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Health Home Care Management Program

(Program)

Assists individuals with needs such as goal setting, health promotion, transitional care, referrals to community and social supports and patient and family supports, and advocacy. Individuals work with a primary care manager to create their own plan of care.

Eligibility: Individuals must: - currently have active Medicaid - meet the NYS DOH eligibility criteria of either two chronic physical health conditions or HIV/AIDS and the risk of developing another chronic condition, or one or more serious mental illnesses - have significant behavioral, medical, or social risk factors which can be addressed through care management

Application Process: Referrals come through Health Homes (585-613-7670)

Required Documentation: Call for required documentation

Fees: None

Oswego County

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