Wellpoint Iowa, Inc. offers a CMS-approved health home program for Medicaid members with chronic medical and behavioral health conditions. Chronic condition health homes are established for members with two qualifying chronic health conditions or one qualifying chronic condition and at risk of a second qualifying condition.
What is a health home?
A health home supports a member’s total health care and service needs — body, mind and quality of life. The health home service model encourages communication and collaboration among a member’s service providers and caregivers.
A health home facilitates access to a range of health and community services, simplifying the process for the member. Core health home services include:
- Comprehensive care management
- Care coordination
- Transitions in care
- Support to individual and family members
- The facilitation of referrals to community services and supports
- Health promotion and self-care
How does it work?
Members are assign a dedicated care manager who oversees their care and promotes access to health providers and social service organizations. Health home services are provided through a network of organizations that includes providers, health plans and community-based organizations. When all of the services are considered collectively, they become a collaborative health home.
Health home eligibility
To be eligible for health home services, a patient must have two chronic conditions, or one chronic condition and the risk of developing one of the following:
- Mental health condition
- Substance use disorder
- Heart disease
- BMI over 25
- Child BMI > 85th percentile
- One serious mental illness
Integrated health homes are established for adults with a serious mental illness and children with a serious emotional disturbance.
For detailed health home eligibility critieria, please refer to the Medicaid provider manual.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Provider Training Academy
- Pharmacy Information
- Electronic Data Interchange
Interested in becoming a provider in the Wellpoint network?
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