Michigan's Integrated Health Homes for Medicaid Beneficiaries

Overview

Pursuant to Section 1945 of the US Social Security Act, Medicaid “Health Homes” afford states the option to develop innovative, integrative, and sustainable care management/coordination programs for high-need, high-cost Medicaid beneficiaries with chronic health conditions. Health Homes allow states to develop sustained reimbursement mechanisms for services typically not covered, including community health workers and the gamut of resources needed to affect the social determinants of health (e.g., housing, transportation, food assistance, employment assistance, etc.). The goal of Health Homes is to increase outcomes and decrease costs by transcending barriers to care through enhanced access and coordination.[1]

Michigan has two integrated health homes for the specialty behavioral health population – the Behavioral Health Home for serious mental illness/serious emotional disturbance and the Opioid Health Home for opioid use disorder.

 

Program Benefits
  • Comprehensive Care Management
  • Care Coordination
  • Health Promotion
  • Comprehensive Transitional Care and Follow-up
  • Patient and Family Support
  • Referral to Community and Social Support Services

 

Infrastructure

MDHHS administers its Health Homes through contract with a lead entity (e.g., the region’s Prepaid Inpatient Health Plan), who in turn collaborates with designated health home partners (HHPs) to provide health home services. These partners include physical and behavioral health system providers—transcending traditional barriers to collaboration and integration. The HHPs may include Community Mental Health Services Programs (CMHSPs), Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Tribal Health Clinics (THCs), hospital-based practices, and/or substance use disorder providers. The providers are required to utilize a multidisciplinary care team comprised of physical and behavioral health expertise to holistically serve enrolled beneficiaries.

 

Highlights

Behavioral Health Home

  • Section 1945 of the US Social Security Act provides an enhanced 90 percent federal match for eight quarters for Medicaid Health Homes, meaning the federal government matches 9 dollars for every 1-dollar Michigan invests for eight quarters (or 24 months)
  • The BHH has demonstrated cost savings between $103-$366 per member per month per independent evaluations by Milliman
  • Michigan’s BHH is comprised of primary care and specialty behavioral health providers, thereby bridging the historically two distinct delivery systems for optimal care integration
  • Michigan’s BHH is predicated on multi-disciplinary team-based care comprised of behavioral health professionals, primary care providers, nurse care managers, and peer support specialists/community health workers
  • Michigan’s BHH utilizes a monthly case rate per beneficiary served that is in addition to current reimbursable services
  • Michigan’s BHH affords a provider pay-for-performance mechanism whereby additional monies can be attained through improvements in key metrics
  • MDHHS is in the process of expanding the BHH to PIHP Region 1 (the upper peninsula), all of PIHP Region 2 (Michigan’s 21 northernmost counties in the lower peninsula), and PIHP Region 8 (Oakland County) with a targeted October 1, 2020 effective date—it is expected that up to 6,000 beneficiaries will be served once implemented

 

Opioid Health Home

  • The federal SUPPORT Act of 2018 allows states to utilize an enhanced 90 percent federal match for ten quarters for Medicaid Health Homes, meaning the federal government matches 9 dollars for every 1-dollar Michigan invests for ten quarters (or 32 months)
  • Michigan’s OHH is comprised of primary care and specialty behavioral health providers, thereby bridging the historically two distinct delivery systems for optimal care integration
  • Michigan’s OHH is predicated on multi-disciplinary team-based care comprised of behavioral health professionals, addiction specialists, primary care providers, nurse care managers, and peer recovery coaches/community health workers
  • Michigan’s OHH utilizes a monthly case rate per beneficiary served that is in addition to current reimbursable services
  • Michigan’s OHH affords a provider pay-for-performance mechanism whereby additional monies can be attained through improvements in key opioid metrics
  • MDHHS is in the process of expanding the OHH to the upper peninsula, Calhoun County, Kalamazoo County, and Macomb County with a targeted October 1, 2020 effective date—it is expected that up to 3,000 beneficiaries will be served once implemented

 

Resources