Foothold Care Management (FCM) requires that members enrolling into the Health Home Programs be entered into the system with an associated Medicaid CIN number. Foothold sends member Medicaid CIN information for members in active segments to ePaces on a nightly basis to confirm member's current insurance details. The results of these nightly Medicaid eligibility checks can be found in the Overview tab of each member's chart.
Medicaid Restriction Exception Codes
FCM users can find the restriction codes linked to a member's Medicaid directly in FCM by navigating to the Insurance Details section of a member's Overview tab. This information can also be found by performing a member CIN search in the MAPP portal. In order to determine if a member's restriction codes are compatible with Health Home services, refer to this guide issued by the NYS Department of Health.
Medicaid Coverage Codes
Medicaid coverage codes are not currently available in FCM as a code, but rather as a description under Medicaid Description, highlighted in the screenshot below.
It can be found by performing a member CIN search for the member in the MAPP portal. In order to determine if a member's coverage codes are compatible with Health Home services, refer to this guide issued by the Department of Health.
Plans Ineligible with Health Homes
Effective January 1, 2018, the State determined that Care Management services offered by FIDA Plans and the Health Home Program are both comprehensive and comparable. To avoid the need to develop and
continue to implement complicated rules for determining payments and care manager roles to
ensure care coordination services are not duplicated, Medicaid Members enrolled in a FIDA Plan are excluded from enrollment in the Health Home Program. To see which plans are not compatible with Health Home services, please see this guide from the State.
To view which of your enrolled members may have a plan that is incompatible with Health Home, use this filtered search from FCM. From the Patient Index window, filter for Active members with an Insurance Type Medicaid Managed Care - Ineligible Plan.
DSP Admins are able to identify whether there are active, enrolled members with any incompatible plans by navigating to Configuration -->Managed Care Plans.
Here, DSP Admins will see under the Payer column whether the plan is payable or not.
FCM will also let Users know in the member's overview that the member's plan is incompatible with HH services. See the screenshot below:
