August 3, 2022 – The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), recently rolled out guidance on a Medicaid health home benefit that is newly available for children with complex medical conditions. 

The new optional benefit helps state Medicaid programs connect Medicaid-eligible children who have complex medical conditions with person-centered care management, care coordination, and patient and family support. Children with complex medical conditions—including those with mental health conditions, blood diseases, and cerebral palsy—often require immense care coordination and specialized treatment that can be costly, difficult to obtain, and burdensome for families. The new benefit allows children and families to get help managing and obtaining care. 

“Every child deserves the care and support they need to stay healthy and thrive. This new Medicaid health home benefit will give states new options and financial incentives to improve care for children with complex medical conditions. At HHS, we are committed to providing families with access to appropriate pediatric specialty and subspecialty medical services, including when those services are needed across state lines,” said Health and Human Services Secretary Xavier Becerra.

As outlined in the letter to state Medicaid directors, on October 1, 2022, states will now have the option to offer the new health home services benefit for children with medically complex conditions. The new benefit provides a variety of services including access to a full range of pediatric specialty and subspecialty medical services, including services from out-of-state providers.

“CMS and our state partners are doing all that we can to provide whole-person care through Medicaid and the Children’s Health Insurance Program (CHIP),” said CMS Administrator Chiquita Brooks-LaSure. “This new state plan option is about ensuring that children and families can get coordinated, high-quality care — particularly children with complex medical conditions. CMS is committed to working with states interested in pursuing this option to ensure they can quickly and efficiently get kids the care they need.”

The guidance released by CMS outlines the new health home benefits and details including payment methodologies, provider standards, state reporting, monitoring, and assurance requirements. CMS has also committed to providing technical assistance in implementing the benefit. 

For more information on CMS’ latest guidance, you can refer to the state Medicaid director letter found here.