Affordable Care Act147 as an optional Medicaid State Plan benefit, health
homes are a specialized extension of the Patient-Centered Medical Home
model. Health homes are set up for individuals requiring an increased level
of care coordination or facing greater challenges in navigating the health
care system, such as those with developmental disabilities or behavioral
health challenges and those living in long-term care facilities.148 As with
Patient-Centered Medical Homes, providers are to receive incentives for
promoting wellness among their patients or clients and for achieving
positive health outcomes. This component of APII is still in the
Creating opportunities for low- to middle-income residents to obtain
health care insurance at reasonable cost is a critical task for the nation. The
Affordable Care Act has opened up a number of paths by which that task
can be accomplished, but the Supreme Court has left chiefly to the states
the choices about which paths to follow—if any.
Across much of the nation, opposition to President Obama and
resistance to Obamacare have made it difficult to achieve progress toward
the goal of access to care at reasonable cost, even in states where the need is
greatest and the potential benefits clearest. The task is difficult—but not
impossible. Despite a political environment increasingly hostile to President
Obama, Arkansas political and health policy leaders—encompassing
Democrats and Republicans, Medicaid officials and private insurers,
hospitals and physicians’ groups—have cooperated in building a system
that appears, from early results, to be succeeding in two ways. Arkansas is
reducing the proportion of uninsured residents faster than any other state.
At the same time, the state is transforming some sectors of health care from
wasteful fee-for-service payments to a more efficient “bundled payment for
episodes of care” approach. Discussions are under way, with broad
stakeholder representation, about what steps to take next. But the needle is
147. 42 U.S. C. § 300gg-2 (2012).
148. For an overview of the “Health Homes” concept as envisioned by § 2703, see
Health Homes, MEDICAID.GOV, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Integrating-Care/Health-Homes/ Health-Homes.html (last visited Apr. 18, 2015).
149. See, e.g., ARK. DEP’T OF HUMAN SERVS., DIV. OF BEHAVIORAL HEALTH SERVS.,
Behavioral Health Home Certification Rule: Agency and Performing Providers (Proposed)
(Oct. 6, 2014), available at http://www.paymentinitiative.org/referenceMaterials/
(last visited Apr. 18, 2015) (proposing “to establish requirements, standards, and procedures
for certification of Behavioral Health Homes (BHH) and related performing providers”).