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
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.
Read Success Stories to see how the AHI Health Home Care Management program has positively impacted the lives of our community members.
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||Counties Served||Specialties||Population|
|Alliance for Positive Health||Clinton||Foster Care, Severe Emotional Disturbance, Assisted Outpatient Treatment, HARP||Adults and Children|
|Capital District Psychiatric Center||Embedded into GFH||Former OMH, Severe Emotional Disturbance||Adults and Children|
|Catholic Charities Community Maternity Services||Warren and Washington||Foster Care, Child Welfare||Adults and Children|
|Citizen Advocates/North Star Behavioral Health Services||Franklin (+ parts of Clinton, Essex and St. Lawrence)||Severe Emotional Disturbance, Assisted Outpatient Treatment, HARP||Adults and Children|
|Families First in Essex County||Essex||Severe Emotional Disturbance||Children|
|Fort Hudson Care Management||Clinton, Essex, Hamilton, Warren and Washington||Complex Medical Needs||Adults|
|Glens Falls Hospital||Warren and Washington||Severe Emotional Disturbance, Complex Medical Needs, HARP||Adults and Children|
|Hamilton County Community Services||Hamilton||Behavioral Health, HARP||Adults|
|HCR Care Management LLC||Clinton, Essex, Franklin, St. Lawrence, 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||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||Assisted Outpatient Treatment, HARP||Adults and Children|
|UVMHN-Champlain Valley Health Network||Clinton, Essex and Franklin||Complex Medical Needs, Transition of Care, Primary Care||Adults|