Medical Homes

Updated April 2008

Medical Homes have recently come into the spotlight as a way to provide comprehensive health care for children. Medical homes do not provide housing; rather it is a conceptual model for pediatric care that originates in a primary care setting. The American Academy of Pediatrics defines a medical home as family centered, coordinated, compassionate, comprehensive, culturally effective, accessible and continuous as a model of pediatric care. Pediatric health professionals and families partner to address all of the child's health and non-health related issues. This approach is targeted at the 9.4 million children in the U.S. diagnosed with special health care needs (CSHCN), or one out of five households. This population alone accounts for 80% of pediatric health care expenses.

Medical homes address the U.S Department of Health and Human Services' Healthy People 2010 goal to "increase the proportion of children with special health care needs who have access to a medical home."

According to the American Academy of Pediatrics, a medical home consists of the following elements:

A partnership between the family and the child's/youth's primary health care professional
Relationships based on mutual trust and respect
Connections to supports and services to meet the non-medical and medical needs of the child/youth and their family
Respect for a family's cultural and religious beliefs
After hours and weekend access to medical consultation
Families who feel supported in caring for their child
Primary health care professionals coordinating care with a team of other care providers

Twelve states (California, Connecticut, Florida, Idaho, Iowa, Louisiana, Maryland, Mississippi, Rhode Island, Texas, Washington and West Virginia) have enacted legislation to create or encourage the creation of medical homes for children. Some state medical home programs target children with special health care needs while others recognize the importance of a medical home for all children. The Oregon Health Policy Commission submitted a report to the governor titled, Road Map for Health Care Reform: Creating a High-Value, Affordable Health Care System. The report outlines several key recommendations, including promoting medical homes for primary care.

Finding a Medical Home for Children: A Discussion for Health Care Practitioners, Policymakers, and Public Health Agencies
NCSL Webcast from February 21, 2007
This Web conference brings together the private and public sectors to discuss their potential roles in helping all children obtain a medical home to coordinate health services and improve the quality of care.
***Click Here to access this archived webcast for FREE***

Resources
For more information, consult the following resources. (NCSL provides links to the following websites for informational purposes only. The views expressed on these websites do not necessarily reflect the views of NCSL.)

National Center of Medical Homes Initiatives for Children with Special Needs
This American Academy of Pediatrics website provides numerous resources on medical homes.

State Policy Options to Establish Medical Homes for Children and Youth
Issue Report from the Association of State and Territorial Health Officials (ASTHO) discusses policy options among states. January 2005.

The Center for Medical Home Improvement
Provides resources and information for improving and establishing medical homes.

Family Voices
Advocates for health care services that are family-centered, community-based, comprehensive, coordinated and culturally competent for all children and youth with special health care needs.

The “Medical Home” Gets Updated: Improving Outcomes While Reducing Costs
NCSL's State Health Notes, Volume 29, Issue 511, March 17, 2008

Click here to see information on Medical Homes in your state.

State
Summary of Statute

Alabama

Alaska

Arizona

Arkansas

California
Cal. [Health & Saf] Code § 124011, 124013 (Deering 2006) initiates further expansion of medical homes through demonstration projects requested by hospitals. It expands already funded medical home projects by two years and grants three years of funding to new sources.

Cal. [Wel & Inst] Code § 15904, 15905 (Deering 2006) uses designation of medical home as criterion for evaluating applicants for funding available under the Health Care Coverage Initiative Program.

Colorado
Col. Rev. Stat. 25.5-103 and 25.5-1-123 (2007) Tasks the Department of Health with developing systems to maximize the number of children in enrolled in the State Medical Assistance Program or the Children's Basic Health Plan who have medical homes. Appropriates funds, creates 1.0 FTE position. (SB 130)

Connecticut
Conn. Gen. Stat. § 19a- 45b, c (2006) Granted the Commissioner of Public Health federal finances and private funds to develop a medical home program in one region of the state to enhance health outcomes for children.

Delaware

District of Columbia

Florida
Fla. Stat. § 391.016 (2006) set guidelines for the Children's Medical Services program. The program links community-based health care with private pediatric practices to provide family-centered, comprehensive and coordinated care for children with special health needs.

Fla. Stat. § 409.91211 (2006) authorizes under the Medicaid Managed Care Pilot Project, the development of service delivery alternatives for children with chronic medical conditions that establish a medical home to integrate the family, medical and developmental concerns.

Fla. Stat. § 411.227 (2006) requires local demonstration projects under the Learning Gateway program to assist families in establishing a medical home.

Georgia

Guam

Hawaii

Idaho
Idaho Code § 56-252, 253 (2006) allows the state Medicaid Director to seek federal approval to require participants to establish a medical home.

Illinois

Indiana

Iowa
Iowa Code § 135.106 (2006) is under the Health Opportunities for Parents to Experience Success (HOPES)- Healthy Families Iowa (HFI) program. Program components must include assistance to participating families to create a medical home in order to promote preventive health care.

2005 Iowa Acts, Chap. 175 this is an appropriations bill. It also creates the Iowa Safety Net Provider Network to create a formal network of safety net providers for several purposes; including to emphasize preventive services and disease management, reduction of errors, continuity of care, and the medical home concept (H.F. 825).

Kansas

Kentucky

Louisiana
La. Acts 2006, Act 17 relates to a program designed to enroll 80% of Medicaid eligibles in Primary Care Case Management programs, providing a medical home and continuity of care (H.B.1- Appropriations).

La. Rev. Stat. Ann § 46:978 (2007) directs the Department of Health to develop and implement a system of medical homes for all residents who receive Medicaid or are low-income uninsured, this system must include the use of health information technology.

La. Rev. Stat. Ann § 39:100.51 (2007) creates the Health Care Redesign Fund, the sole purpose of which is to fund specific initiatives, including Act 243 (above), which establishes medical homes for Medicaid recipients and the low-income uninsured.

Maine

Maryland
Md. [Health-General] Code Ann § 19-2201 (2006) establishes a Community Health Resources Fund. Community health resources whose applications for a grant include a number of components, including plans to assist patients in establishing a medical home with a community health resource will be given priority.

Massachusetts

Michigan

Minnesota

Mississippi
Miss. Code Ann. § 43-13-117 (2006) states that upon enrollment, Medicaid beneficiaries shall be encouraged to undertake a physical exam that will establish a base-line level of health and a medical home.

Missouri

Montana

Nebraska

Nevada

New Hampshire
N.H. Stat. Ann. 167:3-f, 167:3-g (2005) extends a Medicaid program to provide in-home healthcare for children with severe disabilities (HB 259).

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island
R.I. Gen. Laws § 40-5.1-18 (2006) establishes that managed care provided under the Aid to Families with Dependent Children program, the RIte Care, the elderly and Disabled Residents Act, and medical assistance for pregnant women/RIte Start Programs will provide a medical home to assure appropriate care, deter unnecessary and inappropriate care, and place emphasis on preventive and primary care. (Also see the following sections: R.I. Gen. Laws § 40-8.4-5 (2006), R.I. Gen. Laws § 40-8.5-1 (2006), R.I. Gen. Laws § 42-12.3-2 (2006) and R.I. Gen. Laws § 42-12.3-3.5 (2006)).

South Carolina

South Dakota

Tennessee

Texas
Tex. [Family] Code Ann. § 266.003 (2006) requires medical services delivery for foster care children to include the establishment of a medical home for each foster child on entering foster care at which the child will receive an initial comprehensive assessment as well as preventive treatments, acute medical services, and therapeutic and rehabilitative care to meet the child's ongoing physical and mental health needs throughout the duration of the child's stay in foster care.

Tex. [Health and Human Services] Code Ann. § 531.085 (2006) states that hospital emergency room reduction initiatives may include a program under which the health and human services commission contacts a recipient who accesses a hospital emergency room three times during a six-month period and provides the recipient with information on ways the recipient may secure a medical home to avoid unnecessary treatment at hospital emergency rooms.

Tex. [Health and Human Services] Code Ann. § 533.002, 533.061 (2006) requires the Commissioner of health and human services to develop an integrated care management model of Medicaid managed care that will assign patients to a medical home and establish a method for reporting to medical homes and other appropriate health care providers on the utilization by recipients of health care services and the associated cost of utilization of those services.

Tex. [Health and Safety] Code Ann. § 12.0115 (2006) states that one of the primary goals of the Health Department in integrating the delivery of health care services for the benefit of recipients shall be providing for continuity of care for individuals and families, accomplished to the extent possible by providing an individual or family with a medical home that serves as the primary initial health care provider.

Tex. [Human Res.] Code Ann. § 32.071 (2006) establishes guidelines for the Health Department's comprehensive medical assistance education campaign. The campaign must include elements designed to encourage recipients to obtain, maintain, and use a medical home to reduce their use of high-cost emergency department services for conditions that can be treated through primary care or non-emergency physicians or other providers.

Utah

Vermont

Virginia

Washington
Rev. Code of Wash. § 74.09.402 (2006) states that the legislature intends to provide health care coverage to all children by 2010 and that this effort should include measures to expeditiously link children to a medical home.

Rev. Code of Wash. § 13.34.315 and 74.13.031 (2006) establishes a foster care health unit that will provide recommendations to the legislature by 9/1/06 on a number of issues including establishing a medical home for each child placed in foster care to ensure that appropriate, timely, and necessary quality care is available through a coordinated system of care and analyzing how a medical home might be utilized to meet the unique needs of children in foster care. In establishing a medical home, the department shall consider primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. (H.B. 2985)

2007 Wash. Laws, Chap. 259 Instructs the Health Care Authority and the Department of Social and Health Services to develop a plan to restructure their reimbursement payments to, among other things, encourage providers to establish medical homes. Also instructs departments to develop medical homes in conjunction with chronic care management systems for aged, blind and disabled enrollees.

West Virginia
W. Va. Code § 16-2J-1 et seq. (2006) creates a preventive care pilot program that will encourage participants to establish and use a medical home to provide a centralized, comprehensive record of all health related services to provide continuity of care. (HB 4021)

Wisconsin

Wyoming

Sources: National Conference of State Legislatures and the American Academy of Pediatrics (http://www.aap.org/)
Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.

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