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The U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, has released guidance on a new Medicaid health home benefit for children with medically complex conditions.

The new optional benefit helps state Medicaid programs provide Medicaid-eligible children who have medically complex conditions with person-centered care management, care coordination, and patient and family support. CMS anticipates the new benefit will help these children receive care even across state lines.

Children with medically complex conditions – including serious health concerns like cerebral palsy, cystic fibrosis, blood diseases, and mental health conditions that can severely impact a child’s ability to function – often require tremendous care coordination and highly specialized treatment, said CMS. 

Finding needed services often requires traveling beyond a family’s home, and often care is only available for these children out-of-state. The new health home services are expected to give these children and their families help in coordinating and managing care.


As outlined in a letter to state Medicaid directors, states will have the option to offer the new health home services benefit beginning October 1. The services provided under the new benefit include providing access to the full range of pediatric specialty and subspecialty medical services, including services from out-of-state providers, as medically necessary.

The guidance provides information to states about the new health home benefit, including about payment methodologies, provider standards, provider and state reporting, state monitoring and state assurance requirements. 

States with approved Medicaid state plan amendments to cover the new health home benefit will receive a 15 percentage point increase in federal matching for their expenditures on health home services during the first two fiscal year quarters that the SPA is in effect. CMS also has committed to offer ongoing technical assistance to states regarding implementation of the new benefit.

CMS has engaged with stakeholders since January 2020 on the push. The agency issued a Request for Information to obtain feedback from the public, including advocates, families and states, on best practices for coordinating care provided by out-of-state providers to Medicaid-eligible children with medically complex conditions. In October 2021 it issued a bulletin on those best practices.


The administration has made a push to expand healthcare coverage for young people. In June, HHS awarded $49 million to organizations trying to reduce uninsured rates among children, parents and families.

The agency said it’s looking to invest in outreach and enrollment through Medicaid’s Connecting Kids to Coverage program. Grantees were funded through the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 (HEALTHY KIDS Act). The HEALTHY KIDS Act provides continued funding for outreach and enrollment to reduce the number of children eligible for, but not enrolled in, Medicaid and CHIP.

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CMS offers guidance to help connect children to Medicaid services – Healthcare Finance News