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Health Home Program

The Health Home is a care coordination program for our Medicaid patients who have complex medical, behavioral and social needs.  We assist our members with any challenges they are facing that prevents you from focusing on their health. When you enroll in the program, we will provide you with a designated Care Coordinator who will gradually work with on obtaining specific goals that you set for yourself and with your Provider. These goals will assist you in maintaining your health and becoming independent.

The goal of this program is to provide you with support and guidance in addressing your everyday social and medical needs. Ultimately, our Health Home program will educate you, advocate for you, help you navigate and connect you to various community resources.

Through our Health Home Program, you can get help with:

  • Finding your PCP
  • Linking you to specialists including Mental Health and Substance Use Treatment
  • Signing up for entitlements
  • Looking for Food Access and SNAP applications
  • Connecting with Immigration Support
  • Assisting you with Transportation, DME and Home Health Attendants
  • Coordinating for Housing applications
  • Connecting with your insurance and renewal of your Medicaid
  • Following up on your medical and social needs in case you are hospitalized
  • Connecting with Legal Support
  • Connecting with Counseling services
  • Connecting with wellness activities and employment programs

To Enroll in our Health Home Program you must meet the following criteria:

  • 21 years old or older
  • Active non-restricted Medicaid
  • Have 2 or more long-term health problems like Diabetes, Hypertension, Hyperlipidemia, Asthma, COPD, Obesity, etc OR  has been diagnosed with HIV or Mental Health condition
  • Have a need for care coordination that if left without help, may put your health at risk

Our Health Home program is open to all members even they are seeing other PCPs in the community.

Walk-ins Welcome 9:00 am - 5:00 pm at 2024 Creston Avenue, Bronx NY 10453

Call us at (646) 362-4141

We’re here to help with all your
Care Coordination needs. Call us today.

If you have any questions or need immediate assistance, please feel free to give us a call, visit an urgent care center or schedule an appointment.

Health Home