Health Home Efforts Making Progress in Missouri, Kansas

A couple of states, namely Missouri and Kansas, are working towards developing so-called “health homes” for individuals receiving Medicaid who suffer from chronic conditions. Chronic conditions result in high costs for a state’s Medicaid program, partly because of the increased incidence of hospitalization.  Health homes are meant to centralize and coordinate the medical and behavioral health care that these individuals require.

Creation of the Program

For the first two years the health home program is effective, states receive additional federal medical assistance percentage (FMAP) funds for providing health home services to individuals on Medicaid who suffer from chronic conditions.  Mandated by section 2703 of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), health homes coordinate care to treat the person as a whole–meaning all primary, acute, behavioral health, and long-term services are provided. To be eligible for health homes, the person must have two or more chronic conditions, have one chronic condition and be at risk for a second, or have one serious and persistent mental health condition. Some chronic conditions include mental health issues, substance abuse, asthma, diabetes, heart disease and being overweight.

Some of the services that health homes should provide are coordination of care and care follow-up, health promotion, and patient and family support. Providers for health homes can include a designated provider (e.g., physician, rural health clinic or community health center), a team of health professionals (e.g., physicians, social workers, or behavioral health professionals), or a health team comprised of certain specified providers.

Missouri’s Program

Missouri has had a health home program in the works since before the enactment of PPACA, and was the first state to have its health home plan approved in October 2011.  According to a representative from the Missouri Department of Mental Health, about $4.2 million was saved in hospital and emergency room costs for Medicaid in its first year of effectiveness, 2012. Hospitalizations were down, as well, by about 3 percent, breaking the recent upward trend. The department has learned that it is better to place a mental health professional in a primary care setting because individuals in small towns might be hesitant to seek care at a mental health center because of the stigma surrounding mental illness.  People were more inclined to see a mental health professional at a primary care clinic because they can do so less conspicuously.

Kansas’ Program

Using Missouri as a model, Kansas’ Medicaid overhaul, KanCare, will include a health homes initiative. Discussions are being held to determine how best to integrate medical and behavioral health services for its 380,000 individuals covered by the state’s Medicaid program. The goal is to have the Kansas health home program in effect starting for 2014, and the Kansas Department of Health and Environment is working with a 70-person task force to create the proposal for CMS.