Make a Referral

We are accepting referrals from the community for enrollment of eligible individuals into Health Home Services. Individuals must meet all eligibility requirements to be considered for enrollment.

Health Home Care Management Eligibility:

  1. Individual currently has active Medicaid AND,
    Individual resides in one of the following counties: Albany, Cayuga, Herkimer, Lewis, Jefferson, Madison, Oneida, Rensselaer, St. Lawrence and Schenectady counties AND,
  2. Individual meets the New York State Department of Health eligibility criteria of: two or more chronic conditions, or HIV/AIDS, or one or more serious mental illnesses AND,
  3. Individual has significant behavioral, medical or social risk factors which can be addressed through Care Management.


How to Make a Referral:

  1. Complete a Community Referral Application Form, including as much detail as possible to allow us to verify eligibility for Health Home Care Management services.
  2. Complete a signed Consent to Disclosure of Health Information Form.
  3. Enclose supporting documentation of diagnosis (if available).
  4. Upload the completed application, consent and supporting documentation via the upload button below or send the completed application and consent via secure e-mail or fax, or mail to:

1500 Genesee Street
Utica, NY 13502
Office: 315-624-9670
Toll free: 1-855-784-1262
Fax: 315-624-9673

Approved individuals will be assigned to a Care Management agency who will conduct outreach and attempt to engage the person in Health Home Care Management services. Health Home services are voluntary, and the individual will be asked to consent during the outreach and engagement process.

Download Community Referral Applications Form  Adult Community Referral Application 010 11 2017
Download Community Referral Application Form for Children HHSC Community Referral Application 09 06 2017

Upload completed Community Referral Application Form or mail to

Questions? Call 1-855-784-1262 for more information.