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 healthhomes@hca.wa.gov or WAHealthHome@elevancehealth.com 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
- Log in to Availity Essentials
- Launch provider learning hub
- Learn about Availity Essentials
- Prior authorization lookup tool
- Prior authorization requirements
- Claims overview
- Member eligibility and pharmacy overview
- Provider manuals and guides
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange
Interested in becoming a provider in our network?
We look forward to working with you to provide quality service for our members.
Join our network