IHA Update – Medicaid Integrated Health Homes

October 16, 2020


On Oct. 15, the Dept. of Healthcare and Family Services (HFS) issued a Provider Notice providing updates on Medicaid behavioral health service reimbursement and care coordination plans for 2021. These updates include implementation of a comprehensive array of community-based services for children with complex behavioral health needs and further delaying the Integrated Health Home (IHH) Program.

Effective July 1, 2021 and consistent with the requirements of the N.B. Consent Decree, children with complex behavioral health needs will have access to specialized care coordination and intensive services, including:

  • High-Fidelity Wraparound/ Intensive Care Coordination;
  • Intensive Home-Based Services;
  • Respite;
  • Therapeutic Mentoring; and
  • Family Peer Support.

This expanded service array is designed to enhance the community-based behavioral health service for children, providing children and families with the services necessary to support their success at home, school, and in the community.  Further details on service reimbursement implementation are expected to be released closer to the effective date.

Now anticipated to begin after July 1, 2021, HFS is delaying and updating its IHH program eligibility criteria to target children and adults with chronic physical health conditions, or who are at risk of developing chronic health conditions due to the presence of unmet social or environmental needs (e.g., housing, food security, employment, safety).  HFS previously delayed the IHH program to Jan. 1, 2021, as summarized in an IHA memo.  Under HFS’ modified approach, IHHs will focus on addressing social determinants of health and health disparities for the most medically complex Medicaid patients.  IHHs will demonstrate positive health outcomes for participants through enhanced engagement, outreach, disease management, and care coordination services that are individualized, person-centered, integrated, and community based.  IHA will provide additional information to members as it becomes available.

For questions or comments to IHA staff, please contact IHA.