AHI is a New York State-designated lead Health Home and serves all ages. A Health Home is not a place; it is a care management service that connects community and social supports with health care, and provides better organization of medical and behavioral health care. A Health Home ensures all caregivers involved with a person talk to one another so they can focus on their client’s needs.
We coordinate medical and behavioral health care by connecting community and social supports with health care for high-risk Medicaid members with:
- HIV/AIDS; or
- a serious persistent mental illness; or
- two or more other chronic conditions.
Additionally, any of the following risk factors must be a part of the person’s situation. These reasons include, but are not limited to:
- Homelessness or risk of homelessness;
- Lack of social/family supports;
- Deficits in activities of daily living;
- Non-adherence to treatments;
- Learning or cognitive issues.
The AHI Health Home Care Management program goal is to improve care coordination for high-risk Medicaid individuals, reduce duplicative services, reduce emergency department visits and inpatient admissions, and lower costs.
The AHI Heath Home Care Management program is a partnership of primary care providers, hospitals, and several behavioral health and community-based organizations.
For more information about the AHI Health Home Care Management program, call 866.708.2912 or email [email protected].
Complete the AHI Health Home Community Referral Form.
|Care Management Agency (CMA Name)||Counties Served||Specialties||Population (Age)|
|Alliance for Positive Health||Clinton, Essex, Warren, and Washington||HIV/AIDS, HARP||Adults|
|Behavioral Health Services North||Clinton||Foster Care, Severe Emotional Disturbance, HARP||Adults and Children|
|Capital District Psychiatric Center||Embedded into GFH||Former OMH, Severe Emotional Disturbance||Adults and Children|
|Citizen Advocates/North Star Behavioral Health Services||Franklin (+ parts of Clinton, Essex, and St. Lawrence)||Severe Emotional Disturbance, HARP||Adults and Children|
|Community Maternity Services||Warren and Washington||Foster Care, Child Welfare||Adults and Children|
|Essex County Mental Health Services||Essex||Behavioral Health, HARP||Adults|
|Families First in Essex County||Essex||Severe Emotional Disturbance||Children|
|Glens Falls Hospital||Warren and Washington||Severe Emotional Disturbance, Complex Medical Needs, HARP||Adults and Children|
|Hamilton County Community Services||Hamilton||Behavioral Health||Adults|
|HCR Care Management LLC||Clinton, Essex, Warren, and Washington||Complex Medical, Transition Care, HARP||Adults|
|Hudson Headwaters Health Network||Clinton, Essex, Hamilton, Warren, and Washington||Complex Medical, Primary Care, Transition Care||Adults and Children|
|Mental Health Association in Essex County||Essex||Behavioral Health, HARP||Adults|
|St. Anne Institute||Clinton, Warren, and Washington||Foster Care, Severe Emotional Disturbance, Behavioral Health||Children|
|St. Lawrence Psychiatric Center||Embedded into BHSN||Former OMH||Adults and Children|
|Transitional Services Association||Warren and Washington||Assisted Outpatient Treatment||Adults|
|United Helpers Mosaic||St. Lawrence||Assertive Community Treatment, HARP||Adults and Children|
|UVMHN/Champlain Valley Health Network||Clinton, Essex, and Franklin||Complex Medical Needs||Adults|
|Warren-Washington Association for Mental Health||Warren and Washington||Severe Emotional Disturbance, HARP||Adults and Children|