North Country Health Home Network (NCHHN)

(Agency)

Offers comprehensive care management to Medicaid recipients in Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, and St. 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: - currently have active Medicaid - have 2 or more chronic health conditions, OR be living with HIV/AIDS, OR have a serious mental illness Children with: - active Medicaid - 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 St. Lawrence counties

Get directions