain diseases as well as geographic locations can be targeted. Funding for this initiative is a federal-state match for Medicaid health home services with the state contributing 10% and the government contributing 90% of health home costs for 8 quarters. For the Ohio program, services would be reimbursed through a tiered, per member per month payment method with adjustments by patient severity and provider’s capabilities. 

The program’s success will be measured by tracking and reporting outcomes including avoidable admissions and readmissions, emergency room usage, care transitions, follow-ups, and screenings. The managed care plans would administer the health home services for chronic medical conditions. The program is based on the Geisinger medical home model and would include a managed care plan, funded embedded nurse care manager and the use of a team of health care professionals with a single point of accountability. 

In order to become a Medicaid health home practice site, providers must meet quality core elements (i.e. behavioral and physical health integration, NCQA PCMH recognition, attain a nurse care manager, provide a team of health care professionals, contract with a managed care provider, provide appropriate transitions of care, and communicate health information electronically). The program design is intended to foster and promote patient empowerment and engagement. Patient participation in the health homes program will be on an “opt-in” basis and a non-binding agreement may be utilized with the patient in order to increase patient participation in the health home.  

Work is still underway to design the health home details with the intent to gain approval from the Centers for Medicaid and Medicare Services and rollout the program to providers in limited geographic regions by the spring of 2012 and to identify, assess and enroll consumers into the program by the summer of 2012. The AMCNO will continue to provide additional information to our members on this initiative as it becomes available.