Physical, mental or behavioral health conditions along with difficult social influences can be barriers to improving health. Medicaid members facing such difficulties are considered Medically Complex.
DHHS and the Heritage Health plans provide care and case management services to support health goals, wellness, and quality of life.
Who may be considered medically complex?
A member with:
- A mental health or substance use condition that affects the ability to work or attend school
- A physical, intellectual, or developmental condition that significantly affects the ability to care for self
- A Social Security disability determination
- Medical condition(s) that require frequent monitoring or follow ups with a health care provider
OR
A member who is:
- Eligible for both Medicare and Medicaid
- In the foster care system
- Transitioning from a state facility (mental health treatment, corrections)
- Homeless or at risk for homelessness
Examples of homelessness include:
- Not having a place to stay overnight
- Couch surfing
- Living in motels, hotels, or camping grounds
- Living in emergency or transitional shelters, a halfway house, or other temporary housing
- Sleeping in a car
Examples of being at risk for homelessness include:
- Receiving an eviction notice
- Being the victim of domestic violence
- Having chronic disabilities or health problems
- Having a mental health or substance use condition
What are the benefits?
The Heritage Health plans have specially trained medical and behavioral health teams who use a personalized approach to address their members' health and wellness needs. The Heritage Health plans can provide:
- Assistance with finding a health care provider, making clinic appointments and coordinating care between health care providers
- Assistance with transportation to appointments
- Housing assistance
- Information on community resources for food, child care, clothing and other needs
How to get started
We have made two forms available for this purpose. The appropriate form can be selected and completed by the member, the caregiver, or the health care provider.
The form should be submitted to the Heritage Health plan and the care manager will provide assistance.
- The Medically Complex self-identification form asks about health care needs.
- The Homelessness identification form asks about homelessness or being at risk for homelessness.
Heritage Health plan contact information