Medical Home – CSHCN

What is a Medical Home? 

  • A medical home is not a building. A medical home is a family-centered approach to comprehensive care with a partnership between a child, the child’s family, and the child’s primary health care setting. A family works with their primary health care team to get needed medical and non-medical services for their child. 
  • Receiving care through a medical home can improve a child’s health and make life easier for the child’s family. A medical home care team can include: 
    • Doctors and nurses; 
    • Therapists; 
    • Dentists; 
    • Pharmacists; 
    • Community health workers; 
    • School staff; 
    • Friends; 
    • Neighbors; and 
    • Anyone who cares for your child. 

Medical Home Components: 

  • Accessible – services are within the child’s and family’s community. Someone can help the child 24 hours a day, 7 days a week. 
  • Family-Centered Care – providers recognize the family as the expert in the child’s care. Family members are valued members of the care team and contribute to decision making. 
  • Continuous Care – the child sees the same pediatric health care team over time. The team supports the child during the transition to adulthood. 
  • Comprehensive Care – the child’s care includes: 
    • Check-ups; 
    • Preventative care; 
    • Primary care; and 
    • Specialty care. The child and family are connected to support and education opportunities. 
  • Compassionate Care – the medical home care team is genuinely concerned about the overall wellbeing of the child and family 
  • Culturally Competent Care – services are delivered in the child’s and family’s preferred language. The care team respects the family’s cultural and religious beliefs.

Medical Home Resources and Continuing Education


The Maternal and Child Health Section has family and provider brochures to help explain the importance of the medical home model. To order brochures, please use our online order form.  

Additional Medical Home Resources

  • The Mountain State Regional Genetics Network helps families connect to genetic services and resources. The network also helps providers understand available services so they can make referrals.
  • The Texas Parent to Parent Medical Home Toolkit explains what a medical home is and how to get one.
  • Navigate Life Texas includes tips for families on how to work with your child’s doctor to create a medical home.
  • Texas Primary Care Consortium is a nonprofit, practitioner-led organization. The Consortium’s mission is to promote the Patient-Centered Medical Home Model of care in Texas.
  • AMCHP National Standards for Systems of Care for children and youth with special health care needs (CYSHCN) - The Association of Maternal & Child Health Programs has an interactive website for the National Standards for Systems of Care for Children and Youth with Special Health Care Needs, Version 2.0. This tool strives to serve the nation’s 14.2 million children and youth with special health care needs. Version 2.0 sets the core components for the structure and process of effective systems of care. The tool also streamlines content for easier use by states and stakeholders.

Medical Home Learning Collaborative

The Medical Home Learning Collaborative (MHLC) provides quarterly resources for members to share knowledge, implementation strategies, and best practices on the philosophy and effectiveness of medical homes. A

To join or learn more about the collaborative, email  


To enhance the development and promote the principles of the Patient-Centered Medical Home model within the state of Texas for all children and youth including those with special health care needs. 


All Texas children and youth, including children with special health care needs, will have a medical home that provides accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally sensitive services. 

History and Strategic Plan 

The Medical Home Work Group (MHWG) was formed in 2003 after participants of an American Academy of Pediatrics conference spearheaded efforts to encourage Texas providers to establish medical homes. The MHWG was formed to share information, facilitate progress, and coordinate efforts to promote person-centered medical homes. In 2020, the group changed their name to the Medical Home Learning Collaborative (MHLC). The group furthered DSHS efforts to advance medical homes for children and youth with special health care needs in Texas.  

Download the Strategic Plan (PDF)