Frequently Asked Questions
Health Homes is an optional state Medicaid plan benefit, and services are free. The Centers for Medicare and Medicaid Services (CMS) pay the costs for this service. However, individuals (both adults and children) must meet a few criteria:
They must be eligible for Medicaid or Medicare/Medicaid.
They must meet HCA risk criteria by means of a PRISM scoring (Predictive Risk Intelligence System), a tool used by the Washington State Health Care Authority to estimate healthcare costs for Medicaid recipients.
AND meet ONE of the following criteria:
Two or more chronic conditions
One chronic condition with risk of another
A serious and persistent mental health condition