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Health Homes Eligibility and Services

The Health Homes Program (HHP) is an opportunity to improve care coordination and care management for L.A. Care's highest risk members.

HHP aims to further the integration of health services, social services and housing agencies, and to leverage existing infrastructures and expertise. 

 

Eligibility

HHP is for Medi-Cal members only; Cal Mediconnect members do not qualify. HHP is intended to target the top three to five percent highest risk Medi-Cal members.

To be eligible, a member would have to meet at least one condition from each of the two eligibility criteria below: Chronic Conditions and High Acuity.

Chronic Conditions

For the chronic condition criteria, the member must have a chronic condition in at least one of the following categories:

→ At least two of the following: chronic obstructive pulmonary disease, diabetes, traumatic brain injury, chronic or congestive heart failure, coronary artery disease, chronic liver disease, chronic renal (kidney) disease,  dementia, substance use disorders

OR

→ Hypertension and one of the following: chronic obstructive pulmonary disease, diabetes, coronary artery disease, chronic or congestive heart failure

OR

→ One of the following: major depression disorders, bipolar disorder, psychotic disorders (including schizophrenia)

OR

→ Asthma 

High Acuity

The member must meet at least one acuity/complexity criteria:

→ Has at least three or more of the HHP eligible chronic conditions

OR

→ At least one inpatient stay in the last year

OR

→ Three or more emergency department visits in the last year

OR

→ Chronic homelessness

 

Required Health Homes Services

L.A. Care and other Medi-Cal managed care plans will work with Community-Based Care Management Entities (CB-CMEs) to provide HHP members with the following set of required services. For details about the services, please visit the Department of Health Care Services Health Homes website.

  • Comprehensive Care Management
  • Care Coordination
  • Health Promotion
  • Comprehensive Transitional Care
  • Individual and Family Support Services
  • Referral to Community and Social Supports
  • Housing Navigation and Tenancy Support (for enrollees experiencing homelessness)