UPDATED
Health Home Eligibility and Individuals (Adults and Children) with Intellectual and Developmental Disabilities
- Update is also available in Portable Document Format (PDF)
This guidance is being released by the Department of Health (DOH) and the Office for People with Developmental Disabilities (OPWDD) in response to questions seeking clarification regarding Health Home eligibility for Medicaid members with Intellectual and Developmental Disabilities.
As planned and indicated in the State Plan for Health Home, the State has intended to phase in the populations, and expand the authorization for certain Health Home chronic conditions that would be eligible for Health Homes. In 2012, Health Homes began enrolling adults. In December 2016, the Health Home program was expanded to include children, and to authorize complex trauma and serious emotional disturbance as single qualifying conditions. The next phase will be to expand eligibility to serve Medicaid Members with Intellectual and Developmental Disabilities (adults and children) and to authorize single qualifying IDD conditions (see the list below) that would meet the eligibility criteria for Health Homes. The list of chronic conditions has been updated to clarify that these conditions have not yet been approved as eligibility criteria for Health Home and will be updated upon approval CMS to include IDD conditions. If you have enrolled a member with such IDD conditions, that does not otherwise meet current Health Home eligibility conditions or you have any questions, please contact the Department by sending an email to HHSC@health.ny.gov and in subject line indicated: IDD Eligibility, for documentation purposes of children enrolled in HH with IDD.
As indicated by the Department during the development and rollout of the Health Home model, members with IDD who meet currently authorized eligibility conditions, other than IDD, and are not currently receiving OPWDD Medicaid Service Coordination or OPWDD services may be enrolled in Health Home at this time. Examples include: 1) a member with a serious emotional disturbance, which is a single qualifying condition for Health Home, and a IDD condition who is not receiving OPWDD Medicaid Service Coordination (MSC) or OPWDD services may be enrolled in Health Home and 2) a member with two or more qualifying chronic conditions, other than IDD conditions, who is not currently receiving OPWDD MSC or OPWDD services may be enrolled in Health Home.
The list of currently authorized Health Home chronic conditions is posted here.
Please see the proposed list of single qualifying Health Home IDD eligibility conditions for which the State will seek CMS approval.
| PROPOSED OPWDD Conditions for Health Home |
|---|
| MILD INTELLECTUAL DISABILITIES |
| MODERATE INTELLECTUAL DISABILITIES |
| SEVERE INTELLECTUAL DISABILITIES |
| PROFOUND INTELLECTUAL DISABILITIES |
| UNSP INTELLECTUAL DISABILITIES |
| EXPRESSIVE LANGUAGE DISORDER |
| MIXED RECEPTIVE-EXPRESSIVE LANGUAGE DISORDER |
| SPEECH & LANGUAGE DEVELOP DELAY DUE TO HEARING LOSS |
| OTH DEVELOP DISORDERS OF SPEECH & LANGUAGE |
| OTH DEVELOP DISORDERS OF SCHOLASTIC SKILLS |
| SPECIFIC DEVELOP DISORDERS OF MOTOR FUNCTION |
| AUTISTIC DISORDER |
| OTH CHILDHOOD DISINTEGRATIVE DISORDER |
| ASPERGER'S SYNDROME |
| PERVASIVE DEVELOP DISORDERS, UNSP |
| OTH DISORDERS OF PSYCHOLOGICAL DEVELOP |
| UNSP DISORDER OF PSYCHOLOGICAL DEVELOP |
| LOCAL-REL SYMPTO EPI W/SIMP PRT SEIZ, NOT INTRCT, W/O STAT EPI |
| LOCAL-REL SYMPTO EPI W/SIMP PRT SEIZ, INTRCT, W/O STAT EPI |
| LOCAL-REL SYMPTO EPI W/CMPLX PRT SEIZ, NOT INTRCT, W/O STAT EPI |
| LOCAL-REL SYMPTO EPI W/CMPLX PRT SEIZ, INTRCT, W/O STAT EPI |
| GEN IDIOPATHIC EPILEPSY, NOT INTRACTABLE, W/STAT EPI |
| GEN IDIOPATHIC EPILEPSY, NOT INTRACTABLE, W/O STAT EPI |
| GEN IDIOPATHIC EPILEPSY, INTRACTABLE, W/STAT EPI |
| OTH GEN EPILEPSY, NOT INTRACTABLE, W/O STAT EPI |
| OTH GEN EPILEPSY, INTRACTABLE, W/O STAT EPI |
| OTH GEN EPILEPSY, NOT INTRACTABLE, WITH STAT EPI |
| OTH EPILEPSY, NOT INTRACTABLE, W/O STATUS EPILEPTICUS |
| OTH EPILEPSY, INTRACTABLE, W/O STATUS EPILEPTICUS |
| EPILEPSY, UNSP, NOT INTRACTABLE, W/O STATUS EPILEPTICUS |
| EPILEPSY, UNSP, NOT INTRACTABLE, WITH STATUS EPILEPTICUS |
| EPILEPSY, UNSP, INTRACTABLE, W/O STATUS EPILEPTICUS |
| EPILEPSY, UNSP, INTRACTABLE, WITH STATUS EPILEPTICUS |
| ABSENCE EPILEPTIC SYNDROME, NOT INTRACTABLE, W/STAT EPI |
| ABSENCE EPILEPTIC SYNDROME, NOT INTRACTABLE, W/O STAT EPI |
| ABSENCE EPILEPTIC SYNDROME, INTRACTABLE, W/STAT EPI |
| ABSENCE EPILEPTIC SYNDROME, INTRACTABLE, W/O STAT EPI |
| SPASTIC QUADRIPLEGIC CEREBRAL PALSY |
| SPASTIC DIPLEGIC CEREBRAL PALSY |
| SPASTIC HEMIPLEGIC CEREBRAL PALSY |
| OTH CEREBRAL PALSY |
| CEREBRAL PALSY, UNSP |
| FAMILIAL DYSAUTONOMIA [RILEY-DAY] |
| ANOXIC BRAIN DAMAGE, NOT ELSEWHERE CLASSIFIED |
| BENIGN INTRACRANIAL HYPERTENSION |
| ENCEPHALOPATHY, UNSP |
| DISORDER OF CENTRAL NERVOUS SYSTEM, UNSP |
March 2, 2017 updated 3/29/17
