Situation Report | August 8, 2022
The U.S. Centers for Medicare and Medicaid Services (CMS) has released guidance on a new Medicaid health home benefit for children with medically complex conditions. This new optional benefit helps state Medicaid programs provide Medicaid-eligible children who have medically complex conditions with person-centered care management, care coordination, and patient and family support. CMS anticipates that the new benefit will help these children receive the care they need, including across state lines.
As outlined in a letter to state Medicaid directors, states will have the option to offer the new health home services benefit for children with medically complex conditions beginning October 1, 2022. The services provided under the new benefit include providing access to the full range of pediatric specialty and subspecialty medical services, including services from out-of-state providers, as medically necessary.
The guidance provides information to states about the new health home benefit, including about payment methodologies, provider standards, provider and state reporting, state monitoring, and state assurance requirements. States with approved Medicaid state plan amendments (SPAs) to cover the new health home benefit will receive a 15 percentage point increase in federal matching for their expenditures on health home services during the first two fiscal year quarters that the SPA is in effect. CMS also has committed to offer ongoing technical assistance to states about implementation of the new benefit.