Eligibility Enrollment

New York State’s Health Home eligibility criteria is as follows:

Medicaid eligible/active Medicaid and two (2) or more chronic conditions; or one (1) single qualifying condition of either HIV/AIDS or a Serious Mental Illness (SMI)

"*" indicates required fields

1Personal Information

2Contact Information

3Referral Information

Do you have Medicaid?**

Yes

What health plan do you currently have?*

Do you have two (2) or more chronic conditions?**

Yes

Note: New York State’s Health Home eligibility criteria is as follows: Medicaid eligible/active Medicaid and two (2) or more chronic conditions such as Asthma, Diabetes, High Blood Pressure, High Cholesterol or Arthritis; or one (1) single qualifying condition of either HIV/AIDS, Sickle Cell or a Serious Mental Illness (SMI)

Do you have a social condition appropriate for Health Home services as listed below?*

Yes

To see conditions appropriate for Health Home Services, click here.

First name*

Last name*

Date of birth*

Gender*

Phone*

Address

Street address Address line 2 City State / province / region ZIP / postal code Country

Medicaid ID Number*

Eligibility enrollment

Contact us

Corporate office

Corporate HQ

Conditions appropriate for Health Home Services: