Health Homes for Washington State

Program Location: 
Olympia, WA
Payer Type: 

Reported Outcomes


Washington now has approved 2703 Health Home State Plan Amendment. The State Plan Amendment was 6/28/13 and offers service to Medicaid enrollees with one chronic disease and at risk of developing a second. Washington extends the 2703 definition of "chronic disease" to include 12 additional disorders including cancer, renal failure, HIV/AIDS, and neurological disease. The geographic coverage area of this SPA includes Pierce, Clark, Cowlitz, Klickitat, Skamania, Wahkiakum, Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, and Yakima counties. 

Operated by the Washington State Department of Social and Health Services' (DSHS) and the Health Care Authority (HCA) the Health Homes Program will be comprised of six services: 

  • Comprehensive care management
  • Care coordination and health promotion
  • Comprehensive transitional care from inpatient to other settings, including appropriate follow-up
  • Individual and family support, which includes authorized representatives
  • Referral to community and social support services, if relevant; and, 
  • The use of health information technology to link services, as feasible and appropriate

HCA will qualify health homes based upon the adequacy of the network, Memorandums of Understanding between Health Home partners, and/or subcontracts. A health home may include partnerships between managed care plans; primary care providers; hospitals; mental health and chemical dependency treatment providers and/or clinics; primary care practitioner practices; long-term care services and supports, patient centered medical homes (PCMH); federally qualified health centers (FQHCs); and certified home health agencies.

Payment Model: 

The State pays health homes for delivery of health home services on a per member per month (PMPM) basis, using three payment tiers:

  • initial outreach and engagement,
  • intensive care coordination,
  • and low-level care coordination.

The first payment is a one-time fee of $252.93 for initial outreach and engagement, health screening, assessment for self-management, and development of the enrollee’s HAP. After the health home has submitted an enrollee’s HAP, in succeeding months, it can submit encounters for either intensive or low-level services.

Monthly payments are made only for months that an encounter is submitted by the health home. Health homes are paid for intensive care coordination for months in which the highest level of face-to-face care coordination is provided to an enrollee; the rate for intensive care coordination is $172.61. For any month that low-level care coordination is provided to an enrollee, the health home is paid $67.50

Fewer ED / Hospital Visits: 

RTI independent evaluation (January 2016) evaluates first demonstration performance period, from July 2013 – December 2014

  • the rates of inpatient hospital admission in general and ACSC admissions were either flat or increasing during the baseline period and appear to be falling in the demonstration period
Improved Patient/Clinician Satisfaction: 

RTI independent evaluation (January 2016) evaluates first demonstration performance period, from July 2013 – December 2014

  • More than half of the participants reported that they had experienced a significant improvement in their health or quality of life as a result of the health home services. 
Cost Savings: 

RTI independent evaluation (January 2016) evaluates first demonstration performance period, from July 2013 – December 2014

  • $21.6 million in Medicare spending relative to a comparison group, representing more than 6% savings


Last updated January 2019
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