Frequent Questions
We offer reasonable pricing health care plans, insurance packages based on financial conditions of clients.
01. What is a Health Home?
A Health Home is not a physical place. The Health Home (HH) program is a care management service model where all the professionals involved in a member’s care communicate with one another to address the member’s medical, behavioral health and social service needs in a comprehensive manner. A resolute care manager (HHCM) oversees and coordinates access to all the services a member requires. Appropriate care management is intended to reduce avoidable emergency department visits and inpatient stays and improve health outcomes. With the member’s consent, health records will be shared among providers to ensure that the member receives un-duplicated services. The goal of the Health Home program is to improve care and health outcomes, lower Medicaid costs, and reduce preventable hospitalizations, emergency room visits, and unnecessary care for Medicaid members.
02. What is a Care Management Agency (CMA)?
A Care management Agency assist individuals with gaining access to services and supports appropriate to their needs. CDAA is a CMA. Health Home Care Management services are designed to:
- Provide comprehensive, person-centered care planning using a network of care managers and providers (team approach).
- Provide enhanced coordination and integration of primary and behavioral health services as well as access to medical and dental services.
- Identify community-based resources and make connections to community services and supports, housing, social services, and family services.
03. What is Health Home Serving Children?
Health's Health Home Serving Children is a New York State Medicaid care coordination program that provides access to medical, mental health, substance abuse, social support services, and family support services to children who need them.
- Eligibility for Services: To be eligible, the patient must be enrolled in Medicaid, be under 21 years old, and have two or more chronic conditions, or one single qualifying condition. Single qualifying conditions include HIV/AIDS, Serious Emotional Disturbance, and Complex Trauma.
04. What are the criteria for Care Management Services?
To be eligible for Health Home services, the individual must be enrolled in Medicaid and must have:
- Two or more chronic conditions (e.g., Substance Use Disorder, Asthma, Diabetes) OR
- One single qualifying chronic condition:
- HIV/AIDS or
- Serious Mental Illness (SMI) (Adults) or
- Sickle Cell Disease (both Adults and Children) or
- Serious Emotional Disturbance (SED) or Complex Trauma (Children)
If an individual has HIV or SMI, they do not have to be determined to be at risk of another condition to be eligible for Health Home services. Substance use disorders (SUD) are considered chronic conditions and do not by themselves qualify an individual for Health Home services. Individuals with SUD must have another chronic condition to qualify. Chronic Condition Criteria is not population specific (e.g., being in foster care, under twenty-one, in juvenile justice, etc.), and does not automatically make a child eligible for Health Home. In addition, the Medicaid member must be appropriate for the intensive level of care management services provided by the health Home (i.e., satisfy the appropriateness criteria).
05. Does it cost anything to enroll?
No. Enrollment into our program is provided free of charge to the individual if the individual is on Medicaid.
06. Who is a member?
A member is an individual who is actively enrolled in a Health Home/Care Management and receives services from a Care Management Agency to improve their overall health OR An individual who has been deemed to meet all HH eligibility criteria and has been enrolled in the HH program.
07. How do I enroll?
An individual can talk to a current service provider or contact a Health Home at any time to find out if they are eligible to enroll. An individual may be referred to a Health Home by Medicaid, based on care and services they have already received. They could be referred by their Managed Care plan, doctor, specialist, hospital emergency room or discharge planner, or Social Service District. Self-referrals are also accepted.
08. Does Health Home Care Management include long-term care services?
Health Homes are responsible for assuring that members receive all necessary services, including long-term care. However, members needing substantial long term care services, i.e., greater than 120 days may need to be transitioned into other LTC management programs e.g., Managed Long Term Care (MLTC) Plans. Individuals can be in both a Health Home and an MLTC plan.
09. What is FFS?
Fee-for-Service (FFS) Member: Members that do not belong to a Medicaid Managed Care Plan and receive services from providers who are contracted with the State based on an agreed upon rate for services.
10. What is your target population?
We provide services to individuals of various backgrounds and ethnicity. Our staff are fluent in English, Bengali, Hindi, Urdu, Spanish and other languages.
11. Which boroughs do you serve?
We serve Brooklyn, Queens, Bronx, Manhattan and Long Island.