FAQs – Patient Information

Q: How do I make a referral?

A: Please call the toll-free referral line at 1-866-708-2912. Please note we will need certain information such as a Medicaid ID, diagnoses, and contact information for the person being referred. Please plan on a 4-5 minute call. Download the AHI Health Home Community Referral Form for more information.

 Q: Who qualifies for Health Home?

A: Three things are required to qualify for Health Home:

  1. Active Medicaid.
  2. Two or more chronic conditions or a serious persistent mental illness or HIV/AIDS.
  3. Risk factors such as unstable housing, treatment non-compliance, and/or recent/frequent ER usage.

Q: I am a provider who wants to join the AHI Health Home. How do I do that?

A: There are two ways providers can participate in the AHI Health Home:

  1. Become a Health Home Network Provider, and/or
  2. Become a Health Home Service Provider

We welcome providers from across our region to join our network. By joining the AHI Health Home network of providers, you are agreeing to accept referrals for services (as your capacity allows) for Health Home recipients to receive services from your organization. All billing and authorizations go through the normal channels; this is not a contractual relationship. Additionally, you would make referrals for Health Home Care Management if you feel someone in your care can benefit. Please call us at 518-480-0111, ext. 6 to discuss joining our network.

Health Home Service Providers offer specific services. They perform outreach to locate potential Health Home participants, based on assignment lists from the New York State Department of Health. They accept community referrals as capacity allows for Health Home care management. They provide core care management services to Health Home participants, which includes coordinating care for members across a variety of settings including primary care, behavioral health, and social services, as appropriate. This involves a contract and specific guidelines. If you would like to explore this possibility, please call us at 518-480-0111, ext. 6.

Q: Can I refer someone who does not have Medicaid to Health Home?

A: No. Unfortunately Health Home is only available to Medicaid recipients.

Q: The person I want to refer has Medicaid, but I don’t have their Medicaid Client Identification Number. Can I still make the referral?

A: No. We verify eligibility based exclusively on Medicaid IDs. Please refer the person once you have that number.

Q: Does New York State have any information on Health Home?

A: Yes, the New York State Department of Health has published a Health Home brochure.