Programs & services

Health Home

As an Apple Health provider, use this page to learn more about the Health Home program. This includes links to program resources and the Clinical Eligibility Tool—used to refer your clients to the program.

The Health Home program is a partnership between HCA, the Centers for Medicare and Medicaid Services (CMS) and the Department of Social and Health Services (DSHS).

More about the partnership

What is the Health Home program?

A Health Home is not a place. It is 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

Client eligibility

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 risk score of 1.5 (per WAC 182-557-0225)
  • Meet Apple Health (Medicaid) eligibility criteria

Additional requirements do apply. 

Program providers

Lead organizations

The Health Care 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 Health Home services through qualified care coordinators. 

Becoming a Health Home care coordination organization

If your organization is interested in becoming a care coordination organization (CCO), contact healthhomes@hca.wa.gov to receive information about our lead organizations, which you can contact to get started. 

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