The Health Home for Children with Medically Complex Conditions funding opportunity, issued by the Centers for Medicare & Medicaid Services (CMS), aims to support state-level planning activities to develop a State Plan Amendment (SPA) for children with medically complex conditions. Under Section 1945A of the Social Security Act, this initiative aims to establish health homes for Medicaid-eligible children under 21 who suffer from conditions involving multiple organ systems or rare, life-limiting diseases. The main objective is to enhance care coordination and integrate comprehensive services to improve health outcomes for this vulnerable group.

A total of $5,000,000 is available for this grant, with individual awards of up to $100,000. Up to 50 awards are anticipated, depending on funding availability. Grants will cover a performance period of 36 months from the award date, allowing for the development of SPAs to provide structured care to medically complex children through designated health homes. These homes are intended to coordinate care among a wide range of providers, including pediatric specialties, and offer a family-centered system of care. Health home services will include comprehensive care management, transitional care, patient and family support, and referrals to social support services. Health Information Technology (HIT) will also be used to enhance care linkage, as applicable.

Eligible applicants include a wide range of government and educational institutions, as well as non-profit organizations. This includes state, county, and city governments, Native American tribal organizations, school districts, institutions of higher education, public housing authorities, and recognized non-profit entities. Applicants must also meet several administrative and regulatory requirements, such as having an Employer Identification Number (EIN), Unique Entity Identifier (UEI), and registration in the System for Award Management (SAM.gov). The program does require cost-sharing, with each state needing to contribute an amount equivalent to its standard Medicaid match.

Applications must be submitted by January 4, April 1, July 1, or October 1, with award decisions made on a rolling basis. The application process involves the submission of various documents, including a project narrative (detailing program requirements, goals, and proposed timelines), a budget narrative, and a business assessment of the applicant organization. Applicants must ensure the application conforms to specific formatting requirements, including page limits for each section. The application package must be submitted electronically via Grants.gov by the specified deadline.

The review criteria for this NOFO include the quality of the project narrative, the capacity of the applicant to implement the program, and the proposed evaluation methods for assessing project outcomes. Budgets must be well-justified, providing clear rationales for each expense to ensure effective use of grant funds. CMS will also evaluate the applicant’s organizational capacity, including personnel roles and responsibilities and their ability to manage the grant successfully. Additionally, awardees will need to ensure compliance with accessibility and non-discrimination policies as part of their commitment to providing inclusive services.

Selected applicants will be required to submit progress reports, financial reports, and participate in evaluations throughout the project period to ensure compliance with program objectives. These reports will help CMS track how well states are implementing their SPAs and coordinating services to improve health outcomes for children with medically complex conditions. The initiative also includes special provisions to ensure that states are not reducing existing Medicaid benefits as a result of adopting this health home model, thus safeguarding essential health services for eligible children.