Program Eligibility
What are the patient eligibility criteria for Health Homes?
The New York State Department of Health defines two main criteria for patients to be eligible for a Health Home:
- Patient must be actively enrolled in Medicaid; and
- Patient must have a single qualifying condition
- HIV/AIDS or a Mental Health Diagnosis, or
- Two or more chronic conditions as defined by the 3M Clinical Risk Groups (CRGs) (e.g., asthma, diabetes, heart disease, hypertension, obesity, Chronic Alcohol Abuse and Dependency)
Patients must also demonstrate an unmet social need, which can include:
- Probable risk for adverse events (e.g., death, disability, inpatient or nursing home admission);
- Lack of or inadequate social/family/housing support;
- Lack of or inadequate connectivity with healthcare system;
- Non-adherence to treatments or medication(s) or difficulty managing medications;
- Recent release from incarceration or psychiatric hospitalization;
- Daily living activities limitations (e.g., dressing or eating); and
- Learning or cognition issues
What insurances does the NYP Health Home accept?
- Affinity Health Plan
- Dual eligible Medicaid/Medicare
- EmblemHealth-HIP (Health Ins. Plan of GTR NY)
- Fidelis (NYS Catholic Health Plan)
- Healthfirst NY
- Medicaid FFS
- Medicaid/ADAP (Spendown must be met)
- United Healthcare Community Plan
- VNSNY Choice
- Wellcare