Health Home Chronic Conditions

Health Home Program Chronic Condition Update with Developmental Disabilities Conditions

It has always been the intent of the NYS Health Home Program to eventually expand the Health Home model to include intellectual and/or developmental disabilities (I/DD). As such, with the implementation of the Care Coordination Organization/Health Home (CCO/HH) model, the Health Home Chronic Conditions have been expanded to include the following category of I/DD chronic conditions:

Health Home Chronic Conditions – Developmental Disabilities
  1. Intellectual Disability
  2. Cerebral Palsy
  3. Epilepsy
  4. Neurological Impairment
  5. Familial Dysautonomia
  6. Prader–Willi Syndrome
  7. Autism

Please note: The term Autism includes all diagnoses within Autism Spectrum Disorder. The term Neurological Impairment refers to a disease or disorder that results in a neurological impairment or degeneration that affects the integrity of the individual’s musculature and central nervous system. Examples of potentially qualifying neurological impairments include, but are not limited to, Duchenne’s Muscular Dystrophy and traumatic brain injury. Additionally, the individual’s developmental disability diagnosis must be in the Developmental Disabilities category, originate before the age of twenty– two and be expected to continue indefinitely to qualify as a Developmental Disabilities diagnosis.

The chart below outlines the list of allowable chronic conditions for the Health Home Serving Children and Adults programs. For the Health Home Serving Children and Adults, program eligibility will continue to require two or more chronic conditions, or one single qualifying chronic condition of HIV/AIDS or Serious Mental Illness (SMI) (Adults) or Serious Emotional Disturbance (SED) or Complex Trauma (Children).

Please reference the posted July 2018 guidance for enrollment in the CCO/HH versus the Health Home Serving Adults or Children

Specific Distinctions:

For an individual with developmental disabilities to be eligible for Health Home Serving Children or Adults, the individual can have one or moreof the developmental disabilities within the Developmental Disability category listed above but MUST also have one or moreof the other diagnoses included on the Health Home Serving Children and Adults chronic conditions list.

If the individual has one or more of the developmental disabilities within the Developmental Disability category list above but does not have other diagnoses included on the Health Home Serving Children and Adults chronic conditions list, then the individual should be referred to OPWDD and/or CCO/HH.

"Developmental Language Disorder" and "Developmental Delay NOS / NEC / Mixed" are now added to the Health Home Serving Children and Adults chronic conditions list below as they are not represented in the Developmental Disabilities category.

Therefore, an individual could have Developmental Language Disorder and/or Developmental Delay NOS / NEC / Mixed, and one of the developmental disabilities within the Developmental Disability category listed above to be eligible for Health Home Serving Children and Adults.

The condition of Epilepsy remains on the Health Home Serving Children and Adults chronic conditions list as well as within the Developmental Disabilities category, as Epilepsy is not specific to Developmental Disabilities. Therefore, an individual can be eligible for Health Home Serving Children and Adults if they have Epilepsy and another developmental disability within the Developmental Disability category.

Developmental Disabilities and/or Health Home Serving Children and Adults chronic condition lists do not include any developmental disorder of scholastic skill or motor function.

Health Home Serving Children and Adults Chronic Conditions
Acquired Hemiplegia and Diplegia
Acquired Paraplegia
Acquired Quadriplegia
Acute Lymphoid Leukemia w/wo Remission
Acute Non–Lymphoid Leukemia w/wo Remission
Alcoholic Liver Disease
Alcoholic Polyneuropathy
Alzheimer´s Disease and Other Dementias
Angina and Ischemic Heart Disease
Anomalies of Kidney or Urinary Tract
Apert´s Syndrome
Aplastic Anemia/Red Blood Cell Aplasia
Ascites and Portal Hypertension
Atrial Fibrillation
Attention Deficit / Hyperactivity Disorder
Benign Prostatic Hyperplasia
Bi–Polar Disorder
Blind Loop and Short Bowel Syndrome
Blindness or Vision Loss
Bone Malignancy
Bone Transplant Status
Brain and Central Nervous System Malignancies
Breast Malignancy
Burns – Extreme
Cardiac Device Status
Cardiac Dysrhythmia and Conduction Disorders
Cardiovascular Diagnoses requiring ongoing evaluation and treatment
Cerebrovascular Disease w or w/o Infarction or Intracranial Hemorrhage
Chromosomal Anomalies
Chronic Alcohol Abuse and Dependency
Chronic Bronchitis
Chronic Disorders of Arteries and Veins
Chronic Ear Diagnoses except Hearing Loss
Chronic Endocrine, Nutritional, Fluid, Electrolyte and Immune Diagnoses
Chronic Eye Diagnoses
Chronic Gastrointestinal Diagnoses
Chronic Genitourinary Diagnoses
Chronic Gynecological Diagnoses
Chronic Hearing Loss
Chronic Hematological and Immune Diagnoses
Chronic Infections Except Tuberculosis
Chronic Joint and Musculoskeletal Diagnoses
Chronic Lymphoid Leukemia w/wo Remission
Chronic Metabolic and Endocrine Diagnoses
Chronic Neuromuscular and Other Neurological Diagnoses
Chronic Neuromuscular and Other Neurological Diagnoses
Chronic Non–Lymphoid Leukemia w/wo Remission
Chronic Obstructive Pulmonary Disease and Bronchiectasis
Chronic Pain
Chronic Pancreatic and/or Liver Disorders (Including Chronic Viral Hepatitis)
Chronic Pulmonary Diagnoses
Chronic Renal Failure
Chronic Skin Ulcer
Chronic Stress and Anxiety Diagnoses
Chronic Thyroid Disease
Chronic Ulcers
Cirrhosis of the Liver
Cleft Lip and/or Palate
Coagulation Disorders
Cocaine Abuse
Colon Malignancy
Complex Cyanotic and Major Cardiac Septal Anomalies
Conduct, Impulse Control, and Other Disruptive Behavior Disorders
Congestive Heart Failure
Connective Tissue Disease and Vasculitis
Coronary Atherosclerosis
Coronary Graft Atherosclerosis
Crystal Arthropathy
Curvature or Anomaly of the Spine
Cystic Fibrosis
Defibrillator Status
Dementing Disease
Depressive and Other Psychoses
Developmental Language Disorder
Developmental Delay NOS / NEC / Mixed
Diabetes w/wo Complications
Digestive Malignancy
Disc Disease and Other Chronic Back Diagnoses w/wo Myelopathy
Drug Abuse Related Diagnoses
Ear, Nose, and Throat Malignancies
Eating Disorder
Endometriosis and Other Significant Chronic Gynecological Diagnoses
Enterostomy Status
Esophageal Malignancy
Extrapyramidal Diagnoses
Extreme Prematurity – Birthweight NOS
Fitting Artificial Arm or Leg
Gait Abnormalities
Gallbladder Disease
Gastrointestinal Anomalies
Gastrostomy Status
Genitourinary Malignancy
Genitourinary Stoma Status
Gynecological Malignancies
Hemophilia Factor VIII/IX
History of Coronary Artery Bypass Graft
History of Hip Fracture Age > 64 Years
History of Major Spinal Procedure
History of Transient Ischemic Attack
HIV Disease
Hodgkin´s Lymphoma
Hydrocephalus, Encephalopathy, and Other Brain Anomalies
Hyperthyroid Disease
Immune and Leukocyte Disorders
Inflammatory Bowel Disease
Intestinal Stoma Status
Joint Replacement
Kaposi´s Sarcoma
Kidney Malignancy
Leg Varicosities with Ulcers or Inflammation
Liver Malignancy
Lung Malignancy
Macular Degeneration
Major Anomalies of the Kidney and Urinary Tract
Major Congenital Bone, Cartilage, and Muscle Diagnoses
Major Congenital Heart Diagnoses Except Valvular
Major Liver Disease except Alcoholic
Major Organ Transplant Status
Major Personality Disorders
Major Respiratory Anomalies
Malfunction Coronary Bypass Graft
Malignancy NOS/NEC
Mechanical Complication of Cardiac Devices, Implants and Grafts
Multiple Myeloma w/wo Remission
Multiple Sclerosis and Other Progressive Neurological Diagnoses
Neoplasm of Uncertain Behavior
Neurodegenerative Diagnoses Except Multiple Sclerosis and Parkinson´s
Neurogenic Bladder
Neurologic Neglect Syndrome
Neutropenia and Agranulocytosis
Non–Hodgkin´s Lymphoma
Obesity (BMI at or above 25 for adults and BMI at or above the 85 th percentile for children)
Opioid Abuse
Other Chronic Ear, Nose, and Throat Diagnoses
Other Malignancies
Pancreatic Malignancy
Pelvis, Hip, and Femur Deformities
Peripheral Nerve Diagnoses
Peripheral Vascular Disease
Persistent Vegetative State
Pituitary and Metabolic Diagnoses
Plasma Protein Malignancy
Post–Traumatic Stress Disorder
Postural and Other Major Spinal Anomalies
Prematurity – Birthweight < 1000 Grams
Progressive Muscular Dystrophy and Spinal Muscular Atrophy
Prostate Disease and Benign Neoplasms – Male
Prostate Malignancy
Psychiatric Disease (except Schizophrenia)
Pulmonary Hypertension
Recurrent Urinary Tract Infections
Reduction and Other Major Brain Anomalies
Rheumatoid Arthritis
Secondary Malignancy
Secondary Tuberculosis
Sickle Cell Anemia
Significant Amputation w/wo Bone Disease
Significant Skin and Subcutaneous Tissue Diagnoses
Spina Bifida w/wo Hydrocephalus
Spinal Stenosis
Spondyloarthropathy and Other Inflammatory Arthropathies
Stomach Malignancy
Tracheostomy Status
Valvular Disorders
Ventricular Shunt Status
Vesicostomy Status
Vesicoureteral Reflux

Should there be questions surrounding a specific condition and Health Home eligibility, please contact NYS DOH Health Home team at

October 2018, updated 2/19, 4/19