West Virginia Health Homes

Program Location: 
Charleston, WV
Payer Type: 

Reported Outcomes


West Virginia currently has two Health Homes:

The first Health Home was started in July 2014 in a six county area in southern West Virginia for eligible Medicaid members with bipolar disorder and at risk of having  or having Hepatitis B or C.  In April 2017 this Health Home expanded statewide.  More information about this Health Home can be found be clicking on the following link: Behavioral Health Health Home.

The second Health Home started in April 2017 as a pilot program designed for eligible Medicaid members with pre-diabetes, diabetes or obesity and at risk of having anxiety or depression.  This pilot program is in a 14 county region: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming.  More information about this Health Home can be found by clicking on the following link:  Diabetes Health Home

In January 2015, CMS approved West Virginia's Health Home state plan amendment. West Virginia chose to participate in the Health Homes program and will receive an enhanced federal match of 90% for eight quarters.  The Health Homes initiative provides a place for individuals to have their health care needs identified and to receive the medical, behavioral health and related social services and supports they need in a coordinated manner that recognizes all of their needs as individuals and as patients.  Health Home services include comprehensive care management, care coordination, health promotion and community and social support services.

The goals of the Health Homes program include:

  • Helping members experience longer periods of stability of their condition
  • Decreasing the use of medications and increasing compliance
  • Informing patients of their hepatitis risk and status and educating about its spread; and
  • Helping identify substance abuse more effectively and reducing ER visits and hospitalizations
Payment Model: 

West Virginia will receive a 90% enhanced FMAP (Federal Medical Assistance Percentage) for the specific health home services in Section 2703. The enhanced match does not apply to the underlying Medicaid services also provided to individuals enrolled in a health home. 
The 90% enhanced match is good for the first eight quarters in which the program is effective. West Virginia may receive more than one period of enhanced match, understanding that they will only be allowed to claim the enhanced match for a total of 8 quarters for one beneficiary. 

Fewer ED / Hospital Visits: 

There was a 42% reduction in the average length of stay in a hospital for all Health Homes members who had Medicaid coverage in both 2014 and 2015. Members who were enrolled for the entire year saw a decrease of 32% from 2014. THe decrease can be attributed to better discharge planning.

Cost Savings: 

When compared to potential Health Homes members and health Homes cohorts, the cost savings are significant, despite the fact that total prescription costs increased due to the high cost of treating Hepatitis. For potential enrollees, total medical costs increased by $3.2 million from 2014 to 2015, which Health Homes enrollees only saw an increase of $0.2 million.

Last updated February 2019
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