Health Home

Wellpoint offers a CMS-approved Health Home program for members with chronic medical and behavioral health conditions. The Health Home program is a partnership between the healthcare authority (HCA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Social and Health Services (DSHS).

What is a Health Home?

Health Home is not a place. It’s a set of services supporting eligible clients.

The Health Home program helps clients:

  • Develop a person-centered health action plan.
  • Improve self-management of chronic conditions.
  • Ensure care coordination and care transitions.

The Health Home program provides the following specific services:

  • Comprehensive care management
  • Care coordination
  • Health promotion
  • Comprehensive transitional care
  • Individual and family support
  • Referral to community and social support services

Who coordinates Health Home?

The healthcare authority (HCA) contracts with lead organizations, which include:

  • Managed care organizations (MCO).
  • Qualified community-based organizations.

The lead organizations contract with care coordination organizations (CCO), such as:

  • Area Agencies on Aging (AAA).
  • Child social service agencies.
  • Community health centers.
  • HIV/AIDS networks.
  • Mental health clinics.
  • Substance use disorder (SUD) specialists.

Together, they provide the services of the Health Home program through qualified care coordinators.

Who is eligible?

Apple Health clients of all ages, including Medicaid/Medicare dual-eligible clients, may be eligible for the Health Home program if they:

  • Have at least one chronic condition and are at risk for another.
  • Have a PRISM predictive score of 1.5; this can be determined on the WAC website .
  • Meet Apple Health (Medicaid) eligibility criteria.

Additional requirements apply.

Integrated health homes are established for adults with a serious mental illness and children with a serious emotional disturbance. For detailed Health Home eligibility criteria, please refer to the Provider Manual.

Refer a member for Health Home services

If your organization is interested in becoming a care coordination organization (CCO), contact or to get started.

Additional resources

To learn more about the Health Home program in Washington, you can explore the HCA’s resource website .

Provider tools and resources

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