States have some flexibility in defining the population who will be eligible to receive health home services. The law describes chronic conditions that include a mental health condition, a substance use disorder, asthma, diabetes, heart disease, and obesity, and also gives the Secretary of HHS authority to expand this list of chronic conditions. To qualify to receive health home services, a person must have at least two chronic conditions or one chronic condition and be at risk for another, or one SPMI.
A state may decide to offer this benefit to all people who meet the criteria established in the ACA; alternatively, it may choose to target health home services to people with particular chronic conditions, or a higher number of conditions, or more severe conditions. The law stipulated that states mustserve dual-eligible beneficiaries (who are covered by both Medicaid and Medicare) if they otherwise qualify for health home services.
The types of chronic conditions described in the law include those that are prevalent among chronically homeless people, as well as many other people who are enrolled in Medicaid. It is not clear, however, whether a state can establish target criteria for health home enrollment that might take into consideration additional factors such as chronic homelessness or frequent or avoidable use of hospital inpatient or emergency room care.