Washington Elder Law Practice Report (#4) / The Medicaid “Health Homes” program in Washington State

November 25, 2013

Washington Elder LawThis is installment #4 in a continuing series of Washington Elder Law Practice Reports.

Under section 2703, the Affordable Care Act (ACA) provided an optional “Health Home” (HH) activity for state Medicaid programs to consider, as a new approach to managing care for individuals with chronic conditions.

The State of Washington is presently implementing a version of this program.

In Washington, implementation of the HH program is being managed by the Health Care Authority (HCA) and the Department of Social and Health Services (DSHS), as described at www.hca.wa.gov and www.dshs.wa.gov.

The Washington HH program was “launched on July 1, 2013, after about three years of preparation, and is open to qualifying Medicaid clients, including dual eligibles (those also eligible for Medicare).

Dual eligibles in Washington constitute “only 13 percent” of the caseload, but “account for 30 percent” of the spending, according to an HCA news release of June 28, 2013.

The objective of the HH program is to both improve care and reduce costs.

The HH program is being phased in, which allows for adjustments and improvements to be made as experience is gained with the coordination of care for eligible persons.

HH services are treated as a new benefit under Medicaid, with “care coordination functions” that are in addition to “direct services”.

Eligibility is based on individuals who have “one chronic condition and (are) at risk for a second….”

A Washington HH consists of numerous provider organizations (Care Coordination Organizations, or CCOs) that are networked together.

The State contracts with a “Qualified Lead” (QL) organization or “HH Lead Entity” for the administration of coordinating services.

The QL subcontracts with an appropriate CCO for detailed coordination activities.

The CCO then employs a “care coordinator” to manage services for an eligible individual.

Extensive reporting must be provided to the State. Detailed program evaluations are to take place.

Most eligible individuals are to be initially assigned to an appropriate HH by HCA/DSHS, but they may “opt out” at any time. Beneficiaries must choose to receive HH assistance and be engaged in care coordination efforts.

All attorneys may find the experiences of the HH program to be of interest in helping clients and families understand their options under Medicaid when chronic conditions are involved.

A general introduction to the HH program is provided in another posting to appear this week—on this westlawinsider blog.( See Obamacare Report #21.) An additional posting this week also considers the broader access-to-care issues related to long-term care and chronic conditions (as  discussed in Access to Care Report #21).

Elder law practice in Washington is discussed by Cheryl and Ferd Mitchell in volumes 26 and 26B of Washington Practice (Washington Elder Law and Practice and the associated Elder Law Handbook).