Community Health Navigation Services

Navigation Services

What do community health navigators do?

A community health navigator is a link to community resources and medical providers. They assist patients in improving physical, mental, and social health, helping to develop a care plan that's right for you. They are health care coordinators, connecting people with community support and social service needs.

Community health navigators assist with:

  • Navigating the health care system
  • Linking patients to community resources for finding affordable housing, food, clothing, and transportation
  • Advocating on the patient's behalf, ensuring optimal care
  • Coordinating care through communication with other providers

I have Medicaid, but am I eligible to receive navigation services?

Medicaid members eligible to be enroll in a Health Home must have: 

  • Two or more chronic conditions 

OR:

  • One single qualifying chronic condition:
    • HIV / AIDS, or:
    • Serious Mental Illness (SMI) (Adults), or:
    • Serious Emotional Disturbance (SED), or Complex Trauma (Children)

AND:

An individual must be assessed and found to have significant behavioral, medical, or social risk factors that require the intensive level of Care Management services provided by the Health Home Program.

Determinants of medical, behavioral, and / or social risk can include: 

  • Probable risk for adverse events (e.g., death, disability, inpatient or nursing home admission, mandated preventive services, or out of home placement)
  • Lack of or inadequate social/family/housing support, or serious disruptions in family relationships
  • Lack of or inadequate connectivity with healthcare system
  • Non-adherence to treatments or medication(s) or difficulty managing medications
  • Recent release from incarceration, detention, psychiatric hospitalization or placement
  • Deficits in activities of daily living, learning or cognition issues, OR:
  • Is concurrently eligible or enrolled, along with either their child or caregiver, in a Health Home 

Additionally, currently enrolled Members should be evaluated to determine whether they remain appropriate for the Health Home Program. Can the member manage their condition(s) using existing services and family/natural supports without evidence of risk that supported their HH enrollment? Can the member be disenrolled or transitioned to a lower level of care management?