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North Country Health Home Network (NCHHN)

(Agency)

Offers comprehensive care management to Medicaid recipients in Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, and Saint Lawrence counties. Utilizes a care model to provide care coordination and health promotion, comprehensive transitional care/follow up as well as patient and family support, and referrals to community and social services for patients with qualifying conditions.

Eligibility: Adults must:
1) Currently have active medicaid
2) Have 2 or more chronic health conditions, OR be living with HIV/AIDS, OR have a serious mental illness

Children with:
1) Active Medicaid
2) A diagnosis of serious emotional disturbance, HIV/AIDS, complex trauma OR two or more chronic conditions

Application Process: Call, go online, or walk-in for information and to set up services; self-referrals accepted

Required Documentation: Documentation of health condition(s)

Fees: None

Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, and Saint Lawrence counties

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