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Attachment 2Revised 8/13/18Health Home Eligibility Screening and Referral Form To enroll in the Health Home (HH) program, applicants must be actively enrolled in Medicaid Fee for Service (FFS) or
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What is health home eligibility screening?
Health home eligibility screening is a process to determine if an individual qualifies for enrollment in a health home program.
Who is required to file health home eligibility screening?
Individuals who meet certain criteria, such as having chronic conditions or multiple health care needs, are required to file health home eligibility screening.
How to fill out health home eligibility screening?
Health home eligibility screening can be filled out by the individual, their healthcare provider, or a care coordinator. It typically involves providing information about the individual's medical history and current health status.
What is the purpose of health home eligibility screening?
The purpose of health home eligibility screening is to identify individuals who could benefit from care coordination services provided by a health home program.
What information must be reported on health home eligibility screening?
Information such as the individual's medical history, current health conditions, and any medications they are taking must be reported on the health home eligibility screening.
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