At CINQCARE Health Home, we know that being healthy involves more than just medical care. That’s why our Care Managers, who we call Personal Health Navigators, work with you to figure out everything that affects your health — from housing and nutrition to transportation and medication management. Then, we will make a plan just for you to stay well.
We will also teach you important skills to help you stay healthy. If frequent emergency room visits or hospital stays have become a pattern, we’ll work with you to break that cycle too. We want to take care of all the things that help you stay healthy.
To join CINQCARE Health Home free services, you must be enrolled in Medicaid and have:
- Two or more chronic conditions (for example: Asthma, Diabetes, High Blood Pressure, High Cholesterol, Arthritis)
- A behavioral/mental health condition
- Sickle Cell
Qualifying chronic conditions are defined in the State Plan Amendment as any of those included in the “Major” categories of the 3MTM Clinical Risk Groups (CRGs). A table of qualifying conditions contained in these categories has been compiled and is shown below. Substance use disorders (SUDS) are in the list of qualifying chronic diseases but do not by themselves qualify an individual for Health Home services. Individuals with SUDS must have another chronic condition (chronic medical or mental health) to qualify. A chronic disease in the context of determining eligibility for Health Homes implies a health condition that requires ongoing monitoring and care. The state should not be incidental to the care of the member but have a significant impact on their health and well-being.
In addition to having a qualifying condition, an individual must be appropriate for Health Home services. Individuals who are Medicaid eligible and have active Medicaid and meet diagnostic eligibility criteria may not necessarily be appropriate for Health Home care management. Individuals that meet the eligibility criteria for Health Homes and manage their care effectively do not need the level of care management provided by Health Homes. An individual must be assessed and found to have significant behavioral, medical, or social risk factors to deem them appropriate for Health Home services. An assessment must be performed for all presumptively eligible individuals to evaluate whether the person has significant risk factors and is suitable for Health Home care management services.
Determinants of medical, behavioral, and social risk can include:
- The probable risk for adverse events (e.g., death, disability, inpatient or nursing home admission);
- Lack of or inadequate social/family/housing support;
- Lack of sparse connectivity with the healthcare system;
- Non-adherence to treatments or medication(s) or difficulty managing medications;
- The recent release from incarceration or psychiatric hospitalization;
- Deficits in activities of daily living such as dressing or eating;
- and Learning or cognition issues.
Get in touch to find out if CINQCARE will work for you or your family. We will have one of our health navigators
contact you directly to start the process of better care, where you live.