1978 |
JUAN C PINZON |
(646) 385–3569 |
jpinzon@cssny.org |
www.cssny.org |
All 62 |
Health insurance enrollment and navigation, income support services,financial coaching, reentry services and youth mentoring |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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1digit LLC |
Gail Nayowith |
917–647–3053 |
gnayowith@1digit.nyc |
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nyc |
cvy |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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A New Hope Center |
Francis J Bialy |
607–687–6887 |
franb@anewhopecenter.org |
www.anewhopecenter.org |
Tioga |
victim services, domestic violence, including shelter, rape crisis |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate NY |
unsure |
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Abbott House |
Bridget Carter |
914 365 6719 |
bcarter@abbotthouse.net |
https://www.abbotthouse.net/ |
New York, Bronx, Westchester, Rockland, Orange, Dutchess, Sullivan, Ulster |
Abbott House provides services across NYC and the Lower Hudson Valley including mental health services, CFTSS and HCBS services and supports for children and their families, Children´s Health Home Care Management, Foster Care services, mandated preventive services and residential options and Day Habilitation services for
Adults with Developmental Disabilities. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Metro Plus, MVP, Fidelis, HealthFirst, AffinityCare, |
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Abbott House |
Bridget Carter |
914 365 6719 |
bcarter@abbotthouse.net |
https://www.abbotthouse.net/ |
Bronx, New York, Westchester, Rockland, Orange, Dutchess, Sullivan, Ulster |
Foster Care, Children´s Behavioral Health Services and Supports, Children´s Mental Health, |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Metro Plus, Fidelis, Healthfirst, MVP |
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Acacia Network, Inc |
Gabriela Marinescu–Cruz |
718–960–7568 |
gmarinescu@promesa.org |
www.acacianetwork.org |
Bronx, Kings, Queens and Manhattan |
Acacia Network stands in places of need, has well developed roots, and nurtures the community to reach its potential. We provide primary care, specialty care, mental health, substance abuse. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AsOne IPA, Ince |
Healthfirst, Metroplus, Fidelis, Affinity and Wellcare |
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ACLD |
Robert Ciatto |
516–822–0028 |
ciattor@acld.org |
acld.org |
Suffolk and Nassau |
ACLD provides residential, day habilitation, respite (in home and group), community hab, education (pre–school), IPSIDD, recreation, supplemental day hab, vocational services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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ACR Health |
Jeanette O´Connor–Shanley |
315–475–2430 |
joconnorshanley@acrhealth.org |
www.ACRHealth.org |
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins |
Health Home Care Coordination, Rental Assistance and Housing Retention Services, LGBTQ youth and adult support services and groups, syringe exchange programs, drug user health services including acute medical services and MAT, HIV/STD/HCV testing and screening, NYS of Health Insurance enrollment services and supportive
services including Nutrition, Medical Transportation, Behavioral Health Enrollment, Case Management, Employment. Strong partnerships in all 15 counites with health and human service providers. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Inclusive Alliance IPA |
Fidelis |
United Healthcare |
Excellus |
Action for a Better Community |
Aaron Wicks |
(585) 325–5116 x4511 |
awicks@abcinfo.org |
www.abcinfo.org |
Monroe, Ontario |
ABC serves inidividuals and families with low–incomes –– virtual all ABC customers are Medicaid–enrolles. ABC provides employment, education, health outreach, housing and community mobilization support to these familes |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
I don´t recall the name of our consortium |
Not known |
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Adolescent AIDS Program, Children´s Hospital at Montefiore Medical Center |
Debra Parmer, MS |
718–882–0232 |
dparmer@adolescentaids.org |
www.adolescentaids.org |
Bronx, New York, Queens, Kings |
The Adolescent AIDS Program (AAP) holds the distinction of being the nation´s first adolescent–focused HIV/AIDS center, and is a leader in LGBTQ health care for youth. A model multidisciplinary program, the AAP maintains an ethos of caring, learning and teaching. In every aspect of our work with patients, health care systems and
communities, we strive to maximize the health of all young people infected and affected by HIV/AIDS and to inspire them to reach their full potential. In our work to reduce the burden of HIV/AIDS on young people, we are committed to serving and working with several key stakeholders: All youth living with and at risk for HIV infection, especially youth of color and lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth; Families, friends and partners of youth living with or at risk for HIV infection; Health care systems that provide care to young people; Community–based
organizations serving youth; and Public policy leaders with the power to improve outcomes for vulnerable youth. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Adoptive and Foster Family Coalition of New York |
Renee Hettich |
607–272–0034 |
renee@affcny.orh |
https://affcny.org |
Broome, Cayuga, Chemung, Chenango, Cortland, Madison, Schuyler, Tompkins, Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Rockland, Sullivan, Ulster, Nassau, Suffolk |
We provide support for adoptive and guardianship families such as assessment, case management, in–home support, advocacy for services, parent support groups, referrals, programs for children and youth, and training/information. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Advocates For Autism |
Sally Colletti |
(607) 754–9694 |
advocatesforautism@yahoo.com |
www.advocatesforautism.com |
Broome, Chenango, Tioga, Tompkins, Delaware, Cortland, Dutchess |
Medicaid Brokering; Person–Centered Planning; Housing and Services Navigation; Health Literacy; SSA Representation; Guardianship and Supported Decision Making |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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United Healthcare Services; Excellus; Fidelis |
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AIDS Service Ctr Lower Manhattan dba Alliance for Positive Change |
Marcy Thompson |
212–645–0875 |
marcy@alliance.nyc |
www.alliance.nyc |
Bronx, Brooklyn, Manhattan,Queens |
The Alliance for Positive Change is a community based organization that helps New Yorkers living with HIV and other chronic illnesses make lasting positive changes towards health, housing, recovery and self–sufficiency. Our diverse range of individualized, professional services include access to healthcare, peer education and
safe–practice counseling. Alliance programs promote positive change, self–respect, personal responsibility and connection to community. Care Management: Intensive support to access medical care, pharmacy, housing, and other key services to promote wellness and self–sufficiency. Harm Reduction & Recovery Services: Counseling, education, syringe exchange, coaching, and support to help active and recovering substance users reduce risk, access healthcare, connect with a caring community, and explore recovery at their own pace. Peer Training and Workforce Re–entry
Services: Job–readiness skills training empowers individuals to become community leaders and role models, inspiring others to make healthy choices. Alliance Peer Educators provide services that maximize our impact – and gain marketable skills that lead to jobs in organizations citywide. HIV Prevention and Coaching: HIV and hepatitis C testing, rapid access to medical care, and risk reduction education that enables women, gay and bisexual men, and people with histories of addiction to get healthy and stay healthy.
Supportive Housing: Short–term and permanent housing with a robust mix of onsite services that promote recovery, wellness and self–sufficiency for people facing multiple chronic conditions. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Engagewell IPA; https://engagewellipa.com |
Healthfirst, Metroplus, VNSNY CHOICE |
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Albany County Rural Housing Alliance, Inc |
Tracy Gibeau |
518–765–2425 ex 2588 |
tgibeau@acrha.org |
www.acrha.org |
Albany County |
ACRHA offers home repair grant to assist homeowners with health and safety repairs. Reverse Mortgage, Foreclosure and Pre–Purchase counseling is also offered. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Ali Forney Center |
Joey Lopez |
212–206–0574 |
jlopez@aliforneycenter.org |
www.aliforneycenter.org |
Bronx,Manhattan,Brooklyn,Queens,Staten Island, Westchester and Long Island |
AFC serves LGBTQ Youth 16–24. We provide, Housing, Case Management, Mental and Physical Health screenings, Education and Employment training as well as meals |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Health First |
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Alliance for Positive Change |
Evelyn Lopez |
212.645.0875 x454 |
evelyn2@alliance.nyc |
https://alliance.nyc |
New York, Bronx, Kings, Queens, Richmond |
Every year alliance serves over 6,000 low–income New Yorkers with multiple chronic illnesses many of them seeking benefit assistance, housing stabilization, food and support coordinating their care. Under Housing stabilization we offer housing assistant to temporary housing , retention in permanent housing via emergency
rental, utility assistant and legal consultation. We offer Food Prescription Program that includes nutritional education, meals, grocery pantry and food voucher distribution. Our care management services include accompaniment, social support , coordination with medical providers and services in the client´s community through HCBS services. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
EngageWell IPA |
Amida Care, Inc., Healthfirst PHSP, Inc., MetroPlus Health Plan, Inc., and SelectHealth. |
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American Lung Association |
Claudia Guglielmo |
(516) 972–3850 |
claudia.guglielmo@lung.org |
Lung.org |
New York, Queens, Kings, Richmond, Bronx, Suffolk, Nassau, Westchester, Ulster, Sullivan, Orange, Dutchess, Niagra, Erie, Monroe |
The ALA Asthma Programs in NYS target efforts around asthma in those communities that experience the highest rates of asthma hospitalizations and ED visits. We accomplish this through health systems quality improvement projects and home–based asthma services and interventions.
These efforts focus on chronic disease management, access to health services, physical environments, providing educational resources and supporting bi–directional community clinical partnerships and referrals. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Healthfirst, Healthplus, Fidelis, Anthem |
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ANIBIC |
John F. DeBiase |
347 594 2124 |
jdebiase@anibic.org |
anibic.org |
Queens |
Servies for the ID/DD population: Residential, Vocational, Day programs, recreational |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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CDNY |
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Apicha CHC |
Teresita R. Rodriguez |
646 884 5377 |
trodriguez@apicha.org |
https://www.apicha.org |
New York, Queens, Kings, Richmond, Bronx |
Nutrition, Mental Health Services, Care Management, Insurance Enrollment, Health Literacy, HIV Prevention, Transgender Wellness Program |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
EngageWell IPA |
Health First, Amida Care SN, NYS Catholic Health Plan |
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Arab American Association of New York |
Lauren Hawk |
929–471–6604 |
lauren@arabamericanny.org |
www.arabamericanny.org |
Kings County |
AAANY offers mental health counseling services, facilitated support groups, and preventative health workshops to the Arab and Muslim community of Bay Ridge, Brooklyn. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Arab–American Family Support Center |
Ghadeer Ady |
718–643–8000 ext.12 |
ghadeer@aafscny.org |
www.aafscny.org |
Kings County. Queens County, Bronx County, New York City County, Richmond County |
We provide health insurance coverage, SNAP enrollment, preventive services, anti–violence program services, mental health counselling, and wellness based activities for adults and children. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CTHE Brooklyn Hub |
Affinity, Empire Blue cross blue shield, Emblem Health, Health First, Metro Plus, United Healthcare, Wellcare, |
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Arc Herkimer |
Lorene Bass |
315–574–7564 |
lbass@archerkimer.org |
www.archerkimer.org |
Herkimer County and some services in Oneida and Otsego Counties |
Arc Herkimer provides services and supports to individuals with intellectual and developmental disabilities through OPWDD, HCBS Waiver, and additionally provides supports for HCBS services for children and adults, employment services through contracts with ACCES VR and OMH. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Life Plan LLC NY CCO |
Fidelis; Excellus; OPTUM, MVP |
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Arc of Onondaga |
Ruth Ann Riposa |
(315) 476–7441 |
ruthann.riposa@arcon.org |
www.arcon.org |
Onondaga County |
Arc of Onondaga is one of the largest providers of services to people with developmental disabilities in Onondaga County serving thousands of individuals and their families and employing over 500 people. With nearly 40 different sites throughout Central New
York, Arc provides a wide array of opportunities including residential, day, employment and recreation programs and services. |
Unsure |
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Medicaid |
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Arc Wayne |
Leah Flowers |
(315331) 774–1441 |
Leah.flowers@arcwayne.org |
www.arcwayne.org |
Wayne, Cayuga, Seneca, Monroe, Orleans, Niagara, Ontario |
Arc Wayne serves a wide variety of individuals including I/DD, Behavioral health, etc. We provide a vvariety of I/DD services including residential, vocational, and day services. We provide BH Care Management, BH HCBS, Access VR, Welfare to Work, Criminal Justice Programs, Meals on Wheels, Integrated Pre School, Etc. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
FLST BHCC, Consortium of the Finger Lakes (Arc´s) |
Excellus (PRIMARY), Fidelis, United Health Care, MVP |
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Arthur Ashe Institute for Urban Health |
Faven Araya |
718–826–4999 |
faraya@arthurasheinstitute.org |
https://www.arthurasheinstitute.org/ |
King County |
The Arthur Ashe Institute for Urban Health utilizes a model of community health empowerment and engagement to promote health equity and social justice through strategic partnerships, innovative community–based health promotion & research programs, and the preparation of a more diverse and inclusive workforce of health
professionals. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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MetroPlus, Healthfirst |
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Aspire of WNY |
Martha Farewell |
716–505–5636 |
Martha.farewell@aspirewell.org |
www.aspirewny.org |
Erie, Niagara, Chautauqua |
Aspire of WNY specializes in supports and services for those with disabilities. Services include primary medical care, podiatry, rehabilitation services, residential services, employment training, day habilitation, community habilitation, childhood education and school to adult life transition. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Aspire Health Center is part of ther SNAPCAP IPA (SIPA) |
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Association for Mental Health and Wellness |
Michael Stoltz |
(631) 471–7242 |
amontijo@mhaw.org |
http://mhaw.org/ |
Suffolk |
Adults with psychiatric disabilities, veterans, children care managment. We have partnerships with multiple organizations |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
RHS formerly AHN |
Healhfirst & United HC |
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Astor Services for Children & Families |
Yvette Bairan |
845–871–1097 or 845–871–1001 |
ybairan@astorservices.org |
www.astorservices.org |
Bronx, Westchester, Dutchess, Orange, Ulster |
Mental Health Services for youth and adolescents between the ages of 5 – 18. We also provide Early childhood services. We provide outpatient clinic services, day treatment, foster care services, residential services, care management, crisis services, and educational services. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
PWR, CBHS, As One.BHCC, CCBHO.Community Care. |
Health First |
Beacon |
MVP |
Baker Hall Inc dba Baker Victory Services |
Sheila Hunt |
716 828–9699 |
shunt@bakervictoryservices.org |
www.bakervictoryservices.org |
Erie, Niagara |
Our agency provides an array of services to children, adolescents and adults. We are diverse in that our many programs works with Developmentally Disabled in our OPWDD group homes, behavioral and/or dual diagnoses behavioral health/autism in our Intensive Treatment and Residential Treatment program. We work with children who
have been displaced from their homes in both our emergency foster care and traditonal foster care programs. In our Preventive program we work with children and familes to keep the family unit in tact and prevent out of home placement. The Outpatient Mental health clinic works with children, adolsecents and adults on managing mental health concerns. They are also linked with a Psychiatrist for medication management. Our Community Based programs such as our Health Home program, childrens HCBS and adult HCBS programs work with children and families to assist with SDH such as housing
instability, access to health care and mental health care, transporation barriers, linking to food pantires and early childhood intervention |
Unsure |
Value Network IPA |
Fidelis and Beacon Health Options |
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Bay Ridge Center |
Marianne Nicolosi |
(718) 748–0650 |
mnicolosi@bayridgecenter.org |
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Kings County |
Home Delivered Meals, Friendly Visiting,mental health services, Case Assistance, Health Management, Evidence Based Exercise Programs, Congregate Meals, Benefits and Entitlements for older adults. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Bay Ridge Center, Inc and Community Care Link |
unknown |
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Bedford Stuyvesant Restoration Corporation |
Sarah Wolf |
(917) 267–5597 |
swolf@restorationplaza.org |
www.restorationplaza.org |
Kings |
Bedford Stuyvesant Restoration Corporation (Restoration), the nation´s first community development corporation, relentlessly pursues strategies to close gaps in family and community wealth to ensure all families in Central Brooklyn are prosperous and healthy. To that end, we partner with residents and businesses to improve
the quality of life of Central Brooklyn by fostering economic self sufficiency, enhancing family stability and growth, promoting the arts and culture and transforming the neighborhood into a vibrant place to live, work and visit. As Central Brooklyn experiences gentrification, economic growth and investments, our strategy is to ensure integration rather than displacement of low and moderate income residents, especially people of color. Restoration was established in 1967 through grassroots activism and the bipartisan support of then Senators Robert F. Kennedy and Jacob Javits.
With a 51 year track record, Restoration serves some 50,000 annually across the borough with a focus on the predominantly minority and low income Central Brooklyn communities of Bedford Stuyvesant, Brownsville, Bushwick and East New York. These communities are faced with poverty and unemployment that far exceed state and city averages, some of the lowest graduation rates in New York, and health disparities that disproportionately impact low income households of color. Restoration´s programs work together to promote the social, financial and physical health
and well–being of residents and the community at large. Efforts span affordable housing, economic development, workforce development, asset building, education, financial counseling, health, and the arts and culture. Our efforts begin with the individual and involves changing household and community level spending patterns that undermine the wealth creation of low and moderate income households, while simultaneously advocating for policy and systems reform. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Behavioral Health Services North |
Shawn Sabella |
(518) 563–8000 |
ssabella@bhsn.org |
www.bhsn.org |
Clinton County, with limited services in Essex and Franklin Counties |
BHSN´s PROS, Supported Housing, STOP Domestic Violence, Supported Employment, and Supported Education programs serve adults 18+, while Health Home Care Management, Home and Community Based Services, and outpatient MH clinic services are available to adults and children. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Northwinds Integrated Health Network |
Fidelis |
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Birch Family Services |
Josh Scher |
212–616–1824 |
josh.scher@birchfamilyservices.org |
https://birchfamilyservices.org/ |
Manhattan, Kings, Bronx, Queens |
We provide Early Education/Special Educations, UPK, School age services to children, adolescents and adults with Intellectual Disabilities, Developmental Disabilities and/or Autism, Related Services, CACFP Food Program, Preschool Evaluations, Transition Services for aging out students, Day Habilitation,
Pre–Vocational Services, Supported Employment, Employment, Children´s Residential Services, Individualized Residential Alternatives, Intermediate Care Facilities |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
New York Integrated Network IPA |
Not yet enrolled |
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Bleeding Disorders Assoc. of NENY |
Karla Digirolamo |
(518) 729–3577 |
karla.d@bdaneny.org |
www.bdaneny.org |
Dutchess, Ulster, Delaware, Green, Columbia, Rensselaer, Albany, Schoharie, Otsego, Herkimer, Mongomery, Schenectady, Fulton, Saratoga, Warren, Hamilton, Lewis, Washington, Essex, St Lawrence, Franklin, and Clinton. |
BDANENY serves people affected by inherited bleeding disorders. We work closely with the Hemophilia Treatment Center in our service area and with other medical providers and social services agencies to ensure that our community has access to necessary health care services, prescription drugs
including required blood factor products and support services. We also advocate for adequate insurance coverage including limiting unnecessary pre–authorizations, advocating to limit pre–existing condition exclusions, and ensuring patients can access the pharmacy and delivery method of their choice. We provide limited financial assistance to people who need such help for co–pay, transportation to medical appointments and other costs necessary to ensure their health and well–being. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Unknown |
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Bleuler Psychotherapy Center |
Steven Helfand |
(718) 275–6010 |
steven.helfand@bleulerpc.org |
www.bleulerpc.org |
Queens, Brooklyn, Manhattan, Nassau |
Outpatient mental health and substance use treatment to included target populations of formerly incarcerated and alternatives to incarceration. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health NYC, IPA (BHNYC) |
Healthfirst, Beacon, Empire |
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BOOM!Health |
Delilah Gavilanes |
(718) 295–5605 |
dgavilanes@boomhealth.org |
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USA |
Harm reduction services, Programs for PLWHA, Mental health, CHronic Medical condictions such as HCV, Health Homes,care coordination programs, nutritional programs for PLWHA, Trauma related programs, drop in services such as meals, showers and asccess to laundry and Syringe exchange programing |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Argus/BOOM!Health |
Healthfirst |
Amidicare |
Metroplus |
BRIDGES |
Susan Jenkins |
315–697–3947 |
sjenkins@bridges–mccasa.org |
www.bridgescouncil.org |
Madison, Oneida and Herkimer |
information and referral, smoking cessation, tobacco control policies, suicide prevention training, LGBTQ support group, grief support groupEAP to help employees m |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
ARISE is our HUB through CNYCC |
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Bronx Community Health Network |
Eleanor Larrier |
718–405–7723 |
elarrier@bchnhealth.org |
bchnhealth.org |
Bronx |
At both health centers and in community settings, BCHN assesses for social determinants of health needs and addresses these needs through direct assistance and linkages to approriate resources. We target both patients at our health centers and community residents. We partner with multiple community
resources such as faith based organizations, food pantries and other community based organziations. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Medicaid |
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BronxWorks |
Shali Sharma |
646.276.0702 |
vsharma@bronxworks.org |
www.bronxworks.org |
Bronx |
BronxWorks helps individuals and families improve their economic and social well–being. From toddlers to seniors, we feed, shelter, teach, and support our neighbors to build a stronger community. We offer a variety of services in different settings; addressing the social determinants of health is an essential part of our work. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Health First |
Affinity |
Metro Plus |
Brooklyn bureau of Community Services dba Brooklyn Community Services |
Janelle Farris |
(718) 310–5607 |
jfarris@wearebcs.org |
wearebcs.org |
Kings |
Mental health community supports (Club house), housing, PROS, education, employment |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Affinity Health Plan Inc, MetroPlus Health Plan, Wellcare |
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Brooklyn center for Independence of the Disabled |
Milenka Berengolc |
718 998–3000 |
mberengolc@bcid.org |
BCID.org |
Kings county and city–wide |
BCID serves the disability population, including physical, mental, sensory, and cognitive disabilities. Both our staff and our board of directors have disabilities themselves. The disability population faces a multitude of interlocking barriers, and are overwhelmingly impacted by the social determinants of health, such as housing,
transportation, health care, employment. BCID has partnered with Empire Blue Cross Blue Shield using BCID´s unique CHW program. We will be starting shortly another CHW program with Integra. BCID´s mission is to empower people with disabilities to become self–advocates and improve their quality of life. We are a member of the New York Association of Independent Living, and collaborrate with ACESS–VR. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Communities Together for Health Equity (CTHE) and the Brooklyn Hub |
Integra, long–term managed care organization. |
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brooks–tlc health–gowanda medical |
tracy stevens |
716–532–8100 ext 7379 |
tstevens@tlchealth.org |
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chautauqua, erie, cattaraugus |
discuss or refer medicaid patients to health homes, behioral health if needed, give information to help if transportation is needed |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Fidelis & Your Care (35% patients have medicaid product) |
Medicare (Ind Health, BCBS, 30% patients have medicare product) |
Commercial insurance–Ind Health, empire, etc |
Buffalo Go Green Inc. |
Allison DeHonney |
716–982–1270 |
Dehonn@outlook.com |
UrbanFV.com |
Erie & Niagara |
Urban farms & gardens, Mobile Produce Market, Nutrition Education, Access and Education to health food options serving families with food insecurity and working primary in food desert areas |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Community Health Centers of Buffalo & Niagara Falls |
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Buffalo Prenatal Perinatal Network, INC. |
Marixsa Sanchez |
(716) 359–3049 |
ms@bppn.org |
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Erie |
The Buffalo Prenatal Perinatal Network, Inc. (BPPN) has an overall mission, to collaborate convene and coordinate with all the key maternal child stakeholders in the city of Buffalo as well as Erie County more specifically focuses on identifying and servicing clients in 13 of the 25 zip code areas (14201, 14202, 14207, 14208,
14210, 14211, 14212, 14213, 14214, 14215, 14216, 14218, and 14222) that are identified with the highest–risk neighborhoods). The ZIP codes areas are identified as high–need based on significantly poor birth outcome indicators, including infant and neonatal mortality rates; percentage of premature births, low birth weight births, late or no prenatal care; and the teen pregnancy and birth rates) with the express goal to improve maternal and infant health outcomes for high–need women and their families who reside in targeted high–risk areas. BPPN has
successfully operated for over 32 years and has implemented broad population and evidence based interventions that enhance, promote and improve the perinatal health and care system in Buffalo´s city neighborhoods. BPPN has worked collaboratively with community providers to help identify problems of adequacy, acceptability and accessibility in the delivery of maternal and infant health. BPPN has initiated and continues to initiate activities to address these problems with resources provided by our own agency along with
the support of a maternal child network of providers within the community. Our success is based on the implementation of programs/ services that have proven to have positive effects on the community, especially among high need populations who have the greatest deficits and are difficult to serve. BPPN aims to continue to work on and expand the development of multi–dimensional community–wide systems of integrated and coordinated community health programs and services. These include programs to reduce infant mortality, low birth weight and improve overall health outcomes while
employing new initiatives to further our efforts to narrow the significant health disparities in our community. The Maternal Infant Community Health Collaboratives (Community Health Workers Program) has a long history of assisting with service and system navigation (e.g. helping clients figure out the services they need and how to access them) and we provide the proposed population with unique home visiting and comprehensive case management services. Monthly home visits enable Community Health Workers (CHWs) to
screen and assess immediate needs and provide clients with an increased level of trust that in turn increase their level of participation. Our program provides trained staff that is culturally and linguistically coordinated with the target population to provide a community–based, trauma informed and harm reduction approach that helps with attaining the programs goals. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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BlueCross BlueShield of Western New York |
Independent Health–Health/MediSource |
Fidelis Care of New York; United Health Care, WellCare Health Plans; and YourCare Health Plan |
Callen–Lorde Community Health Center |
Anthony Fortenberry |
(212) 271–7143 |
afortenberry@callen–lorde.org |
callen–lorde.org |
New York |
Callen–Lorde provides health and social services targeted toward New York´s LGBTQ communities. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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CAMBA, Inc. |
Michael Erhard |
347 582–7110 |
michaele@camba.org |
www.camba.org |
Kings, Queens, Bronx, New York and Richmond counties |
CAMBA takes a comphrensive approach to helping individuals, families and communities thrive with programs in Economic Developmet, Education and Youth Development, Family Support, Health, Housing and Legal Services. CAMBA reaches 60,000 individuals and families each year. 85% of families served are living in poverty. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Engage Well, IPA |
Health First, Metroplus, and Health Plus |
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Camelot of Staten Island Inc. |
Logan Lewis |
(718) 632–3275 |
LLewis@camelotcounseling.com |
Camelot of Staten Island Inc. |
Richmond, Queens, Bronx |
Substance Use Disorder both Residential and Outpatient, including certification to provide Integrated SUD, MH and Primary Care services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health New York City – IPA |
Health First, Fidelis, Amerigroup |
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Camp Venture, Inc. |
Marie Pardi, CPO |
845–624–5324 |
marier@campventure.org |
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Rockland County, NY |
Camp Venture, Inc. provides services to individuals with Developmental Disabilities. We offer day habilitation services, respite services, employment services, community habilitation services and residential services. |
Unsure |
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Cancer Resource Center of the Finger Lakes |
Marilee Murphy |
607–277–0960 |
marilee@crcfl.net |
www.crcfl.net |
Tompkins and surrounding counties (Cayuga, Tioga, Cortland, Schuyler, Chemung) |
Create a community of support for those individuals/families touched by cancer. Services include support groups, one on one support, wellness information and education, transportation to appointments, gas cards, and some financial assistance |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Capital District Center for Independence Inc. |
Laurel Kelley |
518–459–6422 |
laurelk@cdciweb.com |
www.cdciweb.com |
Primarily Albany and Schenectady, but also serve consumers in Rensselaer, Columbia, Saratoga, Schoharie, Fulton and Montgomery |
Our Center has over 40 years´ experience providing direct independent living services to people with disabilities. Services provided include a range of advocacy and self–help instruction, which includes a peer–based approach to managing one´s affairs, the development of self–determination, decision–making skills, self–advocacy
skills, assistance in day–to–day community participation, and other social roles. Staff assist consumers in addressing many social determinates of health. For example to address economic stability staff assist consumers to find employment, secure housing, food and other social and community resources to increase their finance independence. Staff assist in addressing other social determinants of health including health and healthcare, economic stability, social, family and.community. We assist consumers with health literacy, accessing appropriate healthcare, finding
employment, securing food and shelter, promote social cohesion, civic participations, and various other social and community resources to increase independence. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate New York |
CDPHP, MVP, Fidelis, New York Quality Healthcare, United Healthcare |
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Catholic Charities |
Mary–Margaret Pekow |
(315) 598–3980 |
mmpekow@ccoswego.com |
www.ccoswego.com |
Oswego |
work with adults and children w MH dx and with low income and those in poverty––assist wit lknage and referrals &case management services |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Fidelis and Optimum (UHC) |
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Catholic Charities Care Coordination Services |
Stephanie Lao |
518–449–3581 |
stephaniel@ccalbany.org |
http://www.carecoordinationcc.org/ |
Albany, Columbia, Greene, Rensselear, Schenectady, Saratoga, Schoharie, Fulton, Montgomery, Otsego, Delaware, Warren, Washington |
Health Home Services, Harm Reduction Services for individuals with active or history of substance use– including low threshold services for IV drug users (syringe exchange, OOPT) |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Capital Behavioral Health Network |
CDPHP, Fidelis, MVP |
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Catholic Charities Community Services |
Lori Van Auken |
585.339.9800 Ext 225 |
lori.vanauken@dor.org |
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Monroe, Wayne, Steuben, Chemung, Schuyler, Livingston, Seneca, Ontario, Tompkins, Tioga, Yates, Cayuga |
Care coordination, Children and Adult Health Homes, Home and Community Based, Services, Developmentally Disabled, HIV/AIDS services for Housing, Peer Support, Health Education, Case Management, Medical Transportation, Employment |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Your Health Partners of the Finger Lakes (Behavioral Health Care Collaborative) |
Excellus |
Fidelis |
MVP |
Catholic Charities Neighborhood Services, Inc. |
Claudia Salazar |
718–722–6065 |
claudia.salazar@ccbq.org |
|
Kings and Queens |
CCNS provides food pantries, assistance with rent and utilities, employment assistance, low income housing and housing support, needs assessments and referrals, behavioral health (mental & SUD) treatment, medical health via nurses and linkages to other providers |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Founding member of CBC and IPA member |
Healthfirst |
Beacon |
Fidelis |
Catholic Charities of Buffalo, New York, Inc |
Marie Andersen–Strait |
(716) 218–1400 |
marie.andersen–strait@ccwny.org |
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Erie, Niagara, Chautauqua, Cattaraugus, Allegany, Orleans, Wyoming and Genesee |
The agency is unique to provide the essential components related to economic stability, neighborhood and physical environment, education, and food security to better outcomes. Catholic Charities provides an array of comprehensive programs such as basic emergency financial assistance; food, clothing and basic needs assistance;
housing, clinical and chemical dependency and support services; school based services; workforce development services; care coordination; immigration/refugee assistance and an array of programs that address prevention and treatment of various family needs. CC is guided by the principles from solution focused trauma informed care to further the enhancement of engagement and empowerment of clients. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Value Network; WNYICC |
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Catholic Charities of Chemung/Schuyler |
Chuck Nocera |
607 734–9784 extension 2229 |
chuck.nocera@dor.org |
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Chemung and Schuyler Counties |
Medicaid managed care, HCBS services, permanent supported housing, homeless shelter, homeless prevention services, runaway and homeless youth program, emergency supports (food, clothing, assistance with benefits/Medicaid enrollment, prescription assistance),
domestic violence services, and regional health literacy training. Target populations: those in poverty, those who are homeless and those with a serious mental illness or substance use disorder. Provide referrals to a robust network of providers (including physical and behavior health) and services. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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NY Quality Healthcare |
UnitedHealtcare |
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Catholic Charities of Chenango County |
Amanda Erickson |
(1607334) 824–4228 |
aerickson@ccofcc.com |
www.ccofcc.com |
Chenango |
Catholic Charities of Chenango County is a regional leader in human and social services, providing an array of programming to support the needs of those who are most vulnerable. CCofCC has substantial experience in providing programs and services related to poverty reduction, healthcare,
housing, crime/violence, residential habilitation, residential rehabilitation, community and congregate respite, community habilitation, counseling, food security, job skills development, benefit and entitlement coordination, Medicaid service coordination, care coordination, nutrition and many additional types of programing. CCofCC also serves all demographic types through these programs such as people with mental illness, people with developmental and/or intellectual disabilities, adults, children, elderly, Medicaid recipients, people living
in poverty, homeless, unemployed and under–employed, uninsured/under–insured as well as many others. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Fidelis |
United Health Care |
Excellus |
Catholic Charities of Orange, Sullivan & Ulster |
John Lent |
(845) 294–5124 |
john.lent@cccsos.org |
www.cccsos.org |
Orange, Sullivan & Ulster |
Food pantry, eviction prevention, utility cutoff prevention, and other basic needs assistance for individuals with a financial need |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBHS Inc https://www.cbhsinc.org/ & PWR IPA |
Affinity |
MVP |
Wellcare |
Catholic Charities of the Diocese of Albany |
Jackie Gentile |
(518) 453–8457 |
jackie.gentile@ccrcda.org |
ccrcda.org |
Albany, Rensselaer, Schenectady, Saratoga, Warren, Washington, Columbia, Greene, Schoharie, Otsego, Delaware, Fulton, Montgomery, Herkimer |
impovershed, disabled, reentry, childcare, homeless, pregnant and parenting teens, care coordination, senior services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Alliance for Better Health, Capital Behavioral Health Network |
Fidelis Care |
CDPDP |
Empire |
Catholic Charities of the Diocese of Rochester, DBA Catholic Charities Livingston County |
Amy Patterson |
(585) 658–4466 |
amy.patterson@dor.org |
www.aboutcclc.org |
Primarly Livingston Coumty; however, Livingston also serves Steuben County for Health Home Care Management Services. |
CCLC provides emergency services such as assistance with rent, security deposit, utility payments, to help people remain in their home. We also help with transportation needs providing bus passes. Further, we help with food through our food pantry. Lastly, we assist with finding employment, transitional jail services, referall for
health insurance enrollment, emergency housing, children´s health home, adult home and community based services. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Excellus |
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Catholic Charities of the Finger Lakes |
Ellen Wayne |
(315) 789–2235 |
ellen.wayne@dor.org |
www.catholiccharitiesfl.org |
Ontario, Seneca, Yates and Cayuga |
housing/homeless assistance, peer support, emergency assistance, congregate meal, family support, SSI application assistance |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Catskill Center for Independence |
Meghan Staring |
607–432–8000 |
meghanstaring@ccfi.us |
www.ccfi.us |
Delaware, Otsego, Chenango, Schoharie |
Serve people with disabilities |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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cattaraugus & wyoming counties project head start |
ira katzenstein |
(716) 806–5128 |
ikatzenstein@headstartnetwork.com |
www.headstartnetwork.com |
cattaraugus, wyoming |
health education for low income parents |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Cayuga Addiction Recovery Services |
Frank Zdanowicz, Chief Financial Officer |
607–273–5500 Ext. 1046 |
fzdanowicz@carsny.org |
www.carsny.org |
We serve all counties in New York State as needed. |
The caring team at Cayuga Addiction Recovery Services uses evidence–based techniques to help people overcome the disease of addiction. The staff, consisting of experienced social workers, nurses, and counselors, build respectful partnerships with patients and their families and work hand–in–hand with them to transform
their lives. We have an Outpatient Addiction Recovery Center in Ithaca, NY and a 60–bed Residential Addiction Recovery Center in Trumansburg, NY. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Integrity Partners and AHP (Accountable Health Partners) |
Fidelis |
Excellus |
Beacon/MVP, United Healthcare, Molina, CDPHP |
Cazenovia Recovery Systems |
Ed Cichon |
(716) 852–4331 |
ecichon@cazenoviarecovery.org |
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Erie and Niagara |
Residential substance use treatment and support services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Affiliate member of Value Network IPA, member of the Niagara County Behavioral Health Network IPA, and a member of the WNY Chemical Dependency Consortium |
Fidelis |
YourCare |
Independent Health |
Center for Comprehensive Health Practice |
Thomas Nicolich |
212–360–7781 |
tnicolich@cchphealthcare.org |
www.cchp.org |
New York |
Treatment for Substance Use Disorders, Primary Health Care |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Metro Plus |
Health First |
Fidelis |
Center for Family Life – SCO Family of Services |
Heath Bloch |
(1516) 953–1920 |
hbloch@sco.org |
https://sco.org/featured–programs/center–for–family–life/ |
Kings |
Center for Family Life (a program of SCO Family of Services) provides comprehensive programs in youth development, employment, education, counseling, foster care, arts, and recreation and engages more than 14,600 children and adults from 10,500 families each year. |
Unsure |
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Central Nassau Guidance & Counseling Services |
Nancy Manigat |
(516) 396–2819 |
nmanigat@centralnassau.org |
www.centralnassau.org |
Nassau; Suffolk |
CN Guidance & Counseling Services provides integrated behavioral & physical health treatment and support services. Our PROS, ACT, Health Home, HCBS Adult Waiver and Housing services adults with serious mental illness and all have components that address the SDH impacting the
individual´s ability to function independently in the community. Our Certified Community Behavioral Health Clinic treats children, adolescents and adults with wrap around services such as targeted case management and psychiatric rehabilitation that address the SDH. Our OASAS COTI Mobile Recovery Unit services adults with opioid use disorders and has a case management component that addresses the SDH impacting the individual´s recovery. The Starry Night Café services adults with IDD or MH that focuses on improving social supports.
Registered nurses are impeded in most of our programs to improve health literacy. We also have food pantries on site for our clients. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Recovery Health Solutions: https://recoveryhealthsolutions.com/; Advanced Health Network: https://www.ahn–ipa.com/ |
Affinity Health Plan, Inc./ Beacon |
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Centro Corazon de Maria |
MARY E. MOORE |
(631) 728–5558 |
corazondemaria2@gmail.com |
in process |
Suffolk, NY |
We work with Latino immigrants, many of whom do not speak English and are undocumented. However their children are citizens. We work individually with persons who use hospital E. R. services to connect them with emergency Medicaid. We also do referrals to providers for children. We partner with Sepa Mujer
for a wide range of services to women. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Fidelis |
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Champlain Valley Family Center for Drug Treatment and Youth Services |
Constance Wille |
518–561–8480 |
cwille@cvfamilycenter.org |
cvfamilycenter.org |
Primarily Clinton, some service in Franklin and Essex Counties (Tobacco Free Clinton, Essex and Franklin Counties) |
Champlain Valley Family Center (CVFC) provides an array of services focused on Substance Use prevention, education, treatment and support services. Services include: Community Education, school based prevention counselling and evidenced base curriculum delivery, 822 Outpatient clinic, 820
Residential SUD Stabilization and Rehabilitation, "All Ways to Recovery" Community Center, Peer Engagement Services, SUD services in Clinton County Jail, MRT/PSH Housing, Adolescent Case Management, Tobacco Free Clinton, Essex and Franklin Counties, Adolescent Case management, CVFC is in the process of onboarding for Health Home Care Management (AHI). Community Education focuses on Substance Use Disorders, Bridges Out of Poverty, and Trauma Informed Care. Depending on the audience, other trainings are available. The majority of clients
admitted in the clinic and the residential center have multiple diagnosis in addition to SUD. Social Determinants of health are evaluated during the assessment process and adressed during the course of care. CVFC provides Peer Engagement Services to CVPH hospital, Clinton County DSS, NYS Department of Community Supervision, and outpatient clinics. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Northwinds Integrated Health Network IPA |
Fidelis Care |
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Chautauqua Striders, Inc. |
Jennifer Swan–Leuze |
716–489–3488 |
jswanleuze@chautauqua–striders.org |
www.chautauquastriders.org |
Chautauqua |
Tutoring, Mentoring and Life Skills Education |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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CHDFS, Inc |
Julio Barros |
212–695–4562 |
jbarros@chdfs.org |
www.chdfs.org |
NYC, Lower Hudson Valley |
1115 Waiver, Health Homes, Early Intervention, OPWDD Waiver |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Several |
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CHDFS, Inc |
Julio Barros |
212–695–4562 |
jbarros@chdfs.org |
www.chdfs.org |
NYC, Lower Hudson Valley |
1115 Waiver, Health Homes, Early Intervention, OPWDD Waiver |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Several |
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Chenango Health Network, Inc |
Theresa Davis |
(1607) 337–4128 |
theresa@chenangohealth.org |
http://www.chenangohealth.org |
Chenango & Delaware |
Cancer Support Group – A group of individuals with common experiences or concerns who provide each other with encouragement, comfort, and advice. Care Transitions/Health Coach (based on the Coleman Model) – Involving the patient and family in discharge planning can improve patient outcomes,
reduce unplanned readmissions, and increase patient satisfaction. The goal is to reduce 30–day avoidable hospital readmissions. Chenango Substance Abuse Prevention Coalition (CSAPC) – The mission of the Coalition is to bring individuals and organizations together to promote a clean, safe, and addiction–free community. Chronic Disease Self–Management Programs (CDSMP), Diabetes (DSMP) Chronic Pain (CDSMP) – workshops designed to help people gain self–confidence in their ability to control their
symptoms and learn how their health problems affect their lives. Community Based Education Services – The purpose of community learning and development is to develop the capacity of individuals and groups of all ages through their actions, the capacity of communities, promote learning and to improve their quality of life. Community Health Advocate Program – Community Health Advocates assist individuals with a wide range of health related issues from finding a health care provider to understanding medical bills. Dental Project – This
initiative provided a dental kit to each student in Chenango County up to fifth grade. The dental kits included a toothbrush, toothbrush cover, toothpaste, floss and educational materials on proper brushing techniques. Emergency Department Navigation Services – A Case Manager educates patients on how to access health care and other needed services such as transportation to medical appointments, and provides patients with the skills and tools needed to assert a more active role in their care and ensure their needs are met Financial Assistance Program – Assists
individuals with a breast or gynecological cancer diagnosis pay for treatment and/or other needs related to their cancer diagnosis. Health Insurance Navigator Assistance Program – Trained Navigators assist individuals to apply for health insurance through the New York State of Health Insurance Marketplace. Referral Services – The process of transferring and individual to another service within CHN or to another agency, service or program not provided by CHN. Prescription Assistance Program – Assists
individuals with enrollment into pharmaceutical companies´ patient assistance programs so that medically underserved individuals are able to obtain medicines needed to manage their health. Youth, Adult, Fire & EMS Mental Health First Aid – is a public education program that introduces participants to risk factors and warning signs of mental health problems in adolescents. The program builds understanding of the importance of early detection and intervention. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Excellus Health Plan, UnitedHealthcare of NY |
MVP Health Plan, Inc |
NY Quality Healthcare Corporation |
Child & Family Services |
Gretchen Szymanski |
335–7154 |
gszymanski@cfsbny.org |
www.cfsbny.org |
Erie and Niagara |
Child & Family Services provides mental and behavioral health services to youth, families, and adults to promote healthy families and communities. Services include, but are not limited to, out–patient and community mental health, residential services, family support services (e.g. Health
Homes). Targeted populations include individuals from birth through adult with mental and behavioral health challenges. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Fidelis, Independent Health Association, Your care |
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Children´s Aid |
Jaime Huertas |
212–503–6808 |
jaimeh@childrensaidnyc.org |
Childrensaidnyc.org |
New York, Bronx, Richmond |
At risk Children and Families, Children in Foster Care |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AsOne Healthcare IPA |
Healthfirst |
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Children´s Home of Jefferson County |
Michelle Monnat |
315–777–9747 |
mmonnat@nnychildrenshome.com |
http://nnychildrenshome.com/ |
Jefferson, Lewis, St. Lawrence, Franklin, Onondaga, Oneida, Oswego, Clinton, Herkimer, Essex |
OMH Article 31, Health Home Care Management for Adult and Children, Adult HCBS, CFTSS, Foster Care, Crisis, Forensics |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
North Country Initiative IPA |
United Healthcare, Fidelis and MVP |
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Chinese–American Planning Council, Inc |
Steve Mei |
(718) 492–0409 |
smei@cpc–nyc.org |
www.cpc–nyc.org |
All five boroughs of New York City |
CPC offers a variety of services from child care to senior services, and everything in between. CPC Brooklyn offers services to our Special Needs community members, Geriatric Mental Health Services, and all walk–in services( including access to healthcare, housing, employment, translation, legal services, language access, etc) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Citizen Advocates |
James Button, COO |
518–651–2245 |
jamesbutton@citizenadvocates.net |
citizenadvocates.net |
Franklin, Clinton, Essex, St. Lawrence, Hamilton |
Mental Health; Addiction prevention, treatment & recovery; Intellectual & Developmental Disability |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Northwinds Integrated Health Network, IPA |
Fidelis |
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City Mission of Schenectady |
Erin Simao |
518–346–2275 x 406 |
esimao@schenectadyworks.com |
citymission.com |
Schenectady |
emergency shelter, transitional housing, food, clothing, job search and career readiness, health care and social services navigation |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Alliance IPA |
Fidelis, CDPHP |
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Claxton Hepburn Medical Center |
Kelley Tiernan |
(315) 713–5350 |
ktiernan@chmed.org |
chmed.org |
St. Lawrence County, Jefferson County, Franklin County |
We provide Diabetes and Nutritional Counseling, we have a language line service, we have facilitated enrollers on site for access to Healthcare. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
North Country Initiative (northcountryinitiative.org) |
Fidelis |
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Clinton County Chapter NYSARC, Inc |
Lorraine Lobdell |
518–563–0930 |
llobdell@cviarc.org |
cviarc.org |
Clinton, Essex, Franklin, St. Lawrence, Jefferson |
OPWDD provider for individuals with ID/DD, supervised residential homes, day habilitation, prevoc, transportation, employment, clinical/behavioral/nursing supports and Fiscal Intermediary services are provided to a mix of residents and community people authorized for OPWDD services. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Clinton County Mental Health and Addictions |
Richelle Gregory |
518–565–4068 |
richelle.gregory@clintoncountygov.com |
https://www.clintoncountygov.com/mental_health_addiction_services |
Clinton |
Vocational Services On–Site, Grant to address Nutions and Food Security with CC Helath Department, Transportation for the SUD population, DIR on site, Healthy Steps Grant Partnership, Integrated Services in Primary Care (Pediatric and Adult), Certification in Infant Mental Health, Peer Services on Site , Mental Helath
and Addictions Services in Jail, |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Northwinds IPA |
Fidelis |
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Collaborative for Children & Families |
Jodi Saitowitz |
646–459–3971 |
jsaitowitz@ccfhh.org |
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All 5 Boroughs of NYC, Nassau, Suffolk and Westchester |
Health Home Care Coordination |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
AsOne |
HealthFirst |
Empire |
Affinity |
College Initiative Upstate (a Program of O.A.R. of Tompkins County) |
Suzanne Burnham |
607–882–0355 |
collegeinitiativeupstate@gmail.com |
www.ciutompkins.org |
Tompkins County |
A bridge to college for formerly incarcerated, court involved and prior court involved individuals. No age requirement. Must be a HSD or GED/TASC holder. Offering direct services such as: assistance with college application, assistance with FAFSA and TAP. Scholarships, 6 week long college prep classes, and more! |
Unsure |
|
CHP |
Medicaid |
|
Comfort Food Community |
Amelia Gelnett |
518–530–9299 |
amelia@comfortfoodcommunity.org |
|
Washington, Warren, Saratoga |
We address food insecurity, social isolation, health and community resource connection, and individual nutritional support. Our target population is low–income individuals experiencing chronic illnesses. We have developed a Fresh Food Collective which integrates social agencies, food pantries, libraries, and a local FQHC
to distribute local produce. We run a Fresh Food Farmacy which targets diabetes, hypertension, and other conditions in the Medicaid and Medicare populations in partnership with Hudson Headwaters Health Network. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis |
CDPHP |
Humana |
Community Action of Greene County, Inc. |
Florence Ohle |
(518) 943–9205 |
fohle@cagcny.org |
www.cagcny.org |
Greene/Columbia |
housing and homelessness, emergency services, food pantry, financial empowerment, victim assistance and domestic violence |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Community Agency for Senior Citizens, Inc. |
Angelina DeSantis |
718–981–6226 x170 |
angelina.desantis@cascsiny.org |
https://cascsiny.org |
Richmond |
CASC serves older adults, 60 yrs and older and residents of Staten Island. Services incl case managment, case assistance with entitlements and benefits applications, transportation, nutrition, arts, edducation, recreation and socialization at 2 neighborhood senior centers, elder abuse and crime
victims assistance. CASC partners with other local & city/state agencies working in aging, health, social sevices, law enforcement and legal seervices/agencies. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Community Based Services, Inc. |
Dr. Pela S. Terry, Ed.D. |
914–277–4771 |
pterry@commbasedservices.org |
www.commbasedservices.org |
Westchester, Putnam, Dutchess |
Medicaid Waiver: Home and Community Based Services via DOH/OPWDD |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Hudson Valley Service Providers, LLC (provider membership LLC;IPA application is pending) |
MCAID |
Affinity |
MVP |
Community Concern of WNY |
Valerie Nowak |
716–947–5025 |
vnowak@communityconcern.org |
|
Erie, Chautauqua, Cattaraugus |
Behavioral heath services (13 and over), health home services (21 and over), senior services (60 and over) |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Value Network |
HealthNow |
Independent Health |
YourCare |
Community Health Center of Richmond |
Benito Lindo |
(718) 924–2254 |
jyandun@chcrichmond.org |
www.chcrichmond.org |
Richmond County |
The Community Health Center of Richmond provides affordable, quality health care and coordinated access to specialty services to the Staten Island community. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Medicaid, Medicare, All HMO´s, Child Health Plus |
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|
Community Maternity Services |
Anne Marie Couser |
Tom Giaquinto |
annemarie@cccms.org |
www.cccms.org |
Albany, Rensselaer, Saratoga, Warren, Washington, Schoharie, Otsego, Schenectady |
Residential services for pregnant and parenting youth and you 0–18 with special needs; foster care prevention services; parent education, community based case management for pregnant and parenting adolescents; community based respite services for children ages 5–18 in
Albany County only; school based counseling services in Albany, Adult Care management services in Warren & Washington counties. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
CDPHP |
Fidelis |
|
Community Progress, Inc. |
Julie Chevalier |
(607) 962–3506 |
juliec@communityprogressinc.com |
www.communityprogressinc.com |
Chemung, Schuyler and Steuben |
CPI provides home repair assistance for homeowners, this includes addressing lead, asbestos and radon issues. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Unknown |
|
|
Community Resources (CRIS) |
Karisha Solomon |
(315) 655–5743 |
director@cris–caz.com |
www.cris–caz.com |
madison |
senior services |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
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Community Services for Every1 |
Sharon Chmielnicki |
716–883–8888 |
schmielnicki@csevery1.com |
www.csevery1.com |
Mostly Erie and Niagara County, for some services are able to do so in most WNY Counties |
Majority of our services are OPWDD serving the I/DD population. Additionally, we provide Children and Adult Health Home Case Management and HCBS Services, Preventive Services, High Fidelity Wrap Services, Alternative to Incarceration Services,
Employment Readiness and Training for a variety of populations. We also own and operate several affordable housing apartments. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Compeer Rochester |
Sara Passamonte |
585–546–8280 |
spassamonte@compeerrochester.org |
|
Monroe |
1:1 Mentoring, Psychosocial Rehab for children and adults, Habilitation for adults, Family Peer Support, Family Caregiver Support and Training for family members of youth and adults, Youth Peer Support, Adult Peer Support |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
we are part of a Behavioral Health Care Collaborative that may become an IPA in the future– Your Health Partners of the Finger Lakes |
Excellus |
Fidelis |
FFS Medicaid |
Comunilife |
Beverly Raudales |
(917) 500–2906 |
braudales@comunilife.org |
www.comunilife.org |
Kings, Manhattan, Bronx, Queens |
Supported and Affordable Housing for Mentally, Chronically Homeless, low income, individuals; also provide temporary housing to individuals currently hospitalized are medically cleared but do not have housing via our Respite Program |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
MetroPlus, United Health Care, Healthfirst |
|
|
Consortium for Children´s Services |
Kathleen Harter |
(315) 471–8331 |
KHARTER@CHILDRENSCONSORTIUM.ORG |
www.childrensconsortium.org |
Onondaga, Cortland, Cayuga, Oswego, Madison |
Parenting education for at–risk families |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Crouse Hospital |
|
|
Consumer Credit Counseling Service of Buffalo, Inc. |
Noelle Carter |
(716) 771–3255 |
noelle.carter@cccsbuffalo.org |
www.consumercreditbuffalo.org |
Niagara, Erie, Chautauqua, Cattaraugus, Allegany, Wyoming, Genesee, and Orleans. |
Financial education and counseling |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
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COORDINATED BEHAVIORAL CARE IPA, INC. |
Sara Belly Sezer |
(646) 930–4784 |
ssezer@cbcare.org |
\http://www.cbcare.org/ |
Bronx, Kings, Queens, New York, Richmond, |
Through Health Home and Network Provider agencies, CBC connects clients to a range of services for the entire spectrum of life. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Coordinated Behavioral Care IPA |
|
|
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Cornell Cooperative Extension of Herkimer County |
Linda Robbins |
(315) 866–7920 |
LLR6@cornell.edu |
www.cce.cornell.edu/herkimer |
Herkimer County |
Nutrition education programs for low income families (see website) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
CHP, COMM, HARP, MCAID |
|
|
Cuba Cultural Center, Inc. |
Suzanne Flierl Krull, Executive Director |
(585) 376–4583 |
Suzanne@cubaculturalcenter.org |
www.cubaculturalcenter.org |
Allegany and Cattaraugus Counties |
We provide survival programs for poor, low–income, oppressed and otherwise marginalized individuals and families. We offer several food security programs & serve on area coalitions (food, housing and homeless, and suicide prevention). Our ED serves as a board member of the HUD 501 Continuum of Care, and the Hunger Action
Network of NYS. She is also a member of the Coordinating Committee of the NYS Poor People´s Campaign: A National Call for Moral Revival, which continues the human rights work called for by Dr. King back in the 60s. We are also developing a Speakers´ Bureau of people impacted by hunger and poverty, to advocate for themselves personally and for others in their community in a variety of ways. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
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Developmental Disabilities Institute, Inc. |
Kim Kubasek |
631–366–2965 |
kim.kubasek@ddiny.org |
www.ddiny.org |
Suffolk and Nassau |
Educational services (early intervention and preschool through school age) and long term services and supports (residential habilitation, day habilitation, vocational services, etc.) for children and adults with autism and other developmental disabilities. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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|
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Diaspora Community Services |
Carine Jocelyn |
(718) 399–0200 |
cjocelyn@diasporacs.org |
www.diasporacs.org |
Kings |
Health insurance enrollment, HIV services, case management, food stamp assistance, homeless housing for youth. linkage to services, care |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Engagewell |
MetroPlus, Fidelis, HealthFirst, |
|
|
Docs for Tots |
Liz Isakson |
917.318.4201 |
liz@docsfortots.org |
|
Nassau and Suffolk |
Help Me Grow – Long Island serves families with children prenatal to age 5. It is a centralized access point that connects families to a wide array of service that support child development, – everything from basic needs to developmental interventions. It also offers free development and social emotional screening to families. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Dominican Women´s Development Center |
Rosita Romero |
(212) 994–6060 |
Rromero@dwdc.org |
Dwdc.org |
New York |
Care coordination, home visiting early childhood education, pantry with the West Side Campaign Against Hunger, New York State of health insurance enrollment |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Health first |
|
|
E. John Gavras Center |
Danielle Wright |
(315) 255–2746 |
dmw@gavrascenter.com |
www.gavrascenter.com |
Cayuga, Onondaga, Tompkins, Wayne, Seneca |
Early childhood education, Article 28 clinic |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Excellus |
|
|
Economic Opportunity Council of Suffolk, Inc. |
Halim Kaygisiz |
(631) 241–2119 |
hkaygisiz@eoc–suffolk.com |
|
Suffolk AND Nassau Counties |
Financial assistance for rental and utility arrears (in–house when funds are available and through partnerships at other times), food pantry services (both in–house and through partnerships), transportation services (for HIV–positive clients), social service navigation for benefits, workforce readiness and development (via
partnerships), child care, re–entry services for formerly incarcerated indivdiuals, access to health care, access to PCP/infectious disease care; health literacy, crime and violence |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
Affinity |
Fidelis |
United Health Care |
ElderChoice Inc. |
Rei Thompson |
315–252–7889 |
rthompson@elderchoiceinc.com |
elderchoiceinc.com |
Onondaga County and Oneida County |
PCA services including Medicaid Waiver, TBI, NHTD |
Unsure |
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ElderLife, Inc, dba Parkway Center |
Kari Johnson |
315–223–3973 ext.117 |
kjohnson@theparkwaycenter.org |
www.theparkwaycenter.org |
Oneida and Herkimer |
The Parkway Center´s mission is to provide programs and services to individuals 50+ empowering them to live healthy and vibrant lives. The services being provided include: health, wellness, and nutrition; transportation; education; arts/music; social/recreation;
financial independence; volunteer services; veteran services; and access to resources. All of the Parkway Center´s services provide programs that help seniors remain active and independent as they age. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Upstate CBO Consortium |
Excellus BC BS |
MVP |
CDPHP |
Empower (formerly Niagara Cerebral Palsy) |
Eric DesSoye |
716 803–2184 |
edessoye@empower–wny.org |
empower–wny.org |
Niagara |
Empower provides a full array of supports for people with Intellectual and Developmental Disabilities, as well as elders, and pre–k aged children. The services we provide either directly provide those items checked in question 5, or facilitates their presence in the lives of people we support. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Western New York Integrated Care Collaborative, and CBO Consortium of Upstate New York |
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|
|
Endeavor Health Services |
Kristin Kight |
(17168956) 700–4085 |
kkight@ehsny.org |
https://www.ehsny.org |
Erie, Niagara, Orleans, and Monroe counties |
HCBS, TCM, HH, MAT, CFTSS, PROS, PSR, Advocacy, School–based Clinics, and Behavioral Health Integrated Clinics |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Value Network |
Fidelis, Excellus Health Plan, HealthNow of New York, Independent Health Association |
|
|
EPIC Family of Human Service Agencies |
Jennifer Colbert |
516–739–7733 ext. 400 |
jcolbert@epicli.org |
www.epicli.org |
Nassau, Suffolk, Westchester, five boroughs of NYC, Orange, Ulster, Dutchess, and Sullivan |
Mental health, substance abuse prevention, services for intellectual and developmental disablitlies including residential, community habilitation and day habilitation, mobile crisis, home based crisis intervention, and CFTSS services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
ACA,COPA, IAC |
Health First |
Fidelis Care |
United Health Care |
Erie County Bar Association Volunteer Lawyers Project |
Bob Elardo |
(716) 847–0662 |
relardo@ecbavlp.vom |
ecbavlp.com |
Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schulyer, Seneca, Steuben, Tioga, Tompkins, Wayne, Wyoming, Yates |
Providing free civil legal services to low income individuals, including individuals and families affected by HIV/AIDS |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Independent Health, Excellus |
|
|
Esperanza Center |
Yesenia Estrella |
(212) 928–5810 |
yestrella@esperanzacenter.com |
esperanzacenter.com |
Manhattan, Bronx |
Organization provides day and residential services to people with developmental disabilities. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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|
|
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Essex County Mental Health |
Terri Morse |
(518) 873–3670 |
tmorse@co.essex.ny.us |
http://www.co.essex.ny.us/MentalHealth.asp |
Essex |
Behavioral Health services, psychiatry – children and adults; telemental health; case management; trauma–informed treatment; groups therapy; CFTSS; early childhood mental health; mental health treatment in the county jail. Target populations – all citizens of Essex County |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Northwinds Integrated Health Network, IPA |
Fidelis |
United Health Care |
CDPHP |
Essex County Public Health CHHA |
JENNIFER M NEWBERRY |
(518) 873–3710 |
jnewberry@co.essex.ny.us |
www.essexcounty.ny |
Essex |
Home Health |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Evergreen Health |
Melissa Gulino |
(716) 847–2441 |
mgulino@evergreenhs.org |
evergreenhs.org |
Allegany, Erie, Niagara, Chautauqua, Cattaraugus, Orleans, Genesee, Wyoming |
Care Coordination, Social Work and Medical Case Management |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Safety–Net IPA (SIPA) and Value Network |
Fidelis |
|
|
Every Bottom Covered |
Raziya Hill |
(716) 597–2303 |
raziyahill@everybottomcovered.org |
www.everybottomcovered.org |
Erie, Niagara |
Providing hygiene basic needs to low–income families, workshops for family sufficiency, resources to other community based organizations that assist low–income families |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium http://www.cboconsortium.org/ |
Excellus Health Plan, Inc. |
WellCare of New York, Inc. |
YourCare Health Plan, Inc., UnitedHealthcare of New York, Inc., New York Quality Healthcare Corporation, Independent Health Association, Inc., HealthNow of New York, Inc. |
Faith in Action Steuben County |
Richard Russell |
(607) 324–1138 |
rrussell@fiasteuben.org |
www.fiasteuben.org |
Steuben |
Medical and nutritional transportation for older adults (60yo+) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate NY, http://www.cboconsortium.org/ |
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|
|
Families First in Essex County, Inc. |
JoAnne Caswell |
(518) 546–3569 |
jcaswell@familiefirstessex.org |
|
primarily Essex, but also Clinot, Franklin, Warren & Washington |
CFTSS & HCBS Services along with HH Care Manangement and NYS OMH Family and Youth Support, 0–21 target population, transporation, housing support, food |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Northwinds Integrated Health IPA |
Fidelis |
|
|
Families on the Move Inc. |
Ravi Ramaswamy |
347–682–5490 |
ravi@fotmnyc.org |
Families on the Move Inc. |
All boroughs of New York City |
CFTSS, HCBS awell as Family and Youth advocate support in South beach children´s hospitaladvocates for the Astor case management program and Family and youth peer support for the South Beach children´s hospital |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
Healthfirst, Affinity,Wellcare |
|
|
FAMILY AND CHILDREN´S ASSOCATION |
LISA BURCH |
(516) 746–0350 |
lburch@fcali.org |
www.fcali.org |
Nassau, Suffolk |
SUD, CFTSS, HCBS Waiver, food pantry, co–op nursery, vocational–educational, ESL/GED, |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Recovery Health Solutions |
Health First, Fidelis, United Healthcare |
|
|
Family Care Certified Services |
Kesha Yansen |
718–570–6815 |
kyansen@familyhomecare.com |
familycarecertifiedservices.com |
Kings, Queens, Nassau, Bronx, Westchester, Putnam, Dutchess, |
Homecare services, Skilled services (Nursing, Physical & Occupational Therapy, Medical Social Services), Para–professional Services (Home Health Aide, Personal Care Aide) |
Unsure |
|
Healthfirst |
United Health Care |
Emblem Health |
Family Counseling Service of the Finger Lakes |
Cathy Thurston |
315–789–2613 x2115 |
cthurston@fcsfl.org |
www.fcsfl.org |
Ontario, Seneca, Wayne, Yates |
Trauma–informed care in Counseling/therapy and asessment; advocacy related to crime victims support and accessing resources |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate New York |
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|
|
Family Reading Partnership |
Amber Smith |
(607) 277–8602 |
amber@familyreading.org |
http://www.familyreading.org/ |
Tompkins County |
We partner with WIC to give all who are entering the program a new book. Read Along Love Songs with Baby goes to the Mom´s Program which include books that are also songs, this collection also comes with a CD of recordings of the songs. Our Talk, Sing, Read, Play
with Me collections comes with materials to promote positive interactions between the caregiver and the baby, this collection is for families in rural places in Tompkins county. Our Books To Grow On Program provides a book to every child going to a well visit until they are 4 years old in Tompkins County. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
We are a legally formed CBO |
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|
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Family Residences and Essential Enterprises, Inc |
Matthew Collins |
516–870–1600 x1862 |
mcollins@familyres.org |
|
Suffolk, Nassau, Queens, Staten Island |
Behavioral Health, Housing, Entitlements, Employment |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AHN/RHS |
United Healthcare |
Beacons |
Health First |
Family Resource Center |
Theresa Wilkins |
(315) 402–0151 |
ed@familyresourcecenter.life |
www.familyresourcecenter.life |
Oswego |
We provide free pregnancy testing, free parenting classes and free material items such as diapers, wipes, baby formula, baby clothes and more when clients take parenting classes. We help any parents in Oswego County that would like to work with us; this includes single parents and couples. Clients who do not have
custody or visitation of their children may also work with us to be pro–active in gaining visitation. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
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Family Service Association of Glens Falls, Inc. |
Kim Sopczyk |
518 793 0797 |
150warreb@albany.twcbc.com |
www.fsaglensfalls.org |
Warren, Washington, Northern Saratoga |
We work with families and individuals who are facing a situation that is beyond their resources: food insecurity, housing needs, transportation needs, emergency RX, budgeting programs, and support to move forward out of crisis. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
|
|
Family Service League, Inc |
Jeff Steigman |
631–470–6790 |
jsteigman@fsl–li.org |
http://www.fsl–li.org/ |
Suffolk |
FSL has many safety net programs that address SDH. These service include assistance with benefits, housing (we have several housing programs including family shelters), food insecurity, vocational educational goals |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Advanced Health Network/Recovery Health Solutions |
United Healthcare |
Affinity |
Healthfirst |
Family Services |
Robin Peritz |
845–486–2703 x 1325 |
rperitz@familyservicesny.org |
familyservicesny.org |
Dutchess, Ulster and Orange Counties |
Family Services has been bringing people together to find the port they need improving their lives and communities, and building a stronger, safer Hudson Valley. We offer a wide range of programs in the areas of: Behavioral Health, Victim Services, Family Programs, Youth Services, Community Safety, and Prevention. Last year, over
17,500 children, adults, and families benefited from our services in Dutchess, Ulster and Orange counties.Through our programs, families, adults, teens and children overcome trauma, addiction, violence, unemployment and isolation. We offer after–school programs for K – 12 youth, providing young children with activities in a safe environment to enhance their academic, life and social skills; and helping teens to find meaningful work, stay active and fit, be creative and discover connections to their talents. We
support and nurture those who have been victimized and provide 24–hour crisis assistance to help those impacted by domestic violence, sexual assault and other crimes. We ensure access to high–quality individual and group therapy and support those with behavioral health needs to carry on safely through their most challenging times. We provide critical support to stabilize families and ensure child safety. We help communities become safer and foster communications that yield positive results. We are regional leaders in programming that increases individuals´
awareness and coping skills to reduce sexual violence, gun violence, and substance abuse. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBHS |
Beacon Health Options, Fidelis, Wellcare |
|
|
Family Services Network of New York, Inc. |
Benjamin Igwe |
718.455.6010 x 6101 |
bigwe@fsnny.org |
www.fsnny.org |
Kings, Queens, New York, Bronx, Richmond |
FSNNY provides health and human services to individuals and their families with chronic health, mental health and substance use disorders through prevention education, counseling and case management to improve their conditions. These services assist the individual
to obtained those social and human services necessary to access and stabilize their chronic medical or mental health treatment. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Engagewell IPA www.engagewellipa.com |
Metroplus, Healthfirst, affinity |
|
|
Family Ties of Westchester, Inc |
Kerry Whelan–Megley |
(914) 995–5238 |
kmegley@famtieswest.org |
www.familytieswestchester.org |
Westchester County, NY |
Community–based Family and Youth Peer Support and advocacy services, including CFTSS and HCBS |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Affiliate member of CBHS |
|
|
|
Famiy Services of Chemung County, Inc. |
David Crist |
607–733–5696 |
dcrist@familyservices.cc |
|
Chemung |
Our agency operates a Care Management Program for Children and Adults; a NYS OMH licensed Mental HealthClinic and 18 Clinic Satellites providing a full range of clinical services including case management and referral; a NYS OMH licensed Comprehensive PROS with Clinical Treatment, also providing case management
and referral; an Adult HCBS Program; a licensed Home Care Program; and ancillary mental health programs including case management and care coordination in the local jail and in the local office for the aging and adult protective services; Care Management for individuals with Eating Disorders; and Representative Payee Case Management Services for Individuals identified with Mental Health challenges. Our Adult Mental Health Programs include Trauma, Sexual Abuse, Sex Offender, Domestic Violence, Anger Management services and coordination with community partners. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Finger Lakes Independent Practice Association (FLIPA); Finger Lakes Southern Tier Behavioral Health Care Collaborative (FLST BHCC) |
Fidelis Care (NY Quality Healthcare Corp) |
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|
Federation of Organizations |
Elizabeth Galati |
(631) 669–5355 |
egalati@fedoforg.org |
www.fedoforg.org |
Queens, Kings, NYC, Bronx, Nassau, and Suffolk |
Federation provides residential, clinical, outreach, and care coordination that address all areas of social determinants of health. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Advanced Health Network/Recovery Health Solutions and Coordinated Behavioral Care |
Healthfirst, Fidelis |
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Feeding with TLC, Inc. |
Mary Ciccolella |
(1917) 582–0161 |
Maryciccolella@gmail.com |
Na |
Richmond County |
Soup kitchen and dood pantry |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Medicaid |
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|
Finger Lakes Community Health |
Jennifer Rios–Raner |
(315) 521–9102 |
jenrr@flchealth.org |
www.localcommunityhealth.org |
Ontario, Seneca, Yates, Wanye, Steuben, Cayuga |
Community based organization, care coordination, reproductive health, language assistance, HHUNY care mangement, medical services, dental services, most low income |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Excellus |
Fidelis |
|
Finger Lakes Independence Center |
Rachel Ferrara |
607–272–2433 |
rachel@fliconline.org |
www.fliconline.org |
Tompkins, part of schyular, but most programs do not have residence as an eligibility requirement |
Independent Living skills, housing, benefits advisement, in–home personal care, peer counseling, individual advocacy, equipment loan, systems advocacy, community outreach and education, transition from institutions, employment services, |
Unsure |
|
Fidelis |
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Finger Lakes Land Trust |
Kelly Makosch |
607–275–9487 |
kellymakosch@fllt.org |
www.fllt.org |
Cayuga, Cortland, Chemung, Livingston, Onondaga, Ontario, Schuyler, Seneca, Steuben, Tompkins, Tioga, Yates |
By working cooperatively with landowners and local communities, the Finger Lakes Land Trust has protected more than 23,000 acres of the region´s undeveloped lakeshore, rugged gorges, rolling forest, and scenic farmland. The Land Trust owns and manages a network of over 30 nature preserves
that are open to the public and holds perpetual conservation easements on 138 properties that remain in private ownership. The Land Trust focuses on protecting critical habitat for fish and wildlife, conserving lands that are important for water quality, connecting existing conservation lands, and keeping prime farmland in agriculture. The organization also provides programs to educate local governments, landowners, and local residents about conservation and the region´s unique natural resources. |
Unsure |
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First Chinese Presbyterian of NY |
Phaiphan Sangtippawan |
(212) 226–4910 |
Psangtippawan@fcpnyc.org |
n/a |
Manhattan, Brooklyn, Bronx, Queens, Staten Island |
LHCSA, home care services |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
SOMOS |
HealthFirst, VNS |
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|
Forestdale, Inc. |
Lorraine Gonzalez–Camastra |
718–263–0740, x281 |
Lgonzalez–camastra@forestdaleinc.org |
www.forestdaleinc.org |
Queens |
Child welfare case and care mgmt: family preventive services; parenting guidance and support, youth development, integrated health services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Unknown |
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Fort Drum Regional Health Planning Organization |
Linsday Baldwin |
315.755.2020 |
lbaldwin@fdrhpo.org |
www.fdrhpo.org |
Jefferson, Lewis, St. Lawrence |
Health Planning |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate New York (http://www.cboconsortium.org/) |
UnitedHealthcare, New York Quality Healthcare Corporation (Fidelis) |
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Fort Greene Strategic Neighborhood Action Partnership |
Georgianna Glose |
(718) 694–6957 |
drglose@fortgreenesnap.org |
www.fortgreenesnap.org |
Kings, Queens, Manhattan, Staten Island, Bronx |
Parenting/Accountability workshops, Health Care Navigation, Access Health, Computer Basics, Resume Preparation, Job Search, Grandparent Care giver Support |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Health First |
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Fort Hudson Home Care, Inc. |
Andy Cruikshank |
518–747–2811 |
acruikshank@forthudson.com |
www.forthudson.com |
Warren, Washington, Saratoga, Essex, Clinton, Hamilton |
home care services, Day services, case management |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Fountain House |
Nicole Pickett |
(212) 582–3155 |
npickett@fountainhouse.org |
https://www.fountainhouse.org/ |
Kings, Bronx, Brooklyn, Queens |
Fountain House is an innovative, evidenced–based community based organization dedicated to improving the lives of individuals with serious mental illness since 1948. Through our Community System of Care, we operate 2 award–winning Clubhouse programs, a housing program that provides
all levels of mental health housing supports, a Care Management Agency and Home and Community Based Services. We address a wide array of social determents of health, specializing in employment and education support services, with impressive outcomes accordingly. A recent study has shown, we reduce the costs of Medicaid by 21% for our members. We have a partnership with Bright Point Health, an FQHC that is able to provide quality psychiatric and primary care to our members. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
CBC IPA |
Health First, Empire BCBS, MetroPlus, Fidelis Care, Emblem |
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Friends of Mariners Harbor |
Emanuel Bloomfield–Jones |
(347) 599–5686 |
Bloomfield.resource@gmail.com |
http://www.friendsofmh.org |
Richmond |
create and maintain impactful programs to enrich the community and local parks. Our goal is to work collectively with the community to develop events while beautifying their neighborhood through community services and art. |
Unsure |
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Gateway Community Industries, Inc. |
Stephanie Turco |
(845) 331–1261 |
sturco@gatewayindustries.org |
http://gatewayindustries.org |
Ulster, Dutchess, & Columbia counties |
Housing, day programs, employment, food, transportation |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
CBHS Network partner |
Wellcare, Fidelis, United, Beacon/MVP. |
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Glens Falls Independent Living Center Operating as Southern Adirondack Independent Living |
Jocelyn Blanahrd |
518–792–3537 |
jocelynb@sailhelps.org |
|
Warren, Washington, Saratoga, Clinton, Hamilton, Essex, Fulton, Montgomery, Schenectady, and more |
SAIL provides assistance with benefit and entitlement programs and services that help people live safely in the community. SAIL´s services are targeted at people with disabilities but in particular our connection with health insurance enrollment and problem solving services go beyond services to people with disabilities. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Community Alliance |
CDPHP |
Fidelis |
MVP |
Good Shepherd Services |
Katie Blakey–Beisser |
(212) 381–0225 |
katherine_blakey@goodshepherds.org |
https://goodshepherds.org/ |
New York City– Brooklyn, Queens, Manhattan, Bronx and Staten Island. |
*GSS provides the following services: After–School and Summer Camp, Supportive Housing, Child Welfare, In–School Supports, Domestic Violence Programs, Community Centers, Health Care Coordination, Workforce Development and Youth Justice. |
Unsure |
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Goodwill NYNJ |
Gloria Choi |
718–777–4209 |
gchoi@goodwillny.org |
https://www.goodwillnynj.org |
Manhattan, Queens, Bronx, Brooklyn and parts of Northern NJ |
Target populations include individuals with mental health diagnoses, substance use disorders, developemental and learning disorders, spectrum disorders, individuals needing employment, housing, and education supports. Goodwill NYNJ providers job coaching for individuals with disabilities and temporary job placements
through our workforce and GoodTemps programs. Employment is a major focus for al individuals treated at various OMH, OPWDD and DOHMH programs. We also offer nutrition and wellness services to help support employment for individuals with psychiatric disabilities. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Beahvioral Care (CBC) |
Healtfirst, EmblemHealth, BlueCross BlueShield, Affinity, Wellcare, United Healthcare, Metroplus, VNS |
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Hamaspik of Kings County |
Tzvi Wertheimer |
(718) 408–5106 |
hwertheimer@hamaspikkings.org |
www.hamaspikKings.org |
Kings, New York, Bronx |
OPWDD, Harp, Children Waiver, NHTD, TBI, HH Care Management |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Harmony Cafe |
Rosemarie Mccarthy |
(631) 372–0227 |
info@harmonycafeli.org |
|
Suffolk Cty |
We are not aware who receives medicaid–our service we provide doesn´t require having that information at this time. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Harvest House of South Buffalo |
Carol Murphy |
(716) 855–0654 ext. 229 |
cmurphy@harvesthousebuffalo.org |
www.harvesthousebuffalo.org |
Erie and Niagara Counties |
Harvest House works to break down the barriers keeping people in poverty by providing integrated and inclusive support services to underserved and marginalized communities. We offer access to health care and education as well as linkage to services for the working poor, the unemployed, the marginalized and communities at risk.
Most come from 3 of Buffalo´s poorest neighborhoods where 55% of residents are African American; 22% are Latino. 40% live at or below the poverty level; 1–in–8 is unemployed; 20% lack a High School diploma. We partner with Kaleida Health´s Youth Link Program/NYS Department of Health/AIDS Institute PrEP Initiative, Family Justice Center, Buffalo Public Schools Adult Education, Erie 2 CC BOCES, UB´s Schools of Medicine, Dentistry, and Pharmacy and more than 90 volunteer medical and dental providers. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Harvest House is part of the Upstate New York CBO Consortium |
Fidelis Health |
Blue Cross Blue Shield |
Wellcare |
HCA |
Christine Breslin |
6077987117x311 |
c.breslin@hcaserves.com |
|
Broome, Tioga, Chenango |
social work |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Health Literacy For All Inc |
Karen Laing |
(518) 881–6405 |
info@healthliteracyforall.org |
healthliteracyforall.org |
Albany Schenectady Rensselaer Columbia Green Montgomery Saratoga Washington |
We provide health literacy training to patients and their providers. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis |
CDPHP |
MVP |
Health People |
Chris Norwood |
718–585–8585 |
chrisnorwood@healthpeople.org |
www.healthpeople.org |
Bronx |
We use a Community Asset Model, whereby training community members to facilitate programs, we have staff that fully understands the SDH and gain the confidence of people to address their real needs. The core of our model is evidence–based preventive and self–care
education, which not only improves health outcomes but empowers people to want to address their SDH. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
HealthFirst, MetroPlus, Amida Care |
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|
Healthy Capital District Initiative |
Kevin Jobin–Davis |
(518) 486–8400 |
kjobin–davis@hcdiny.org |
www.hcdiny.org |
Albany, Schenectady, Rensselaer |
HCDI provides navigation services to help people of all ages and income apply for health insurance through the New York State of Health. All customers are offered education about how to use their coverage, assistance making appointments with primary care, and help accessing social supports addressing social determinants of
health. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Alliance IPA |
CDPHP |
MVP |
|
Healthy Community Alliance |
Ann Battaglia |
716–532–1010 |
abattaglia@hcanetwork.org |
http://www.communityalliance.org/ |
Cattaraugus, Chautauqua, Wyoming, Erie |
Patient Navigation to Primary Care, Evidence–based Chronic Disease Self Management programs, Community Health Worker Coaching, SNAP Enrollment, NY State of Health Insurance Enrollment In Person Assistance, Rural Older Adult Social Connectivity Programs, rural Food Pantry |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Western New York Integrated Care Hub; Value Network, IPA (BHCC) affiliate CBO member |
Fidelis |
YourCare |
HealthNow |
HEAT Program/SUNY Downstate Medical Center |
Blondell Jackson |
718–613–8408 |
blondell.jackson@downstate.edu |
www.heatprogram.org |
Kings County and all surrounding counties of New York City |
Medical services for HIV+ and high–risk youth; transgender care for youth |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Heights and Hills, Inc. |
Judy Willig |
(718) 596–8789 |
jwillig@heightsandhills.org |
www.heightsandhills.org |
Kings |
Caregiver support services (information, referral, counseling, training and support groups) for individuals providing unpaid care for elderly loved ones, Park Slope Center for Successful Aging – a community center for older adults that provides health and wellness activities and congregate meals |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Hemophilia Association of NY, Inc. |
Linda Mugford |
212–682–5510 |
lindamugford@Hemophiliany.com |
www.hemophiliany.com |
The 5 NY City counties, Nassau, Suffolk, Westchester, Rockland, Sullivan, Ulster, Putnam, Orange, Dutchess |
We provide direct assistance (financial support for non–medical and non–covered medical expenses deemed necessary) scholarships, research support for new therapies, better therapies and possible cures for bleeding disorders. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Emblem Health, HealthFirst, Healthplus, Affinity |
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Henry Street Settlement |
Kristin Hertel |
212–233–5032 x 4253 |
khertel@henrystreet.org |
www.henrystreet.org |
New York County, Brooklyn, Queens |
Case management ( snap enrollment, housing assiatnce/ PA), legal an dfinacial services, youth services, childcare, Afterschool,employment services, healthcrae enrollment |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC |
Heakth First, Metroplus, Fidelis, BCBS, Beacon |
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|
Heritage Christian Services, Inc. |
Jennison Bielemeier |
585–340–2000 |
jbielemeier@heritagechristianservices.org |
|
Cattaraugus, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Steuben, Wayne, Wyoming, Yates |
Heritage Christian Services provides support to individuals with developmental disabilities which includes, but is not limited to, residential, day, respite, employment, community hab, FI, broker, care management within children´s health homes, CDPAP, HCBS children´s provider. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Herkimer County HealthNet |
Elyse Enea |
315–867–1552 |
eenea@herkimercounty.org |
www.healthnetinc.org |
Herkimer & Oneida Counties |
DSM, CDSM, CPSM, NDPP workshops |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate NY |
Excellus |
|
|
Hillside Children´s Center |
Maria Cristalli |
585–256–7600 |
mcristal@hillside.com |
www.hillside.com |
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Tioga, Tompkins, Erie, Genesee, Livingston, Niagara, Orleans, Wyoming,Allegany, Cattaraugus, Chautauqua, Chemung, Schuyler, Steuben, Monroe, Ontario, Seneca, Wayne, Yates |
Hillside serves children/youth ages 0–26 and their families. Our services include clinical and non–clinical. Among the non–clinical, Hillside offers Health Home services, which provvide linkages to a variety of SDH services, including access to health care,
Access to primary care, connection to natural resources, linkage to welfare, employment, housing, etc. Additionally, through our Family Resource Center, Hillside provides early education and home visiting services to support parents in being their child´s first teacher and developing sound parenting skills. Hillside offers skill building to advance social development and connection, as well as school–based services that support youth to obtain a high school diploma and readiness for the future (college, skills training, certification, work). |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Your Health Partners of the Finger Lakes, LLC (formerly Hillside–Catholic Charities BHCC) |
Fidelis |
Excellus |
|
Hispanic AIDS Forum |
Daniel Castellanos |
718–429–5309 |
dcastellanos@hafnyc.org |
http://hafnyc.org/ |
New York City |
Our main target populations are Hispanics and LGBTQ persons. We provide housing assistance, linkage to care, HIV/HCV testing and screening, linkage and navigation services to health and social services, and community education. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Hi–Tech Charities |
Dr. Francis Onukwue |
(314) 922–7139 |
fonukwue12@aol.com |
www.htc.ngo |
Bronx, Manhattan, Queens, Brooklyn, Staten Island, Westchester. |
Hi–Tech Charities (HTC) is a 501(c)(3), nonprofit community development corporation, with operations in St. Louis Missouri and New York City, New York. The organization provides healthcare, employment training, facilities and housing development, and various
economic development and social services that empower individuals, families, businesses and communities. HTC has served over 20,000 individuals and families and over 400 hundred women and minority small businesses in its 18 years of existence. The organization´s New York office is presently located at 60 Saratoga Avenue, Pleasantville, Westchester, NY 10570. HTC New York is a New York State Department of Health approved License Home Care Services Agency (LHCSA–2307–L001), presently serving clients in Bronx, Brooklyn,
Queens, Manhattan, Staten Island, and Westchester Counties in New York State. Home healthcare services provided include: Nursing, Home Health Aide, Personal Care, Physical Therapy, Occupational Therapy, Respiratory Therapy, Speech–Language Pathology, Medical Social Services, Nutrition, Homemaker, Housekeeper, Medical Supplies, Equipment and Appliances. Visit us at: www.htc.ngo |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Archcare |
Integra |
|
Hope 7 |
Samantha Adkisson |
(518) 272–8029 |
hope7.samantha@gmail.com |
www.hopeseven.com |
Rensselaer primarily, some Albany with our youth programs |
Food Pantry |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Hospice & Palliative Care, Inc. |
Shannon Cayea |
(315) 735–6487 |
scayea@hospicecareinc.org |
www.hospicecareinc.org |
Herkimer, Oneida, & Madison |
Hospice & AIM Palliaivte Care for any individuals residing in the counties we service |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Fidellis, MVP |
|
|
Housing Assistance Program of Essex County, Inc. |
Bruce Misarski |
518–873–6888 |
bruce@hapec.org |
www.hapec.org |
Essex, Clinton, Hamilton |
HAPEC provides a full range of housing services that include: rental assistance; housing repair asssistance; housing counseling for eviction, foreclosure, and financial capability; emergency accessibilty assistance |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Housing Works |
Pat Troy |
(845) 674–3354 |
P.TROY@HOUSINGWORKS.ORG |
www.housingworks.org |
Bronx, Kings, Queens, Manhattan |
Housing Works includes the following programs: Four (4) Article 28 clinics, two (2) OASAS programs, two (2) Article 31 programs, two (2) Adult Day Health Care Programs, Health Home, Harm Reduction programs including Syringe exchange, Retention and Adherence
program, Job Training and Programs transitioning clients from jails to jobs. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
IDUHA IPA |
Amida Care, Metropus, HealthFirst, Fidelis |
|
|
Hudson Valley Community Services |
Saqib Altaf |
914–785–8210 |
saltaf@hudsonvalleycs.org |
www.hudsonvalleycs.org |
Westchester, Rockland, Putnam, Orange, Sullivan, Ulster, and Dutchess |
Housing financial assistance an dsupport, nutrition education and food programs, transportation |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Coordinated Behavioral Health Servces IPA (CBHS) |
MVP |
Fidelis |
Affinity |
Human Development Services of Westchester |
Kathy Pandekakes |
845–590–7645 |
kipandekakes@hdsw.org |
www,hdsw.org |
Westchester |
Housing/Residential services, food pantry for clients of our Clubhouse program, Supported Education, Supported Employment, Care Management supports to link to access to health to health care, social engagement, affordable housing, health literacy,etc. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Coordinated Behavioral Health Services, IPA |
MVP |
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Human Services Coalition |
John Mazzello |
(607) 273–8686 |
jmazzello@hsctc.org |
hsctc.org |
Tompkins County and Cortland County (a subset of HSC services) |
211 Information and Referral, Community Health Advocates, Health Insurance Navigation, Community Health Outreach Program, Continuum of Care (lead agency for a network of public & private nonprofit partners addressing homelessness), Coordinated Assessment System (for people who are homeless or at risk of being homeless). Also
supports the nonprofit community through training workshops, planning & coordination, collection of data, and administers the rural health network, population health improvement program, and staffs the Health Planning Council. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis, Molina |
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ICAN |
Matthew Buono |
(315) 731–2641 |
mbuono@ican.family |
ican.family |
Oneida, Onondaga, Madison, Herkimer, Otsego, |
Adult Health Home, Adult HCBS, Adult TBI Program, Childrens ACT, Children – CFTSS & HCBS, VBP with adult diabetic population, prenatal and pregnant women in Oneida County, Healthy Families program, Rapid Re–Housing Programs through Oneida County CoC (HUD), Juvenile Justice and School Based Programming |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
ICAN Administers a Behavioral Health IPA – ICAN IPA |
Fidelis |
|
|
In Our Own Voices, Inc. |
Tandra LaGrone |
(1518) 432–4188 |
tlagrone@inourownvoices.org |
www.inourownvoices.org |
Albany, Schenectady, Saratoga, Greene, Columbia, Rensslaer, Montgomery |
LGBTQ focus: Mental Health Services, Transportation, Housing Referrals, Food, Testing and screening HIV, HepC, Atni–Violence Services |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
AFBH |
CDPHP |
|
|
Institute for Advanced Medicine, Mount Sinai Health System |
Shruti Ramachandran |
212–604–1737 |
Shruti.Ramachandran@mountsinai.org |
https://www.mountsinai.org/patient–care/iam |
New York County, Bronx County, Kings County, Queens County, and Richmond County |
Social Work/Case Management assessment and referrals for all new patients for immediate needs such as linkage to insurance and benefits, affordable housing, job placement/training, access to food pantries and other agencies providing access to healthy foods, GED classes, re–entry support services for justice
involved individuals, linkage to internal language translation services, referrals to Crime Victims Treatment Center and our internal Sexual Assault and Violence Intervention program, linkage to on site/co–located nutritionist for nutrition therapy and linkages to local food pantries; Metrocards are provided for those patients who have trouble traveling to and from for a medical visit; Social support groups for LGBT populations, formerly incarcerated/justice involved patients, our aging/50+ population, and our transgender patients seeking gender affirming surgery; |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Mount Sinai IPA https://ms–ipa.org/ |
Amida Care Inc. SNP and Medicaid Managed; VNS Choic SNP and Medicaid HMO; Healthfirst Medicaid; Healthfirst Medicare; Aetna, Healthfirst HARP; UHC Oxford Commercial, Cigna, Anthem commerical PPO; UHC Commercial; ADAP Medicaid; Empire BC/BS Commercial; Metroplus Medicaid; Fidelis Medicaid; |
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|
Institute for Family Health |
–––– |
––––– |
–––––––– |
––––– |
Dutchess County |
Connection to community resources, education, support |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
MVP and Fidelis Medicaid |
|
|
Interfaith Partnership for the Homeless |
Kristen Giroux |
(518) 434–8021 |
kristeng@interfaithpartnership.com |
|
Albany, Rensselaer, Montgomery, Schenectady, Saratoga |
IPH provides a continuum of services to homeless and low–income individuals and families, including 3 emergency shelters, a Medical Respite shelter, a drop–in/community center (showers, lockers, laundry, clothing, a hot meal, case management), permanent supportive housing, health and wellness services, and the Albany Ambassadors
employement initiative. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Alliance IPA |
CDPHP |
Fidelis |
Wellcare |
International Institute of Buffalo |
May Shogan |
(1716) 883–1900 |
mshogan@iibuff,org |
www.iibuffalo.org |
Erie and Niagara County |
We provide advocacy, support, language access, health literacy, linkage and referrals to services for our refugee and immigrant population support, and |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Community Alliance |
|
|
|
Ithaca Neighborhood Housing Services, Inc. (INHS) |
Johanna Anderson |
(607) 277–4500 |
janderson@ithacanhs.org |
|
Cayuga, Cortland, Chemung, Seneca, Schuyler, Tompkins, Tioga |
INHS provides affordable rental, home ownership, and home improvement programs for low– and moderate–income people. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CHDO, CDFI, NeighborWorks, Neighborhood Preservation Company, Rural Preservation Company |
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JASA |
Alan Cohen |
(212) 273–5346 |
acohen@jasa.org |
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New York County (Manhattan), Kings County (Brooklyn), Bronx County (The Bronx), Queens County (Queens), and Nassau County |
Adult Protective Services: Supervision of daily activities, crisis intervention, and financial management; Caregivers Support: Groups, respite services, and referrals; Care Transitions: Recently discharged hospital patients work with specialists to ease the transition from hospital to home;Case Management: Counseling,
information, and connection to community resources; Chronic Disease Management: Evidence–based programs and peer Community Health Navigators assist with disease management strategies; Community Guardian Program: Legal responsibility for older adults judged incapacitated by the courts; Elder Abuse Prevention and Intervention: Attorneys and social workers assist victims of abuse; Home–Delivered Meals: Nutritious meals delivered to homebound older adults; Home Care: Home health and personal care assistance (LHCSA); Housing: Affordable, safe housing with service coordination for
tenants; Legal Services: Legal assistance to prevent evictions and more; Long Island Center for Dignity and Support: Support for individuals and families coping with advanced illness; Mental Health Services: New York State–licensed outpatient mental health clinic in the Bronx and other supportive programs that welcome older adults with mental illnesses; Naturally Occurring Retirement Communities (NORCs): Health, education, and recreation, for older adults living in buildings where many residents are 60+; Senior Centers: Activities, friendships, trips, special events, and meals |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Jawonio, Inc |
Jane F. Mullin |
(845) 708–2003 |
jane.mullin@jawonio.org |
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Orange, Rockland, Westchester |
HH Care Management, PROS, CDPA, Day Habilitation, PT, OT & Speech services, Serve individuals with I/DD, BH and MH needs, Medically fragile adults and children |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health Care Collaborative (BHCC) |
Fidelis |
MVP |
Affinity |
JCC of Marine Park |
Michael Rinkoff |
(718) 407–1832 |
mendy@jccmp.org |
www,jccmp.org |
Kings (Brooklyn), Queens and New York |
Our services are provided to all within our catchment area, as described above. The services provided involve programs that deal with cases of need primarily food security, but more importantly finding programs of retraining at even the most basic levels in order to increase opportunity and advancement |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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JCCA |
Carletta Green |
(347) 362–8180 |
greenca@jccany.org |
www.jccany.org |
NYC,Kings, Queens, Richmond, Bronx, Westchester |
JCCA addresses medical, mental, behavioral and social health needs with over 30 programs. We work with a wide spectrum of clients (ages 0–21) with a variety of needs. We have partnerships OCFS, ACS, OMH, DOH and OPWDD. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC |
HealthFirst |
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Jewish Family Service of Buffalo and Erie County |
Molly S. Carr |
716–883–1914 ext 307 |
mcarr@jfsbuffalo.org |
www.jfsbuffalo.org |
Erie and Niagara County |
Health Home Service for Adults and Children, Mental and Behavioral Health Clinic, Refugee Resettlement Care Coordination, Survivors of Torture Care Coordination, Occupational Support Services, Parenting Classes |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Independent Health |
BlueCross BlueShield |
United Health Care |
Job Path, Inc. |
Fredda Rosen |
(212) 944–0564 |
frosen@jobpathnyc.org |
www.jobpathnyc.org |
New York, Bronx, Kings, Queens |
Job Path helps people with autism, intellectual and other developmental disabilities find jobs, live in their own homes and participate in community life. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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n/a |
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Ken–Ton Meals on Wheels |
Dan Wiles |
716–874–3595 |
dan@ktmeals.org |
kentonmealsonwheels.org |
Erie |
Home Delivered Meals, Handyman Services, Congregate Dining |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Konbit Neg Lakay, Inc |
Yola Moiso |
(845) 425–4623 |
yolamoiso@konbitneglakay.com |
www.konbitneglakay.com |
Rockland, Orange |
Transportation to local QHC; Diabetes Self–Management Education; ESL classes; Transporation to Behavioral Outpatient treatment; Job Fairs |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Lower Hundson CBO |
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L.I. Against Domestic Violence |
Colleen Merlo |
(631) 666–7181 |
c.merlo@liadv.org |
|
Suffolk, Nassau |
domestic violence counseling, advocacy, shelter and vocational training |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Lake Plains Community Care Network |
Charlotte Crawford |
585–345–6110 |
ccrawford@lakeplains.org |
http://www.lakeplains.org/ |
Orleans and Genesee |
Assistance with the Market Place for enrollement in a Health Care Plan |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis Care |
MVP Health Plan |
BCBS – Health Now of NY Inc. |
Lantern Community Services |
Carol Lemus |
212–398–3073, ext 185 |
clemus@lanterncommunity.org |
www.lanterncommunity.org |
Manhattan, Bronx, Brooklyn, Queens |
supportive housing for chronically homeless adults and youth aging out of foster care |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Unknown |
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LEAF Council on Alcoholism and Addiction |
Julie Dostal |
607–432–0090, x. 101 |
julie@leafinc.org |
www.leafinc.org |
Otsego County |
LEAF provides universal prevention services for Otsego County and participates in public health advocacy at the state and national level. LEAF has 3 main focus areas: 1) Providing prevention education and early intervention at the 12 school districts in Otsego County. 2) Providing population based, community
level prevention that reduces access and availability of harmful intoxicants, and reduces community level norms associated with increased use. 3) Court mandated education services for impaired drivers and underage offenders. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
We serve a universal population; with and without health insurance, public or private. |
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Learning Disabilities Association of CNY dba LAUNCH |
Paulette Purdy |
(315) 432–0665 |
ppurdy@launchcny.org |
www.launchcny.org |
Onondaga |
We support individuals with learning challenges in school and work by providing assistance in remediation of their disability in functional living skills. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Inclusive Alliance |
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Learning Disabilities of Western NY |
Marc Hennig |
(716) 874–7200 |
mhennig@ldaofwny.org |
ldaofwny.org |
Erie, Niagara,Chautauqua |
Vocational Employment Services help adults get and keep a job. , Starlight Studio and Art Gallery, a vibrant art studio located in downtown Buffalo, provides an open–art studio environment with individualized guidance as needed for the cultivation of artistic expression with people who have disabilities.ndependent Living In the
home or for the home, we provide assistance with services needed to maintain independence in your own home in a community of your choosing. Supports and Services Include: Finding and Obtaining Housing Money Management / Budgeting Diet / Cooking Shopping Basic First Aid Medical and Related Appointment Support Parenting Skills Safety Housekeeping / Laundry Recreation / Leisure Activities Community Involvement Transportation Training Self Direction Self Advocacye Educational Advocacy Department assists parents /families through the special
education process, as this process can be very confusing and frustrating. Our advocates are trained in the educational law and work with the family to help the student receive what he/she is entitled to under the law. Post–Secondary education is a key to improved transitions and greater success for young adults. Attending and graduating from a post–secondary program can be critically essential to future success. On average, a person with a post–secondary degree will earn substantially more than one with only a high school diploma. Post–secondary
education for students with learning and/or developmental disabilities can support life success! |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Legal Services of Central New York |
Jim Williams |
315–703–6533 |
jwilliams@lscny.org |
www.lscny.org |
Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Otsego, Oswego |
We provide free civil legal services to people living at or below 200% of federal poverty guidelines in the areas affecting the essentials of life including housing, public benefits, employment rights, access to healthcare, consumer matters, immigrant rights, education rights, mental health and homelessness, racial
justice, civil reights of juveniles and others in jails and prisions. We also have two programs that provide civil legal services to individuals with HIV and/or cancer. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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legal services of the hudson valley |
mary grace ferone |
9149491305x151 |
mferone@lshv.org |
www.lshv.org |
westchester, putnam, rockland ,dutchess, orange ulster, sullivan |
civil legal services including public benefits, medicaid, housing, social security , family, discrimination |
Unsure |
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Lexington Center for Mental Health Services, Inc. |
Adele Agin |
(718) 350–3110 |
aagin@lexnyc.org |
https://mentalhealth.lexnyc.org/ |
Queens, Kings, Bronx, New York, Richmond, Long Island, Westchester |
The Lexington Center for Mental Health Services, NYC, NYS certified outpatient clinic, provides mental health and social services to deaf and hard–of–hearing people in a linguistically and culturally accessible manner recognizing the importance of utilizing every means of communication.
Therapists/clinicians serve individuals from children to adults from crisis intervention to ongoing treatment. Individual, family, group and couple counseling, psychotherapy and case management services are provided. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Care IPA, Inc. |
HealthFirst |
Metroplus |
Fidelis |
Liberty Resources, Inc. |
David Harris |
315–425–1004 |
dharris@liberty–resources.org |
http://www.liberty–resources.org/ |
Oswego,Onondaga,Madison,Cortland,Chenango,Cayuga,Monroe,Erie |
Housing,homelessness, employment, social and family |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Fidelis |
Molina |
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Lifelong |
Lucia Sacco |
607–273–1511 |
lsacco@tclifelong.org |
www.tclifelong.org |
Tompkins |
Free tax counseling for seniors and individuals with low income; free, nonbiased Medicare counseling; we provide a wide variety of activities geared toward older adults in Tompkins County |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO consortium of Upstate NY |
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LifePath formerly Senior Services of Albany |
Monika Boeckmann |
518–465–3322 |
mboeckmann@seniorservicesofalbany.com |
www.seniorservicesofalbany any |
Albany |
We provide nutrition support an dedcuation via the Meals on Wheels program, and our 10 community dining sites. We provide transportation and adult day services for senior who can not safely remain alone at home. We serve adults over 60. ites |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Alliance for Better Health IPA |
Fidelis |
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Life´s WORC, Inc. |
Craig Meyer |
516–741–9000 |
cmeyer@lifesworc.org |
www.lifesworc.org |
Manhattan, Queens, Nassau and Suffolk |
Residential and Community Services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
ACA |
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Lifespire |
Jim Normandy |
212 741 0100 |
JNormandy@Lifespire.org |
Lifespire.org |
Manhattan, Bronx, Queens, Kings & Staten Island |
Clinic = Psychotherapy, Speech, OT, PT for IDD people |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Lifetime Assistance Inc |
Kevin Koch |
585–426–4120 |
Kevin.Koch@lifetimeassistance.org |
https://www.lifetimeassistance.org |
Monroe, Genesee |
service for developmental disabilities |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Literacy New York Buffalo Niagara |
Tara Schafer |
716–876–8991 |
tara.schafer@literacybuffalo.org |
Literacybuffalo.org |
Erie & Niagara |
Literacy Education for adults |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Health Now, Independent Health |
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Literacy of Northern NY |
M. Cecilia Brock |
315–782–4270 |
literacyofnny@gmail.com |
www.literacynny.org |
Jefferson, Lewis |
We provide literacy tutoring so people can read information they receive from the doctor or pharmacist. We also teach English as a second language so people can communicate and understand their medical professionals. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate NY |
United Healthcare |
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LiteracyCNY |
Marsha L. Tait |
315–471–1300 X171 |
mtait@LiteracyCNY.org |
www.LiteracyCNY.org |
Onondaga |
LiteracyCNY provides basic literacy and English language instruction to adults who read, write or speak English below the sixth grade level. Instruction is offered in small group classes of 15–18 students taught by credentialed teachers and in one–to–one pairs with trained volunteer tutors. LiteracyCNY enrolls more than
350 adult students per year. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Living Independently is For Everyone at RCIL |
Donna Gillette |
(315) 866–7245 |
dgillette@rcil.com |
www.rcil.com |
Herkimer County/ and 26 counties covered by our Medicaid Consumer–Directed Personal Assistance Program (CDPAP) providing fiscal intermediary services to individuals qualified for long–term care services in the home. Medicaid CDPAP services through RCIL are offered
in 26 counties. For a full listing of counties covered by our CDPAP program, see addendum. |
Providing consumer–directed advocacy and assistance to individuals with disabilities to access healthcare, education, employment, civic involvement, benefits, programs and services to live as independently as possible. RCIL also provides services to care givers
of seniors with disabilities including a social adult day program for seniors with developmental and cognitive impairments including dementia. Support for care–givers of individuals with disabilities, their healthcare providers, including peer recovery support services and those with co–occurring diagnoses including mental illness. All of our programs and services are aimed at addressing social determinants of health including housing, benefits, food security, IPE and 504 advocacy in schools, employment assistance, and nursing home transition and diversion advocacy. We house the
NY Connects program that works together with the HC Office for Aging to connect residents with information, assistance and referral to long–term care.We partner with the HC Dept. of Social Services and have staff located there assisting DSS staff with individuals receiving benefits who are work exempt or work limited. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Leatherstocking Collaborative Health Partnership (LCHP) PPS/DSRIP; Herkimer County Steering HUB |
Fidelis, Excellus, Senior Network Health, United Healthcare |
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Long Island Alzheimer´s Foundation |
Melissa Katz, LMSW |
516–767–6856 |
mkatz@liaf.org |
|
Nassau County |
Alzheimer´s disease and dementia specific– social adult day program contacted with MLTC´s, free caregiver support groups and trainings, In–Home Respite Services funded by Office of the Aging |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Long Island Cares |
Jessica Rosati |
(631) 582–3663 |
jrosati@licares.org |
www.licares.org |
Nassau and Suffolk |
Food Bank |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Long Island Consultation Center, Inc. |
Nancy Tartakoff |
(718) 896–3400 |
nancytartakoff@aol.com |
liccnewyorkcity.com |
All boroughs of New York City and Long Island: New York, Queens, Brooklyn, Staten Island, Bronx, Nassau, Suffolk |
Outpatient MH and SUD treatment, psychiatric med mgmt, MATS |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health NYC IPA |
Health First |
Empire BCBS Health Plus |
Metro Plus |
LSA Family Health Service, Inc. |
Ray Lopez |
(917) 445–6621 |
rlopez@lsafhs.org |
https://littlesistersfamily.org/ |
New York – Manhattan |
Skilled nursing from our Certified Home Health Agency. Community Health Workers provide in–home asthma services. Community Liaison Wokers provide SDH assessment to patients recently out of the emergency department of our partners, identifies barriers, and connects them to services in their community. Parenting &
Child Development services to immigrant families in particular. The children have Medicaid Managed Care and the parents are uninsured. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
Affinity, Health First, FidelisCare, MetroPlus |
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Madison County Rural Health Council, Inc. |
Bonnie Slocum |
315–447–7625 |
slocum.bonnie@mcruralhealthcouncil.org |
www.mcruralhealthcouncil.org |
Madison |
National Diabetes Prevention Program, Chronic Disease Self Management, Diabetes Self Management and Chronic Pain Self Management programs, Mobility Management, Health Literacy awareness |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium |
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Make the Road New York |
Becca Telzak |
347–512–9073 |
rebecca.telzak@maketheroadny.org |
www.maketheroadny.org |
Queens, Kings, Staten Island, Suffolk, Nassau, Westchester |
Health (insurance enrollment, SNAP enrollment, pantries, healthcare navigation, CHW training and asthma home visiting services), Legal (immigration, housing, employment), adult education (ESOL and citizenship classes), community organizing/weekly meetings |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Mary Rose Clinic |
Amanda Larson |
315–280–0855 |
amanda@gormanfoundation.org |
www.maryroseclinic.org |
Madison, Oneida, Onondaga, etc. No limits |
We provide primary care to uninsured and underinsured people. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Matthew House, Inc |
Angela Ryan |
(315) 252–2052 |
info@matthewhouse.org |
Matthew House, Inc |
Cayuga, Onondaga, Seneca and surrounding areas |
End of Life Care |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Meals on Wheels of Syracuse |
Mason Kaufman, Executive Director |
315–478–5948 ext:204 |
mkaufman@meals.org |
www.meals.org |
Onondaga County (City of Syracuse, Nedrow, Onondaga Nation, Skaneateles,Jordan, Elbridge) |
Two well–balanced home delivered meals to homebound adults; includes daily safety check by delivery volunteers. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Nascentia Health Options, Fidelis Care, PACE CNY, iCircle Care |
|
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Mental Health America of Dutchess County |
Andrew O´Grady |
(845) 473–2500 |
aogrady@mhadutchess.org |
mhadutchess.org |
Dutchess |
Mental Health America Dutchess County is a not–for–profit organization dedicated to promoting mental wellness through comprehensive care management, education, programs, advocacy, and community supports. We provide compassionate creative care for all. MHADC envisions a community in
which every individual is treated with dignity and respect and where comprehensive mental health services of the highest quality are available and accessible to all. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
Fidelis |
Beacon Health Options |
Wellcare |
Mental Health Association in Orange County, Inc. |
Nadia Allen |
(845) 342–2400 ext. 1326 |
nadia@mhaorangeny.com |
http://www.mhaorangeny.com/ |
Orange County |
Care Coordination, Housing Support, Vocational Support, Peer Mentor, Social Club, 24 hour Crisis Call Center |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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I am not sure |
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Mental Health Association of Franklin County Inc. (d/b/a) Community Connections of Franklin County |
Lee Rivers |
518–521–3507 |
lrivers@communityconnectionsfcny.org |
communityconnectionsfcny.org |
Franklin |
We have collaborative partnerships with DSS, Probation, JCEO, Franklin County Community Housing Council, Landlords, Churches, Sherriffs Department, Probations, Family Treatment Court, Food Pantries, St. Joes Outpatients, Citizen Advocates, UVN Alice Hyde Medical Center, Saranac Lake School System, Malone School System,
Chateaugay School System which allows us to help address all Social Determinants of Health either at our facility or through a referral process. We offer advocacy(connection), benefit advisement, mutual support, warm–line, work experience program, male homeless shelter, education on life and social skills, groups, co–chair agency for Franklin County Suicide Prevention Coalition,Recipient Services Funds to assist with environmental conditions, job readiness training, |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Wellness Collaborative IPA of NY |
Fidelis |
Optum |
|
Mental Health Association of Rockland |
Sonia Wagner |
845–267–2172, x323 |
wagners@mharockland.org |
|
Rockland |
care management for adults and children, ACT team, residential services, vocational services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Health Services (CBHS) |
Fidelis |
|
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Met Council |
Julia Kessler–Hollar |
212–453–9598 |
jhollar@metcouncil.org |
www.metcouncil.org |
Manhattan, Bronx, Brooklyn, Queens, Staten Island |
For more than four decades, Met Council has helped seniors, adults and families living in poverty and near–poverty. Met Council provides immediate assistance to New Yorkers in crisis and creates pathways to self sufficiency through the following programs: America´s Largest Kosher Food Pantry System, Emergency Social
Services, Family Violence Services, Free Home Repairs, Benefits Enrollment & Outreach, Senior Services, Holocaust Survivor Program and Affordable Housing. Our grassroots network of sixteen Jewish Community Councils help people in their neighborhoods—right where they live! |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Unknown |
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Metropolitan Center for Mental Health |
Robert Basile |
2128751300x508 |
rbasile@metropolitancenter.com |
www.metropolitancenter.com |
New York, Bronx |
Behavioral Health, Integration with Primary Care, Linkages to Health Home/Care Management, Linkages to Medicaid benefits support, Linkages to Foodbank, Supportive Housing, HRA STARS program |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health NYC, IPA, LLC (BHNYC) |
HealthFirst |
|
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MHA of Westchester |
Charlotte Ostman |
914–265–7509 |
OstmanC@mhawestchester.org |
mhawestchester.org |
Westchester, Rockland, and Putnam |
Apartment Treatment Program, Supported housing beds, Employment services, Rep Payee services, Care Management for adults and children |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Health Services |
MVP |
|
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Mixteca Organization, Inc. |
Lorena Kourousias |
(718) 965–4765 |
lkourosias@mixteca.org |
www.mixteca.org |
City wide |
For nearly two decades, Mixteca´s culturally–competent staff, community–based engagement strategies and welcoming community center have helped to connect marginalized community members to critical health information, resources, health and emotional health services and support. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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MOMMAS House |
Patricia Shea |
(516) 781–8637 |
director@mommashouse.org |
|
Nassau and Suffolk |
MOMMAS House is a mother–child residential program for young mothers, pregnant and/or parenting mothers |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Health First |
Affinity |
Fidelis |
Mount Sinai Adolescent Health Center |
John Steever |
(212) 731–7517 |
John.steever@mountsinai.org |
https://www.mountsinai.org/locations/adolescent–health–center |
New York City |
Provide comprehensive medical and mental health care to youth ages 12–24 in New York City. Emphasis on sexual and reproductive health care. |
Unsure |
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Municipal Housing Authority of the City of Utica |
Robert R. Calli |
315–735–5246 |
bcalli@aol.com |
www.uticamha.org |
Primary County– Oneida but have authority to operate throughout NYS |
Affordable housing provider/ Developer of affordable and market rate housing/ service coordinator for residents in need/ Targeted Populations– low/moderate income/indigent/elderly/disabled/at–risk/ |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
N.Y. Quality Healthcare corporation |
Excellus Health Plan , Inc. |
MVP Health Plan, Inc. |
NADAP |
Joseph Sarno |
(516) 620–1363 |
jsarno@nadap.org |
|
Nassau and Suffolk |
Vocational services for individuals living with HIV/AIDS |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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NAMI Champlain Valley |
Amanda Bulris–Allen |
518–419–9182 |
amanda@nami–cv.org |
nami–cv.org |
Clinton |
Peer Advocacy and Outreach services to those struggling with their mental health and their family |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis, Excellus |
|
|
Nassau/Suffolk Law Services |
Victoria Osk |
(631)232–2400x3329 |
vosk@nsls.legal |
www.nslawservices.org |
Nassau and Suffolk |
Legal services & permanency planning |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Various |
|
|
Nassau–Suffolk Hospital Council |
Wendy Darwell |
631–963–4152 |
wdarwell@nshc.org |
www.nshc.org |
Nassau, Suffolk |
1. Medicaid and Medicare insurance enrollment assistance for aged, blind and disabled populations. 2. Coordinate population health improvement activities among more than 100 providers, local governments and CBOs. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis |
UnitedHealthcare |
|
New Hope Transformation House Ministries, Inc./Grace House |
Carolyn M. White |
315–268–9109 |
whitegracehouse@outlook.com |
newhopetransformation.org |
St. Lawrence County |
supportive living for women in early recovery from SUD |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
most of our residents appear to be enrolled in Fidelis |
|
|
New Horizons Resources, Inc. |
Nancy Slauson, CFO |
845–473–3000 |
nslauson@ |
|
Ulster and Dutchess |
Residential and Day programs |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
|
|
|
New York Council On Adoptable Children |
Cyndi Morales |
(212) 475–0222 |
cmorales@coac.org |
www.coac.org |
Manhattan, Bronx, Brooklyn, Queens, and Staten Island |
supportive counseling, legal, and care coordination |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
MCAID |
|
|
NEw York Foundation for Senior Citizens |
Jaimeson Champion |
212–962–7559 ext 272 |
jaimesonc.nyfsc@gmail.com |
nyfsc.org |
New York, Kings, Queens, Bronx, Richmond |
Social Services for Senior Citizens |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
North Country Healthy Heart Network |
Ann Morgan |
(518) 891–5855 |
amorgan@heartnetwork.org |
www.heartnetwork.org |
Clinton, Essex and Franklin |
We promote health equity by working with organizations that directly address social determinants of health to gain access to disparate populations that can benefit from increased access to chronic disease prevention services. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis |
|
|
North Country Prenatal/Perinatal Council, Inc. |
Tina Cobb |
315–788–8533 ext 227 |
tcobb@ncppc.org |
www.ncppc.org |
Jefferson, Lewis, and St. Lawrence |
For 30 years, NCPPC has been providing a variety of services across Jefferson, Lewis and St. Lawrence counties. Services cover the age continuum with all programs address the SDoH. Programs include: home visiting for maternal and infant health and chronic disease, risk reduction, assistance with access to
healthcare/insurance through the NY State of Health Marketplace, Community Health Advocate programming which addresses health literacy, billing and access to care issues; prevention programs addressing adolescent pregnancy; CDSMP, health literacy, social isolation, avoidable hospitalizations, and a myriad of other services. NCPPC partners with a vast number of partners, over 100, to address the SDoH. Partners include: hospitals, CBOs, transporation, providers, business, etc. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Excellus Health Plan, Inc |
MVP Health Plan, Inc.; United Health Care of New York, Inc |
New York Quality Healthcare, Corpoartion |
North Shore Child and Family Guidance Center |
Andrew Malekoff |
516–626–1971 |
amalekoff@northshorechildguidance.org |
|
Nassau County |
Outpatient Mental Health for children from birth to 24 and their families |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AHN/RHS – Advanced Health Network / Recovery Health Solutions |
|
|
|
Northeast Parent & Child Society, Inc. |
Kelly Busch, Esq. |
518–426–2635 |
kelly.busch@northernrivers.org |
|
Albany, Broome, Chenango, Chemung, Clinton, Columbia, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Montgomery, Oneida, Oswego, Orange, Otsego, Rensselaer, Rockland, Saratoga, Schenectady, Schohaire, Sullivan, St. Lawrence, Tompkins, Tioga, Ulster, Warren, Washington,
Westchester, Yates |
Care management and community–based clinical services, licensed behavioral health, residential and foster care services, educational services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
CDPHP |
Fidelis |
Optum |
Northern Manhattan Improvement Corporation |
Morgan Siegel |
212–822–8300 EXT 410 |
morgansiegel@nmic.org |
https://www.nmic.org/ |
New York, Bronx |
Eviction Prevention, Immigration, Organizing, Adult Education, Domestic Violence, Food Security, Employment |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Northern Manhattan Perinatal Partnership |
Adrienne Mercer |
212 665 2600 ext 302 |
adrienne.mercer@nmppcares.org |
|
Northern Manhattan |
Maternal Child Health Home visiting and Early Learn Head Start |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Health First |
|
|
Northern Regional Center for Independent Living, Inc |
Aileen Martin |
315–785–8703 |
aileenm@nrcil.net |
www.nrcil.net |
Jefferson, Lewis and St. Lawrence Counties |
We provide services for any person with any disability of any age. Our specialty is advocacy in life domains such as health care, housing, employment, education. We also provide independent living skills development, peer support, information and referrals and transition supports. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
United Healthcare |
|
|
Nysarc, Columbia County DBA – Coarc |
Ken Stall – CEO |
518–672–4451 |
kens@coarc.org |
www.coarc.org |
Columbia |
Services to individuals witih developmental disabilties including housing, employment, and Day Habilitation activites |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Not yet, but will be shortly. IPA not formed yet but discussions are taking place. |
CDPHP |
Empire |
soon to be ´Parnters Health Plan´ |
OAR of Tompkins County |
Deborah Dietrich |
(607) 272–7885 |
debsterdietrich@gmail.com |
www.oartompkins.org |
Tompkins, Schuyler |
Assist individuals with applications for Medicaid, refer to providers i.e. TC Mental Health, ADC, REACH,. Provide limited housing (5) for formerly incarcerated males. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate NY |
Excellus Health Plan |
Fidelis Care |
|
Office for Aging Broome Co. |
DeeDee Camp |
607–778–2064 |
dcamp@co.broome.ny.us |
www.gobroomecounty.com |
Broome |
Nutrition education, counseling, application assistance, CDSM, Adult Day care, Home delivered meals |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
Fidelis |
|
|
Olmsted Center for Sight |
Kelly Dodd |
(716) 842–2608 |
kdodd@211wny.org |
www.olmstedcenter.org |
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming |
comprehensive services for individuals with visual impairments or blindness including early intervention services, adjustment to vision loss, employment, senior vision services, also operated 211WNY comprehensive information & referral service |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
|
|
|
Onondaga Council on Alcoholism & Addictions, Inc. d.b.a. Prevention Network |
Beth E. Hurny |
315–471–1359 |
bhurny@preventionnetworkcny.org |
www.preventionnetworkcny.org |
Onondaga, Cortland, Madison, Cayuga, Oswego, Otsego, Delaware, St. Lawrence, Jefferson, Lewis, Oneida, Herkimer, Chenango |
Prevention Network provides community based prevention services/programs across the lifespan. We use evidence–based strategies to reduce risk factors and increse protective factors. We address multiple social determinants of health by working collaboratively with other community partners. Substance use and mental
health issues are often an impactor of SDH. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Inclusive Alliance |
|
|
|
Open Door Family Medical Center |
Andrea B Ruggiero |
(914) 502–1479 |
aruggiero@odfmc.org |
opendoormedical.org |
Westchester, Putnam, Ulster |
Health Home, Nutrition, Dental, Primary Care, School Based Health Centers, Optometry, Podiatry, Wellness, Educational Groups (DPP), Behavioral Health, SUD Services, etc |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
MVP, Affinity |
|
|
Options for Community Living, Inc. |
Georgia Kuhen |
631–361–9020 x 1220 |
gkuhen@optionscl.org |
www.optionscl.org |
Suffolk and Nassau Counties |
Health Home Care Coordination, housing, case management |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
AHN (Advanced Health Network) |
Healthfirst, Fidelis, Affinity |
|
|
Osborne Treatment Services |
Christina Mansfield |
718–707–2693 |
cmansfield@osborneny.org |
osborneny.org |
Bronx |
substance abuse treatment for people with criminal justice involvement |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC cbcare.org |
HealthFirst, Metroplus, Fidelis |
|
|
Oswego County Opportunities, Inc. |
Patrick Waite |
315–598–4717 ext. 1016 |
pwaite@oco.org |
www.oco.org |
Oswego County |
OCO provides a variety of helaht and human services to individuals in Oswego County. This includescrisis intervention, housing, transportation education, case management, health care |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
INclusive Alliance, CNY Care Partners, LifeTime |
|
|
|
Otsego County Office for the Aging |
Tamie MacDonald |
607–547–7571 |
macdonaldt@otsegocounty.com |
https://www.otsegocounty.com/departments/office_for_the_aging/index.php |
Otsego |
Otsego County Office for the Aging assists residents age 60 and older and their caregivers by providing services and support to help older adults live safely and independently in their home and community. OFA services include non–medical personal care, case management, benefit screening,
application assistance, personal emergency response systems, home delivered meals, congregate meal sites, nutrition counseling, legal services, tax preparation, transportation, caregiver respite (in–home, short–term facility or adult day care) and Tai Chi for Arthritis. NY Connects is available to people of any age with a disability, their caregivers and professionals to navigate long term services and supports. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Mohawk Valley Network Hub (working on formation) |
|
|
|
Outreach Development Corp. |
Tony Croce |
(718) 847–9233 |
anthonycroce@opiny.org |
www.opiny.org |
Queens, Kings, Suffolk & Nassau |
Substance Use Disorder/Behavioral Health Treatment: Training of aspiring behavioral health and substance use disorder professionals. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Recovery Health Solutions www.recoveryhealthsolutions.com |
Beacon, HealthFirst, Fidelis |
|
|
Outreach HealthCare |
Sara Stern |
(1718) 855–6666 |
sstern@outreachhc.org |
|
5 Boros NYC / Orange and Rockland counties NY |
Care Management/ Advocacy/ Creation of services in HPSA areas |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Brooklyn HUB |
HealthFirst |
United HealthCare |
Fidelis |
Parent Network of WNY |
Susan Barlow |
(716) 568–6366 |
srb@parentnetworkwny.org |
www.parentnetworkwny.org |
Erie, Niagara, Chautaqua, Cattaraugus; Orleans, Genesee, Wyoming |
Parents/Families of people with a Disability (all ages) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
IHA |
Fidelus |
Your health |
ParentChild+ |
Andre |
Eaton |
5168837480 |
|
Kings, Bronx, Queens, New York, Erie, Monroe, Suffolk, Nassau, Westchester, Rockland, Onondaga |
ParentChild+ uses education to break the cycle of poverty for low–income families. We engage early in life and help toddlers, their parents, and their family child care providers access a path to possibility through an early childhood home visiting model.
. This addreeses the SDS on family engagement, early literacy and education. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Parker Jewish Institute for Health Care and Rehabilitation |
Loraine Breuer |
(718) 289–2102 |
lbreuer@parkerinstitute.org |
www.parkerinstitute.org |
Nassau, Suffolk, Queens, Kings, New York, Bronx, Westchester |
Skilled nursing, home care, hospice |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
|
|
|
Parsons Child and Family Center |
Kelly Busch, Esq. |
518–426–2635 |
kelly.busch@northernrivers.org |
|
Albany, Broome, Chenango, Chemung, Clinton, Columbia, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Montgomery, Oneida, Oswego, Orange, Otsego, Rensselaer, Rockland, Saratoga, Schenectady, Schohaire, Sullivan, St. Lawrence, Tompkins, Tioga, Ulster, Warren, Washington,
Westchester, Yates |
Care management and community–based clinical services, licensed behavioral health, residential and foster care services, educational services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Healthy Alliance IPA |
CDPHP |
Fidelis |
Optum |
Partners in Care |
Jessica Williams |
212–609–5051 |
jessica.williams@vnsny.org |
www.vnsny.org |
New York, Queens, Kings, Bronx, Richmond, Nassau, Suffolk, Westchester |
Care management services address clinical, behavioral health, and social determinants needs. Key to this model is engagement of paraprofessional health coaches who conduct health literacy and serve as community navigators. Care Managers conduct SDH risk assessments, stratification and use search engine technology (like
Healthify) to link individuals to services to address economic instability, housing instability, food insecurity, family/community support, and health literacy. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
VNSNY CHOICE MLTC |
|
|
PATH Center at The Brooklyn Hospital |
Sheila Anane |
718–250–8408 |
sanane@tbh.org |
https://www.tbh.org/ |
Kings, Queens, Bronx, New York, Richmond |
PATH provides healthcare, case management, mental health, nutrition, and social services to individuals with or at risk for contract HIV. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
|
|
|
PathStone |
Sislyn Vazquez |
(585) 589–5511 |
svazquez@pathstone.org |
https://www.pathstone.org/ |
Orleans |
We provide education, advocacy, linkage services to the female incarcerated population inside Albion Correctional Facility. We collaborate with DOCCS, community partners and other Community Base Organizations. |
Unsure |
|
Medicaid |
|
|
Pathways, Inc. |
Cynthia Gee |
607–937–4519 |
cgee@pathwaysforyou.org |
www.pathwaysforyou.org |
Allegany, Broome, Tioga, Tompkins, Steuben, Chemung, Schuyler, Yates, Ontario, Wayne, Seneca, Monroe, Genesee |
CFTSS, Children´s HCBS, Care Management, Adult HCBS, Day Habilitation, Community Habiltation, Waiver Services for NHTD/TBI/OPWDD, Residential facilities for OMH and OPWDD |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Fidelis, Excellus, Optum, Molina, MVP, Beacon, Univera, Capital District Physician´s Health Plan |
|
|
Peace Valley Haven Inc |
Daphne Haynes |
(516) 850–6765 |
daphhaynes@aol.com |
peacevalley haven.org |
USA |
Peace valler Haven provides emergency services to homeless and the tool to achieve self sufficiency, we also provode tranisionaal housing for homeless senior and casemanagement srvices for homeless women and children in the Hempstead school district. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
HEAL H |
United Healts and medcade , Medicaid Medicare, Medicaid, Medicaid and Affinity, Medicaid and Health First, |
|
|
PEACE, Inc. |
Carolyn Brown |
(315) 634–3737 |
carolyn.brown@peace–caa.org |
Peace–caa.org |
Onondaga, Oswego |
We serve low income individuals from birth to seniors through a variety of programs including Head Start, Big Brothers Big Sisters, Family Resource Centers, Weatherization, Free Tax Prep, Senior Nutrition, Foster Grandparents, Eastwood Community Center and Senior
Supports. We promote kindergarten readiness, high school graduation, economic self–sufficiency and seniors aging in place. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Medicaid, Medicare, Molina, United Healthcare |
|
|
Peer Coach Academy |
King McELvy |
(518) 479–9245 |
king@peercoachacademy.com |
www.peercoachacademy.com |
Albany Troy,Schenectady |
Peer Advocates,Returning Inmates, High School Seniors, Recovering People |
Unsure |
|
NA |
|
|
Phoenix Houses of NY/LI |
Ann–Marie Foster |
718–222–6608 |
amfoster@phoenixhouse.org |
phoenixhouse.org |
NYC, Long Island, Westchester |
offer substance abuse services, 820/819 , OMH mental health CR and PROS services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Healthplus |
Beacon |
United Healthcare |
Planned Parenthood of Nassau County |
Nancy O´Keefe |
516.750.2501 |
nancy.okeefe@ppnc.org |
ppnc.org |
Nassau |
PPNC provides reprodutive health care, including abortion and prenatal care, and limited primary care. Included in this care is screenings for IPV, depression, and alcohol and substance abuse. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
HIP, Affinity, UHC |
|
|
Planned Parenthood of New York City |
Carmina Bernardo |
212–274–7277 |
carmina.bernardo@ppnyc.org |
www.ppnyc.org |
Bronx, Kings, New York, Queens, and Richmond |
We provide social and health services referrals to other organizations if we cannot provide them on site. Referral partnerships include: The Door, Family Justice Center, Safe Horizon, and Community Healthcare Network. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
FidelisCare, Health First, and MetroPlus |
|
|
Polonians Organized to Minister to Our Community, Inc. (POMOC) |
Ewa Kornacka |
(718) 366–5365 |
pomoc@verizon.net |
in progress |
Queens, Brooklyn, Staten Island, clients from other NY counties |
health literacy outreach and workshops, individual assistance with all healthcare related issues. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Empire Health Choice HMO |
Healthfirst |
United Health Care of NY |
Population Health Collaborative |
John Craik |
(716) 863–2295 |
jcraik@phcwny.org |
https://www.pophealthwny.org/ |
Erie, Niagara, Chautauqua, Cattaraugus, Orleans, Genesee, Wyoming, Allegany |
We bring together people and organizations, share resources and measurably improve their skills and connections. As a result, efforts are more aligned, strategic, and meaningful than they would be without our involvement and leadership. As a neutral thought leader and expert, we collectively identify, implement and advance best
practices that are proven to improve health and well–being in the 8 counties of WNY. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Blue Cross/Blue Shield of WNY |
Independent Health |
Univera |
Power of Two |
Erasma Monticciolo |
(347) 559–1519 |
erasmam@powerof2.nyc |
https://www.powerof2.nyc/ |
Kings County and New York |
Our mission at Power of Two is to partner with caregivers to help them develop resilience so that they can better care for their families and promote healthy trajectories for their children and their communities. Through our work, we address the reality that
children born into poverty and to families that have themselves experienced trauma are often exposed to prolonged toxic stress and are therefore at higher risk for negative effects on mental health, learning, behavior, and physical health across their lifespan. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Prevention Council of Saratoga County |
Janine Stuchin |
(518) 581–1230 |
execdir@preventioncouncil.org |
www.preventioncouncil.org |
Saratoga |
Healing Springs Recovery Community Center – We are a community center with peer–driven, peer–delivered services, offering hope to those in recovery from addiction and their family members. We have resources, we make referrals and we connect people. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Pride for Youth (Long Island Crisis Center) |
Devon Zappasodi |
(631) 940–1964 |
dzappasodi@longislandcrisiscenter.org |
http://www.prideforyouth.org/ |
Queens, Nassau, and Suffolk Counties |
Pride for Youth provides the following free services to LGBTQ youth up to age 30; social support (EBIs) groups, individual and family counseling sessions, case management services, community level events designed to mobilize the community to access supportive services, in–school workshops in elementary/middle/high schools on
homophobia,and transphobia, and PrEP/PEP support program services. For LGBTQ individuals up to age 45, free services include rapid HIV testing, rapid syphilis testing, on–site comprehensive extragential STI testing via medical partner (service is billed), hormone replacement therapy (HRT) for transgender individuals with cannot obtain health insurance due to immigration status, PrEP/PEP screenings/asessments/intakes and enrollment, insurance navigation support, an EBI designed to meet the sexual health needs of Hispanic/Latino LGBTQ individuals (groups held in spanish). All services
are available in english and spanish. Pride for Youth also hosts an open food pantry for any clients suffering from food insecurity. This food pantry is in partnership with Island Harvest. Clients accessing any of our services have access to the agency´s free van transportation and/or will be reimbursed the cost of their public transportation usage to and/from services. For the larger community, Long Island Crisis Center, provides 24 hr, 7 days a week, 365 days a year, crisis intervention hotline service for all people. The
crisis intervention hotline is available via phone, internet chat, and text with the ability for multilingual translation abilities. Long Island Crisis Center/PFY has partnerships with the following medical health systems: Northwell Health, Damian Family Health Centers, Healthy Transitions LLC, Planned Parenthood, and HRHcare. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
|
|
|
Project Hospitality |
Michelle Gassama |
718–448–1544 |
Mgassama@projecthospitality.org |
Www.projecthospitality.org |
Richmond |
It is the mission of Project Hospitality, Inc. to reach out to community members who are hungry, homeless or otherwise in need in order to work with them to achieve their self–sufficiency — thereby enhancing the quality of life for our community. Project Hospitality seeks to realize its mission both by advocating for those
in need and by establishing a comprehensive continuum of care that begins with the provision of food, clothing and shelter and extends to other services which include health care, mental health, alcohol and substance abuse treatment, HIV care, education, vocational training, legal assistance, and transitional and permanent housing. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Care – CBC |
Amerigroup, Fidelis, Health First |
|
|
Project Renewal, Incorporated |
Rebecca Stauffer |
212–620–0340 443 |
rebecca.stauffer@projectrenewal.org |
www.projectrenewal.org |
Manhattan; Bronx, Kings |
Since 1967, we have pioneered programs that provide health, homes, and jobs which empower individuals and families to renew their lives. Each year we provide services to 16,000 individuals.We are one of New York City´s largest providers of comprehensive health
services to homeless individuals—delivering healthcare to more than 12,000 people a year.We provide award–winning emergency, transitional, and permanent housing to more than 3,900 homeless New Yorkers a year, including veterans and families.We incorporate employment services into every aspect of our programming, connecting clients to services that match their needs. We get adults into competitive jobs quickly and help them stay employed. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Metro Plus, Health First, Fidelis, Affinity, AmidaCare, Health Plus, WellCare, United Healthcare Community Plan, United Healthcare, Oxford, Emblem Health/GHI |
|
|
Public Health Solutions |
Arielle Burlett |
(646) 619–6454 |
aburlett@healthsolutions.org |
www.healthsolutions.org |
Kings, Queens, Bronx, New York, Richmond |
Public Health Solutions´ (PHS) mission is to support vulnerable New York families in achieving optimal health and building pathways to reach their potential. We focus on a wide range of public health issues that affect the ability of New Yorkers to live their healthiest life, including food and nutrition for low–income individuals,
families and children at 9 co–located WIC and SNAP centers; access to healthcare for low–income individuals through insurance enrollment navigation and support; maternal and child health through home–visiting programs, including Nurse Family Partnership; and comprehensive reproductive healthcare for women, men and adolescents. We provide services directly to more than 105,000 families each year, and serve more than 240,000 through coordinated networks and public–private partnerships across New York City. We maintain partnerships with
approximately 300 community–based organizations and a range of healthcare partners, including New York Presbyterian–Queens, Community Healthcare Network, Health + Hospitals, and managed care including Empire Blue Cross Blue Shield and WellCare. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
|
MetroPlus |
Healthfirst |
|
Queens Community House |
Hannah Lupien |
7185925757 x224 |
hlupien@qchnyc.org |
www.qchnyc.org |
Queens |
Queens Community House (QCH) is a multi–site, multi–service settlement house that serves the diverse neighborhoods of Queens. We are committed to a holistic approach that deals with immediate needs as well as the barriers that may impede personal, family, and community stability. We recognize the interconnected relationship between
housing, health, employment, education, self–esteem, and financial wellbeing, and ensure all participants in every program have access to a full range of resources to help them achieve wellness and life–long security. Services include childcare & education, youth employment services, housing, food access, immigration services, and senior services (senior centers, social adult day services, caregiver support, case management, NORC, and home delivered meals). |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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RAIN Inc |
Jane Bello |
718–892–5520 |
jane.bello@raininc.org |
www.raininc.org |
Bronx, Manhattan |
Housing, benefit etitlements, home delivered meals, case management, evidence based health promotion, congregant meals, transportation, alzheimer´s caregiver support |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Health First |
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Rainbow Access Initiative, INC |
Arlene Lev |
(518) 463–9152 |
president@raialbany.com |
raialbany.com |
Albany, Schenectady, Rensselaer |
Rainbow Access Initiative provides low–cost mental health services for LGBTQ community. We also provide transition support for transgender identified individuals. |
Unsure |
CBO Consortium of Upstate NY |
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REACH CNY, Inc. |
Elizabeth Crockett |
315–424–0009 ext112 |
execdir@reachcny.org |
www.reachcny.org |
Onondaga, Oswego, Cayuga, Madison |
REACH CNY provides Community Health Worker services for women of childbearing age, including preconception, pregnant, parenting and interconception. Services targeted to women who have health risks and/or are Medicaid eligible. Focus on increasing health equity.
Partnerships with NYSDOH and the Onondaga County Health Department and with Oswego County Opportunities. Also, in partnership with SUNY Upstate Cardiology and Adult Health primary care, we provide CHW services to adults with Congestive Hearth Failure and diabetes. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Reach Medical |
Amy Gecan |
(858) 228–7773 |
agecan@reachmed.org |
http://reachprojectinc.org |
20 counties in the Southern Tier with locations in Tompkins and Broome |
We work with all patients who would typically feel they face stigma in health care. Our largest patient population suffers from Opiate Use Disorder, or Hepatitis C, many of our patients have been recently incarcerate |
Unsure |
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fidelis |
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Recovery Houses Of Rochester,inc. |
Van L. Smith Jr. |
(585) 413–0551 |
van@recoveryhousesofrochester.org |
www.recoveryhousesofrochester.org |
Monroe , Wayne ,Erie , Genesee , Ontario, |
Targeted Population Substance Abuse ,Mental Health , Homeless |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Behavioral Health Collaborative |
Excellus Blue Cross Blue |
Blue Shield |
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Regional Aid for Interim Needs, Inc. |
Jane Arce–Bello |
718–892–5520 |
jane.bello@raininc.org |
raininc.org |
Bronx |
Care Coordination |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Rehabilitation Support Services, Inc. |
Elizabeth Kadatz |
(1518) 464–1511 |
ekadatz@rehab.org |
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Albany, Schenectady, Rensselaer, Saratoga, Schoharie, Otsego, Delaware, Chenango, Tioga, Westchester, Orange, Sullivan, Ulster, Dutchess |
Housing, employment for individuals with behavioral health challenges |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Health Services (CBHS). Also participating in 3 BHCC´s that are awaiting approval of IPAs. |
Fidelis |
CDPHP |
MVP |
Resource Center for Accessible Living, Inc. |
Kathy Hochman |
845–331–0541 |
khochman@rcal.org |
www.rcal.org |
Ulster, Dutchess, Columbia, Greene |
Case Management, employment services, community rehabilitation, respite, benefits advisement, architectural barriers removal, special education advocacy, representative payee services. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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MVP |
Fidelis |
CDPHP |
Resource Center for Independent Living, Inc. |
Wendy Gagliardo |
315–797–4642 |
wgagliardo@rcil.com |
www.rcil.com |
Albany, Bronx, Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Kings, Lewis, Madison, Montgomery, Nassau, New York City, Oneida, Onondaga, Oswego, Otsego, Queens, Rensselaer, Richmond, Saratoga, Schenectady, Schoharie, St. Lawrence, Suffolk, Tompkins, Ulster,
Warren, Washington, Wayne |
Consumer Directed Personal Assistance Program – Fiscal Intermediary for individuals with chronic illness or disability to remain in their homes and avoid institutionalization; Self Direction – Fiscal Intermediary services that allow individuals with developmental
disabilities to direct their own services and care; Open Doors (Money Follows the Person) – Resources and supports to individuals transitioning from institutional placement to community–based living; Elderly Services – Respite for caregivers and activities for seniors and their caregivers; Many Hearts Senior Care Center – social model adult day program; Olmstead Housing and Rapid Transition Housing – Transition services and rental support to individuals transitioning from nursing homes to community–based living.
Partnerships exist with state and local governmental agencies, health homes, care coordination organizations, and human service providers among others. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Fidelis, VNA Nascentia, Senior Network Health |
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RiseBoro Community Partnership |
Chris Leto |
917–9937241 |
cleto@riseboro.org |
riseboro.org |
Kings (mostly) queens, NYC, Bronx (soon) |
Community based organization that has a Home Care program, Assisted Living, Wellness Rising: works on Food and Nutrition, Farmers Markets and an asthma program. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Rockland Paramedic Services, Inc. |
Raymond Florida |
845–627–8612 |
rflorida@rocklandparamedics.org |
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Rockland County |
Emergency Medical Services and Crisis Behavioral Health Services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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CHP |
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Rosa Lee Young Childhood Center |
Jeannine Rey |
(516) 536–5674 |
rlyjrey@aol.com |
www.rosaleeyoungchildhoodcenter.org |
Nassau |
Early childhood Education and Child Care |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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RUPCO, Inc. |
Kelsey Vargas |
845–331–2140 x218 |
kvargas@rupco.org |
https://rupco.org/ |
Ulster, Greene, Dutchess |
Section 8 Distribution, Affordable/Sustainable Residential Housing support, Targeted Populations: Aging in Place, Young Adult, Homeless. Partnerships: OFA, OTDA, local Ulster/Dutchess NGOs, CoC |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Rural Health Network of SCNY, Inc. |
John C. Salo |
607–692–7669 |
jsalo@rhnscny.org |
https://rhnscny.org/ |
All programs: Broome, Tioga, Delaware; Some programs: Chemung, Chenango, Cortland, Otsego, Tompkins, Schuyler, Steuben |
Rural Health Network of SCNY provides SDH services to rural Medicaid members through the Getthere call center (transportation information, education, Medicaid vouchers), the Food and Health Network (food security, nutrition, local food systems, Farm to School, Fruit and Vegetable Prescription program), Community Health Workers
(outreach, screening for SDH needs, patient activation and goal setting, hospital discharges, care transitions, other referrals), and Community Health Education (health literacy, evidence–based interventions, rural cultural competency). We also address social determinants related to mental and behavioral health, including substance use disorder. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Excellus, Fidelis Care, UnitedHealthcare |
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Rural Outreach Center |
Frank Cerny |
(716) 474–4194 |
frank.cerny@verizon.net |
http://theroc.co |
Erie, Wyoming, Alleghany, Cattaraugus |
ROC programs break the negative cycle of generational poverty, as Participants of all ages direct their own path to self–sufficiency. An array of services are offered to meet the multiple, complex needs of the rural population. Our model of empowerment resulted in more than 50% of engaged participants improving their housing and
emotional health status in 2018. Most come to the ROC after hearing about our services from someone who has been helped. Others come to us through our community outreach programs (snack pack, back pack, winter readiness). Immediate needs are assessed and resources accessed – Department of Social Services, utility companies, food pantries, etc. Once stabilized they are asked if they would like to participate in our programs to move themselves away from dependency – from the situations that brought them to the ROC. Should they
wish to become engaged, they participate in an examination process where they set life goals that become part of an agreement where they agree to work toward those goals and the ROC agrees to provide the resources they will need. Adult Participants then enter ROC U that provides opportunities to work on factors that perpetuate poverty; see below for outcome measures. ROC U offers opportunities they need to attain their goals. Virtually all start with a budget examination and development of a financial plan. This determines if the ROC will have to make
resources available to them and, if so, how many. Resources include: habit examination, parenting, relationships, nutrition/cooking, etc., repairing dysfunctional relationships, home organization, civic engagement, developing socialization skills, etc. Earned incentives include many of those listed below in our program listing. Kids ROC is a parallel program for school age children. Based on the Josephson´s Institute Character Counts model, participants engage in activities that develop trustworthiness, caring, responsibility, fairness, respect and citizenship.
When they show evidence of appropriate activities, they get a stamp in their passport and earn ROC bucks that can be redeemed for movie tickets, books, shopping opportunities. Play therapy is available for children who have experienced severe trauma. Babies ROC is a pilot program for children from infancy through 5 years. Toddlers and their parents participate in weekly support communities for formal and informal information exchange. Children from 3 to 6 receive scholarships to preschool programs in addition to the community. All children will be eligible for Theraplay. Outcome
Measures Our outcome measures are based on the National County Health Rankings, that assume that 80% of morbidity and mortality is affected by the social determinants of health – those opportunities that the ROC provide to change lives.Most come to the ROC after hearing about our services from someone who has been helped. Others come to us through our community outreach programs (snack pack, back pack, winter readiness). Immediate needs are assessed and resources accessed – Department of Social Services, utility
companies, food pantries, etc. Once stabilized they are asked if they would like to participate in our programs to move themselves away from dependency – from the situations that brought them to the ROC. Should they wish to become engaged, they participate in an examination process where they set life goals that become part of an agreement where they agree to work toward those goals and the ROC agrees to provide the resources they will need. Adult Participants then enter ROC U that provides opportunities to work on factors that perpetuate poverty; see below
for outcome measures. ROC U offers opportunities they need to attain their goals. Virtually all start with a budget examination and development of a financial plan. This determines if the ROC will have to make resources available to them and, if so, how many. Resources include: habit examination, parenting, relationships, nutrition/cooking, etc., repairing dysfunctional relationships, home organization, civic engagement, developing socialization skills, etc. Earned incentives include many of those listed below in our program listing. Kids ROC is a parallel program for school
age children. Based on the Josephson´s Institute Character Counts model, participants engage in activities that develop trustworthiness, caring, responsibility, fairness, respect and citizenship. When they show evidence of appropriate activities, they get a stamp in their passport and earn ROC bucks that can be redeemed for movie tickets, books, shopping opportunities. Play therapy is available for children who have experienced severe trauma. Babies ROC is a pilot program for children from infancy through 5 years. Toddlers and their parents participate in
weekly support communities for formal and informal information exchange. Children from 3 to 6 receive scholarships to preschool programs in addition to the community. All children will be eligible for Theraplay. Outcome Measures: Our outcome measures are based on the National County Health Rankings, that assume that 80% of morbidity and mortality is affected by the social determinants of health – those opportunities that the ROC provide to change lives. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Safe Inc. of Schenectady |
Shannon Keon |
518–374–0166 |
safeinc@nycap.rr.com |
www.safeincofschenectady.org |
Mainly Schenectady County but have also worked with Albany County, Saratoga County, Rensselaer County, Fulton/Montogmery Counties, |
Safe of Schenectady has two programs: Project Safe and Safe House. Project Safe is an outpatient program for individuals ages 12–35 years old. Project Safe offers a Life Skills Program, Aftercare Program, Street Outreach Program and a Safe Harbour Program (Human Trafficking). Safe
House is a 30 day emergency youth shelter for ages 16–20. Safe House can also house a youth with and infant/toddler. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Medicaid |
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Saint James Church Lake |
James Krueger |
(607) 832–4401 |
saintjames@delhitel.net |
www.saintjamesld.org |
Delaware |
Seniors at risk for social isolation |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Unknown |
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SCAN New York |
Renee Avery |
Renee Avery |
Renee38135@aol.com |
www.scanny.org |
New York |
Case Management, Substance Abuse Treatment, Prevention, Food Pantry |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Renee Avery |
Health First, Blue Cross/Blue Shield, |
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Schenectady County Chapter, NYSARC, Inc. |
Mark Sheehan |
(518) 410–1322 |
marks@sarcny.org |
www.arcschenectady.org |
Schenectady |
Schenectady ARC offers a wide variety of services including residential, Article 16 and 28 (social work, psychiatry, primary medical services), day services and employment |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Medicaid – uncertain of specific health plan |
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Schenectady Inner City Ministry |
Sharon Carter |
518–331–7341 |
sharonc@sicm.us |
www.sicm.us |
Schenectady |
SiCM addresses food insecurity, nutrition and hunger by operating the largest Food Pantry in the County and is the only county–wide, summer–long, Summer Food Service provider : the largest Food Pantry in the County; the only county–wide, summer long – and offers the only diversity education program in Schenectady Co. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Schoharie County Office for the Aging |
Nancy Dingee |
518–295–2001 |
Nancy.Dingee@co.schoharie.ny.us |
www.schohariecounty–ny.gov/ |
Schoharie |
Services are provided primarily to Older Adults under a non–medical model. Services include Home Delivered and Congregate Meals, Case Management, In–Home Contact and Support, Application Assistance, Health Insurance Counseling for Medicare, Outreach, Legal Assistance, Transportation, Nutrition Education and Counseling, and
Health Promotion classes. |
Unsure |
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CDPHP, Empire |
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Seaway Valley Prevention Council |
Larry Calkins |
315 713–4861 |
lcalkins@svpc.net |
SVPC.net |
St. Lawrence |
Substance Use Disorders Prevention |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Selfhelp Community Services, Inc |
Russell Lusak |
(212) 971–7707 |
rlusak@selfhelp.net |
www.selfhelp.net |
The Bronx, Manhattan, Queens, Brooklyn, Nassau, and Suffolk |
Home and Community Based Services through social services and home care to independent older adults and "at–risk" individuals. Social Workers bring entitlements and benefits that impact the SDH in our clients´ private residences, our affordable housing, or senior centers. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Empire Blue Cross Blue Shield |
VNS Choice |
Healthfirst |
Seneca County Community Counseling Center |
Margaret Morse |
(315) 539–1980 |
mmorse@co.seneca.ny.us |
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Seneca |
Vocational Support/Counseling/ Case Management, Case Management, Transportation, Health Monitoring, |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Integrity Partners, Inc. |
United Healthcare |
MVP |
Excellus |
Services for the UnderServed |
Erin Palmer |
646–565–5802 |
epalmer@sus.org |
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Bronx, Kings, Richmond, Nassau, Suffolk, Queens, New York |
Housing and other supports for people with behavioral health issues and/or I/DD, veterans, domestic violence survivors and others who are homless, poor and/or recently released from incarceration/hospitalization |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC |
HealthFirst |
Metroplus |
United |
Settlement Health |
Mali Trilla |
(212) 360–2661 |
mtrilla@settlementhealth.org |
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All NYC counties |
Primary ambulatory health services, case management |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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HealthFirst |
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Sheltering Arms |
Jane Golden |
212–886–5688 |
jgolden@shelteringarmsny.org |
www.shelteringarmsny.org |
Bronx, New York, Queens, Kings |
Mental health services; Children and Family Treatment and Support Services; Foster Care health and mental health clinic |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Collaborative for Children and Families (CCF); AsOne |
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Shiloh Consulting LLC |
Kay Jackson |
(212) 564–7631 |
shilohconsultingllc@gmail.com |
shilohconsultingllc@gmail.com |
Bronx, Manhattan, Queens, Staten Island, Westchester, Brooklyn |
Behavioral healthcare to individuals who have been involved in diverse forms of intimate aggression. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
BHNYC IPA . Also we are a for profit organization. |
Healthfirst |
Beacon |
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Sidney EMS |
David Reynolds |
607 265–3258 |
dvreynolds@stny.rr.com |
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Broome, Chenango, Delaware, Otsego |
We work with Sidney Catholic Charities on access to healthcare |
Unsure |
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Skills Unlimited |
Matthew Collins |
516–870–1600 x1862 |
mcollins@familyres.org |
skillsunlimited.org |
Suffolk |
Employment, PROS, Mental Health Clinic |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AHN |
United Healthcare |
Beacon |
Health First |
South Asian Council for Social Services |
Rehan Mehmood |
(718) 321–7929 |
rehan@sacssny.org |
www.sacssny.org |
Queens, Brooklyn, the Bornx, Manhattan, Staten Island, Nassau and Suffolk |
SACSS focuses on three key areas of healthcare access, education and advocacy, senior support services and food security. Our target population includes South Asians and other immigrants. We assist individuals and families with enrollment into health insurance, resolving any post enrollment issues, benefit programs like SNAP,
Medicare Savings Program, Access a Ride, reduced metro cards, SCRIE, DRIE, etc. SACSS also started the first South Asian Food Pantry which provides culturally palatable food. We also conduct outreach and health literacy events throughout NYC. Through our Senior support program, we offer an array of services to the Seniors like senior movie night, Senior day, healthy breakfast and lunch on Wednesdays, trips to historical places in NYC, focus groups, individual and supportive counselling, workshops on social and emotional wellness. We also provide ESOL and Computer classes and carry out
activities around civic engagement. All our services are free and are provided by culturally competent s |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Communities Together for Health Equity (CTHE), https://cthe.us |
Health First |
Metroplus |
Fidelis Care |
Southern Tier AIDS Program, Inc. |
Michelle McElroy |
607–798–1721 |
mmcelroy@stapinc.org |
www.stapinc.org |
Broome, Chenango, Chemung, Cortland, Delaware, Otsego, Tioga, Tompkins |
syringe exchange services/harm reduction services, housing, care management, treatment adherence, behavioral health education, prevention services, point of care HIV/HCV/STD testing, Health Hub for People Who Use Drugs, re–entry services, prison education services & transitional planning, navigation & linkage services to
primary care, behavioral health & benefits/entitlements, etc. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Fidelis, Molina, CDPHP, Excellus, MVP, New York Quality Health Care, United HealthCare, |
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Southern Tier Health Care System, Inc. |
Donna Kahm |
(716) 372–0614 |
dkahm@sthcs.org |
www.sthcs.org |
Allegany, Cattaraugus and Chautauqua |
STHCS is a rural health networkdesignated by the NYS Department of Health. Our collaborating partners include area hospitals, physician groups, county health departments, home care providers and ambulatory medical services. We work with community partners to build programs and initiatives based on local needs. Our
ever–evolving programs include the Southern Tier Emergency Medical System (STEMS), Southern Tier Overdose Prevention Program (STOPP) and Sexual Assault Forensic Examiner (SAFE) program. Respectively, these cornerstones train and credential a network of 93 local EMS agencies, provide overdose resources and education, and care for survivors of sexual assault. We offer navigation assistance for those seeking affordable health insurance and also to caregivers of older adults. We administer a regional Cribs for Kids program
to give infant safe–sleep education and safe cribs to people in need. Our Stop the Bleed campaign provides community training and equipment to treat life–threatening bleeding emergencies. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Fidelis |
YourCare |
BlueCross BlueShield |
SPCC (Society for the Protection & Care of Children) |
Clarice Lazary |
585–325–6101 ext 237 |
clazary@spcc–roch.org |
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Monroe, Wayne, Yates, Seneca, Ontario |
Preventive programs for families at risk of child abuse and neglect |
Unsure |
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Excellus |
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St. Christopher´s Inn |
Terri Udolf |
(845) 335–1109 |
tudolf@atonementfriars.org |
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Putnam |
Housing – homeless shelter, SUD services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBHS |
Fidelis |
MVP |
HealthFirst |
St. Joseph´s Neighborhood Center |
Candice Lucas |
(585585) 325–5260 |
clucas@sjncenter.org |
|
Monroe and surrounding counties |
We serve the uninsured and the underinsured for primary care, mental health counseling, dental, and specialty care. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Community Alliance – Upstate CBO Consortium |
Excellus |
MVP |
YourCare |
St. Lawrence County Health Initiative, Inc. |
Anne Marie Snell |
315–261–4760 |
anne@gethealthyslc.org |
gethealthyslc.org |
St. Lawrence, Lewis, Jefferson, Oswego, |
Evidenced Based Interventions (Chronic Disease Self Management, Diabetes Prevention, etc), Adolescent Pregnancy Prevention, Health Insurance Enrollment, Cancer Screening Services, Adirondack Wellness Connections Coordinated Network |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Fidelis |
United Health Care |
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Starbridge Services, Inc. |
Terry O´Hare |
585–224–7204 |
tohare@starbridgeinc.org |
www.starbridgeinc.org |
Monroe, Wayne, Ontario, Livingston, Wyoming, Genesee, Orleans, as well as others in the Finger Lakes & Western NY region (depending on program) |
Starbridge supports people with disabilities and their families to connect with education, employment, residential, advocacy, healthy living, and fiscal intermediary supports and services. |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
Person Centered Services IPA |
Blue Choice, Fidelis Care, MVP Health Plan |
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Staten Island PPS |
c |
(917) 830–1140 |
achen@statenislandpps.org |
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c |
c |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Steuben Co OFA |
Patty Baroody |
(607) 664–2298 |
PBaroody@SteubenCountyNY.gov |
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Steuben County |
SCOFA has served consumers of all ages and all income levels for almost 40 years. We provide information and assistance and program–specific services both directly and through contracts. Transportation, the number one need identified, is offered in a variety of cost–effective ways utilizing volunteers and paid drivers. Senior
nutrition is offered through home delivered meals and congregate meal settings. Our EISEP Home care program offers non–medical in home services with a high rate of success in preventing unnecessary hospitalizations and facility placement. One of our fastest growing programs is the health insurance and benefits assistance program helping the confused consumer navigate through complex systems. NYCONNECTS is the aging and disabilities resource center for information and referrals on all LTC services and supports for all ages, mandated in each county since 2007. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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SUNY – University Eye Center |
Richard Soden |
212 938 5761 |
rsoden@sunyopt.edu |
sunyopt.edu |
New York |
Signing people uo for healthcare |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Affinity |
Metroplus |
Emblem |
The Albany Damien Center, Inc. |
Perry Junjulas |
(1518449) 711–9102 |
perryj@albanydamiencenter.org |
http://www.albanydamiencenter.org |
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Green, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties. |
We provide services for persons living with and affected by HIV and AIDS. Our services include housing, food/meals, medication access/adherence, behavioral health counseling, social activities, drop–in community center, HIV/STD/HVC testing and access to care, employment, assistance with pets, access to primary care |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Alliance for Better Health IPA |
CDPHP |
MVP |
Fidelis |
The Arc Mid–Hudson |
Dr. Nancy Dib |
845–338–1234 x42732 |
Nancy.Dib@ArcMH.org |
www.ArcMH.org |
Greene, Putnam, and Ulster |
The Arc Mid–Hudson provides services and supports for people with intellectual and developmental disabilities. We support children through our 2 preschools and various community–based services. The majority of the people we support are adults with I/DD. We offer supervised
and supportive living arrangements, work–training opportunities, day programs, volunteer opportunities, and we run an Article 16 clinic that offers clinical services to the IDD population. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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The Arc of Livingston–Wyoming |
Lynn Fleming |
585–658–2828 ext 106 |
lfleming@lwarc.org |
www.lwarc.org |
Livingston, Wyoming, Steuben, Ontario, Genesee, Monroe |
All services provided by the Arc of Livingston–Wyoming address various SDH for the NY Medicaid population. These services include residential, community habilitation, prevocational and vocational services, day habilitation, ISS housing subsidies, preschool and Headstart, clinical
services, Family support services, recreation, respite, transportation, self advocacy, and self direction . |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Person Centered Services |
MVP, Excellus |
|
|
The Center for Family Support, Inc. |
Steven Vernikoff |
212–629–7939 |
svernikoff@cfsny.org |
www.cfsny.org |
All 5 boroughs in NYC, Nassau, Suffolk & Westchester Counties in New York State and in the State of New Jersey |
Residential and Habilitative support for people with I/DD |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
HIP, HealthPlus, HealthFirst |
|
|
The Door |
Carolyn Glaser |
212–453–0212 |
carolyn@door.org |
www.door.org |
New York, Queens, Brooklyn, Bronx, Staten Island |
Housing Support, Career Services, Education Services, Medical Services, Counseling, Meals, Legal Services, Family Planning and Sexual Health Care, Arts and Athletics |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
HUB |
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The Family Center |
Jan Hudis |
718–230–1379 x. 124 |
jhudis@thefamilycenter.org |
www.thefamilycenter.org |
Kings, New York, Queens, Bronx |
mental health services including 3 evidence based child trauma treatment modalities including Trauma Focused–Cognitive Behavioral Therapy (TF–CBT), Parent Child Interaction Therapy (PCIT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS); Specialized services for Unaccompanied Alien
Children;Specialized services for grandparents and others raising children who are not their biological children including Parenting Support employing 3 evidence Parenting Curricula including Resource Parent Curriculum: Raising Children Exposed to Trauma (RPC), Positive Parenting Program (Triple P ) and Parenting Journey); Specialized Civil Legal Services for families impacted by illness |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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The Family Counseling Center |
Michael Countryman |
(518) 725–4310 |
mcountryman@thefamilycounselingcenter.org |
www.thefamilycounselingcenter.org |
Fulton, Montgomery |
Behavioral Health, Support for Domestic Violence Victims, Health Coaching, Mental Health Crisis Intervention, Family Peer Support, Respite, Children´s Case Management |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
New York Quality Healthcare Corporation |
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The Food Pantries for the Capital District, Inc. |
Natasha Pernicka |
(518) 458–1167 |
natasha@thefoodpantries.org |
www.thefoodpantries.org |
Albany, Rensselaer, Saratoga, Schenectady |
Food Insecurity, Food Assistance, Healthy Food, Fresh Produce, Service Coordination, Network of Food Assistance Providers, Referral Services, Data Tracking Software System, Streamlined Referral and Connection, Medically Tailored Meals, Medically Tailored Food, Food Delivery, Food Pantry.
The Food Pantries is a network of more than 67 food pantries and partners working together to end hunger. Our network serves 57,000 individuals in the New York Capital Region. Enough food is provided for more than 3.2 million meals annually. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Healthy Together IPA |
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|
|
The Institute for Family Health |
Carol Bouton |
845–255–3766 |
cbouton@institute.org |
www.institute.org |
Bronx, Brooklyn, Dutchess, New York, Ulster |
Primary medical care, mental health care, dental care and social support services including care coordination, insurance enrollment and benefits assistance. We participate in three New York State performing provider systems (PPS) as well as an ACO and an IPA. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Community Health IPA (https://www.communityhealthipa.com/) |
HealthFirst |
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|
The Interfaith Nutrition Network, Inc. (The INN) |
Joanne Robinson |
516 534 2810 |
jrobinson@the–inn.org |
www.the–inn.org |
Nassau County |
All free services: Hot daily meals, showers, food pantry, computer lab, assistance w ID documents, government benefits, housing and employment, transportation, mental health services |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
united, health first, fidelis |
|
|
The Jewish Board of Family and Children´s Services |
Diane Novy |
(212) 632–4615 |
dnovy@jbfcs.org |
www.jbfcs.org |
Bronx, Kings, New York, Queens, Richmond and Westchester |
Housing, behavioral health |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC IPA |
Healthfirst |
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|
The League Treatment Center (DBA League Education and Treatment Center) |
Mark Handelman |
718–643–5300 X342 |
mhandelman@leaguecenter.org |
www.leaguecenter.org |
Citywide |
Special Education and Mental Health services for seriously emotionally disturbed children and youth and Day Habilitation for Developmentally Delayed Adults |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Not sure |
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The Lesbian, Gay, Bisexual & Transgender Community Center |
Antonio Ruberto Jr |
(646) 556–9296 |
aruberto@gaycenter.org |
www.gaycenter.org |
New York, Bronx, Kings, Queens, Richmond |
We have two OASAS–licensed outpatient substance use treatment programs, one for ages 13–25 and one for ages 26 and up. Both are designed specifically for the LGBT population. We also offer free HIV testing M–F from 12–4pm, in addition to PEP/PrEP linkage and navigation, short–term mental health counseling, TGNC counseling and
support groups along with case management, and an expansive youth program with groups and internships five–days–a–week, including a drop–in space from 3–7:30pm. We also are a NYS insurance enrollment provider. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Bailey House |
MetroPlus |
|
|
The National Witness Project, Inc. |
Dee Johnson |
(716) 845–1394 |
thenationalwitnessproject@gmail.com |
nationalwitnessproject.org |
Western New York |
The National Witness Project, Inc. is a National Cancer Institute and a Research Test Intervention program listed on Cancer Control Planet.Gov (http://cancercontrolplanet.cancer.gov/index.html). The National Witness Project, Inc.´s goals are to assist low and non utilizer with access to affordable preventative
care and wellness services ie.community outreach services, culturally tailored education programs, navigation services for preventive health screening and Transportation. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
YourCARE Health Plan |
Blue Cross Blue Shield |
Independent Health Association, Inc. |
The New York Foundling |
Sylvia Rowlands |
212–660–1313 |
sylvia.rowlands@nyfoundling.org |
NYFoundling.org |
NY, Bronx, Kings, Richmond, Queens, Westchester, Rockland, Orange |
Educational advocacy, Criminal Justice Services, Health Care, Behavioral Health Care including SUD text, prevent maltreatment, domestic violence trx/prevention, housing services, Early Head Start/Head Start, college retention, academic tutoring, bilingual health/behavioral services, home–based health services, community
development, disproportionality in residential/criminal justice, Health Home Care Management, temporary and permanent supported housing. We partner with 52 other CBOs, are Foundling members of a BHCC and Health Home Collaborative. We have two strategic partnerships with small CBOs service niche populations – African, Arab, Middle Eastern, I/DD, Foster Care Children & Hearing Impaired. We target "complex family systems" for services. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
AsOne Healthcare & Collaborative for Children and Families |
HealthFirst |
|
|
The Newburgh Ministry, Inc. |
Colin Jarvis |
(845) 561–0700 |
cjarvis@newburghministry.org |
newburghministry.org |
Orange |
Homeless and homeless prevention services |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
United Healthcare |
MVP Healthplans |
Affinity Health Plan, Crystal Run Health Plan |
The Partnership for Ontario County |
Tracey Dello Stritto |
(585) 396–4554 |
partnershipforontariocountyed@gmail.com |
www.partnershipforontariocounty.org |
Ontario County |
Prevention services for substance abuse (focused on community engagement and schools) / Free counseling, support groups and wellness initiatives for those in recovery (substance use and mental health recovery and over 18 years of age) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBO Consortium of Upstate New York |
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The Partnership for the Homeless |
N/A |
N/A |
N/A |
https://partnershipforthehomeless.org |
New York county, Bronx county, Kings county, Queens county, Richmond county |
Eviction prevention services (rental assistance, landlord/tenant mediation, housing related legal referrals), voucher–based housing placement services, HIV/AIDS health education, health service navigation, peer support |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Healthfirst PHSP, Amida Care, MetroPlus |
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|
The Salvation Army |
Linda Wright |
315–434–1360 |
Linda.Wright@use.salvationarmy.org |
www.salvationarmyempirestate.org/ |
all 48 Upstate New York Counties |
provides services to address food insecurity, socialization, behavioral health, child care, housing/shelter, family services, employment, spiritual care/pastoral care, homeless prevention, child welfare services and clinical support |
Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers |
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Tioga County Rural Ministry |
Alycia Anthony |
(607)687–3021 |
aanthony@tcrm.org |
www.tcrm.org |
Tioga County, NY |
Food Pantry, Financial Assistance for housing, utilities, car repair, car insurance, prescriptions, etc., Ramp Building and Minor Repairs, Holiday Food Baskets, Spring Cleanup for Seniors, Christmas Clothing Gifts, Back to School Clothing for Teens, Personal Products, Nutrition Classes |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Fidelis, CDPHP, United Healthcare |
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|
Transitional Living Services of Northern New York |
Maureen Cean |
(315) 782–1777 |
mcean@tlsnny.com |
www.tlsnny.com |
Jefferson, Lewis, St. Lawrence |
TLS works with populations who have issues with mental health, homelessness, or living with chronic diseases. We are a licensed provider of residential and clinic programming through OMH. We are also a provider a homeless and supportive housing. We are a health home care management provider assisting people with chronic health
conditions. We are also a provider of HCBS services. Adults and children are both served. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
We are part of a health care IPA formed under DSRIP and a BHCC. |
UHC |
Fidelis |
Excellus |
Transitional Services for New York, Inc. |
Daniel Donoghue |
(718) 746–6647 |
ddonoghue@tsiny.org |
www.tsiny.org |
Queens, Brooklyn, Bronx, Nassau, |
TSINY provides support to over 3,000 New York City residents with a mental illness each year. We are a safety net provider and primarily serve the Medicaid enrolled population. We offer a full range of behavioral health programs including our Clinic, PROS, Mobile Outreach, Care Management, HCBS services, Employment Services,
Educational Supports, Adult Protective Services, Rapid Response Mobile Crisis Team, Crisis Respite Center, Peer Run Empowerment Center and over 700 units of housing ranging from Supervised Community Residences to Supported Housing. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Healthfirst |
Affinity |
MetroPlus, Fidelis |
TRI Center Inc |
Joe Gonzalez |
212–268–8830 |
Tricenter@msn.com |
|
Bronx,Kings, New York |
Out–patient drug treatment services, CMA CASE MANAGEMENT, HCBS and HARP services, Recovery Coach academy. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Health First |
Affinity Beacon |
United Healthcare Community Plan |
Trillium Health, Inc |
Donna Leone |
585–210–4125 |
dleone@trilliumhealth.org |
www.trilliumhealth.org |
Monroe, Wayne, Ontario, Livingston, Stueben, Schuyler, Yates, Seneca, Chemung |
Trillium Health provides comprehensive, integrated, primary and specialty health care services, supportive services and care management, prevention, education and testing, harm reduction and syringe access services to the Greater Rochester/Finger Lakes Region. Trillium Health provides these services to address health
disparities and improve outcomes of at–risk communities, including racial and ethnic minorities, LGBTQ populations, and individuals and families living in poverty. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Accountable Health Partners, https://ahpnetwork.com/ |
Excellus Health Plan |
|
|
Trinity Alliance of the Capital Region |
Harris Oberlander |
(518) 449–5155 |
h.oberlander@ta–cr.org |
trinityalliancealbany.org |
Albany, Schenectady, Rensselaer |
We have three program divisions (health and wellness, community based network services, alternatives to incarceration). We address micro and macro level social determinants to promote holistic wellness (services include housing navigation, social support services, early childhood intervention, food pantry, foster care
prevention, gun violence prevention, substance use treatment facility) |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Healthy Alliance IPA, Capital Behavioral Health Network |
CDPHP |
|
|
Truth Pharm |
Alexis Pleus |
607–245–6878 |
alexis@truthpharm.org |
|
Broome, Chenango, Delaware, Madison, Tioga, Chemung, Tompkins |
Addiction, Harm Reduction, Food, Hygiene, Housing, Healthcare, Incarceration, Re–entry, Social Justice |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Excellus |
Fidellis |
MVP |
Union Settlement Association, Inc. |
David Nocenti |
(212) 828–6046 |
dnocenti@unionsettlement.org |
www.unionsettlement.org |
New York County (Manhattan) |
Union Settlement is the oldest and largest social service provider in East Harlem, which is a neighborhood rich in culture and diversity, but also one of the lowest–income communities in New York City. We are both an on–the–ground resource for East Harlem residents of all ages, and a strong
advocate for the needs of underserved communities. Since opening our doors in 1895, Union Settlement has brought a wide range of education, wellness and community–building programs to this community. Our current services include: Early childhood education Youth afterschool and summer programs College preparation Job readiness Programs for disconnected and court–involved youth Adult education (including ESOL, HSE and citizenship classes) Mental health counseling Senior centers Meals on Wheels Small business assistance We
provide services to approximately 10,000 individuals every year from more than a dozen locations in East Harlem. Our services are designed to support the needs of every generation and culture, and we are also a strong advocate for underserved communities in New York City and beyond. Union Settlement is also one of the largest employers in East Harlem, with a staff of over 350 dedicated employees, and we also have the wonderful support of scores of volunteers. Together, we help give the residents we serve the skills, tools and education they need to build better lives for
themselves and their families. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
We are a participating provider in the Coordinated Behavioral Care (CBC) IPA |
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United Cerebral Palsy of New York City d/b/a ADAPT Community Network |
Mariette McBride |
212 683–6700 ext 1117 |
mmcbride@ucpnyc.org |
adaptcommunitynetwork.org |
Manhattan, Bronx, Queens, Kings, Richmond, Suffolk |
Health Care Centers, Article 16 clinics, residential and day habilitation programs |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
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Unity House of Troy. Inc. |
Linda Lewis |
518–274–2607 ext 4180 |
Llewis@unityhouseny.org |
www.unityhouseny.org |
Primarily Rensselear, but also Albany, Schenectady, Saratoga |
dedicated to enhancing the quality of life for People living in poverty, adults with mental illness, victims of domestic violence, children with deverlopmental delays, people living with HIV/AIDS, and others whose needs can be effectively met by Unity House services and philosophy |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Behavioral Health Care Collaborative |
CDPHP |
FIDELIS |
|
University Settlement |
Mary Adams |
(212) 453–4505 |
marya@door.org |
www.universitysettlement.org |
New York City – Manhattan, Brooklyn, Bronx |
Services available for ages 0 – older adults. English, Spanish and Chinese. Family child care, early childhood education, after school, entitlement counseling, housing stability and eviction prevention, food support, literacy programs, arts programming, parenting support programs/services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Collaborative Behavioral Care (CBC) www.cbcare.org |
Healthfirst, Metroplus, Fidelis, |
|
|
Vanderheyden |
Barbara Cataldo |
518–283–6500 X719 |
bcataldo@vanderheyden.org |
www.vanderheyden.org |
Albany, Renssealer, Schenectady, Fulton, Montgomery, Columbia, Greene, Herkimer, Saratoga, Schoharie, Warren and Washington |
Hard to Place youth, Children and Family Treatment and Support Services, Foster care sevices, OPWDD sevices, HCBS services, Supervised Independent Living Services and Health Home Services |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Capital Behavioral Health Network https://cbhnetwork.com |
CDPHP |
Fidelis |
United |
Venture House Inc. |
Leila McCarthy |
(347) 396–6670 |
lmmcarthy1@health.nyc.gov |
https://www1.nyc.gov/site/doh/index.page |
Richmond County |
We are a mental health psycho–social rehabilitation clubhouse, serving adults diagnosed with a serious mental illness. We assist our members with housing, education, and vocational services, as well as providing a familial atmosphere so people feel they belong to a community that will support them in achieving their
goals and not judge them. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
CBC IPA |
|
|
|
VIBS Family Violence and Rape Crisis Center |
Reina Schiffrin |
631–360–3730 |
rschiffrin@vibs.org |
vibs.org |
Suffolk County |
Counseling, Advocacy, Legal, 24/7 Hotline, Case Management , Education for victims of domestic and sexual violence. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
|
Victor Orlando Woolson Foundation, Inc. |
n/a |
n/a |
n/a |
www.vow–foundation.org |
Oswego County, Regionally, State and Country |
Education about synthetic drugs, addiction & Mental Health |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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|
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Villa of Hope |
Ruby Cosme |
585–865–1550 ext. 284 |
ruby.cosme@villaofhope.org |
www.villaofhope.org |
Monroe, Wayne, Ontario, Orleans, Genesee, Livingston |
Services we provide are Children & Family Treatment Support Services, Home & Community Bases Servcies for Adulth and Children, Adulth Health Home, Children´s Helath Home, Outpatient SUD Clinic, Outpatient Integrated Clinic, Inpatient RRSY, CD Prevention,
Peer Mentor, NYSED Part 853 Day School. Partnerships with DHS Monroe County, Bivona Child Advocacy Center, and Seven School Districts for Integrated Outpatient Services. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Rochester Planning Consortium and Behvavioral Health Care Collaborative |
Excellus Blue Choice Option |
|
|
VISIONS/Services for the Blind and Visually Impaired |
Nancy D Miller |
212–219–4071 |
nmiller@visionsvcb.org |
|
Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, Westchester |
in–home training for independence for legally blind and severely visually persons of all ages and their families and unpaid caregivers; falls prevention through orientation and mobility training; training for providing child care or elder care with limited vision or no vision; combatting social isolation with congregate
programs offering meals, socialization, evidence based programs for blind older persons (NYC only); workforce and job placement services for legally blind persons; pre–employment services for blind high school graduates that are disconnected youth (not in school and not working) |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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VNSNY Home Care |
Jessica Williams |
212–609–5051 |
jessica.williams@vnsny.org |
www.vnsny.org |
New York, Queens, Kings, Bronx, Richmond, Nassau, Suffolk, Westchester |
VNSNY´s Care Management Organization (CMO) offers comprehensive complex care management which addresses clinical, behavioral health, social determinants, and advanced illness needs. Key to this care management model is engagement of paraprofessional health coaches who conduct health literacy and serve as
community navigators. The CMO conducts SDH risk assessments, stratification and uses search engine technology (like Healthify) to link individuals to services to address economic instability, housing instability, food insecurity, family/community support, and health literacy. PEARLS conducts outreach and home–based evidence–based treatment to address social isolation and depression for seniors 65+. Parachute provides a continuum of evidence–based services for high utilizers of institutional settings. An interdisciplinary team provides six to nine months of in–home treatment,
serving as a bridge to a stable and multifaceted outpatient aftercare plan. Services include: outreach, crisis intervention, in–home psychiatric and medical assessment and treatment, in–home individual and family therapeutic services based on care plan, medication management and support, peer support, network meetings for participants and families/caregivers (NATM), rehabilitation support, and care management. Working closely with young, low–income, first–time mothers—nearly half of whom are teenagers—and their babies in the Bronx and Nassau County,
VNSNY´s Nurse–Family Partnership breaks the cycle of poverty and improves the future for both the mother and her family. NFP pairs mothers with a specially trained nurse who meets regularly with the mother from pregnancy through the child´s second birthday. The nurse monitors the mother´s and child´s health, encourages mother–child interactions (such as reading aloud) that enhance the baby´s development, and helps the mother plan for her child´s future and pursue her own education and career goals. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
CBC IPA |
United Healthcare |
|
|
Vocational Instruction Project Community Service |
Anna Otero |
718–589–5150 |
aotero@vipservices.org |
https://vipservices.org/ |
Bronx |
VIP offers integrated medical, behavioral health, housing, and wrap–around services to improve the health and well being of the Bronx and surrounding communities |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
|
Fidelis, Health first, and Metroplus |
|
|
Wayne Behavioral Health Network – County of Wayne |
James Haitz |
(315) 946–5725 |
jhaitz@co.wayne.ny.us |
|
Wayne also Monroe, Ontario, Seneca, Orleans, Wyoming, Genesee, Yates, Livingston |
We provide a full aray of mental health and substance use outpatient clinic treatment and support services. We also operate a Regional Open Access Center & COTI Mobile Response Service. Care management is also provided. Psychosocial Program is available. Forensic and jail based services. 31 School
based mental health clinics. We also function and as the LGU for the Dept of Mental Health for Wayne County. |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Integrity Partners for Behavioral Health IPA, Inc. |
Excellus Health Plan |
Fidelis Care |
United Health Care |
WellLife Network |
Sherry Tucker |
718–559–0516 |
sherry.tucker@welllifenetwork.org |
www.welllifenetwork.org |
Queens, Kings, Bronx, Nassau, Suffolk |
housing, food pantry, transportation education, clinical services, money management, life and social skills, health education, |
Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency |
Coordinated Behavioral Care (www.cbcare.org/ and Advanced Health Network (www.ahn–ipa.com) |
Beacon |
|
|
Western New York Integrated Care Collaborative |
Nikki Kmicinski |
(716) 887–2749 |
nkmicinski@wnyicc.org |
www.wnyicc.org |
Erie, Niagara, Cattaraugus, Orleans, Wyoming, Genesee, Allegheny and soon Chautauqua |
We provide community–based programs such as in–home care management, chronic disease self–management program, diabetes self–management program, diabetes prevention program, and can help partner with additional CBOs to offer more services according to the needs of the community and the health plans. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
Western New York Integrated Care Collaborative |
|
|
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WHMC MICHC Program |
Eleanor Juray |
718–963–7545 |
ejuray@wyckoffhospital.org |
|
Kings |
WHMC´s MICHC program aims to improve maternal and infant health outcomes. We aim to accomplish this by empowering and promoting women to seek knowledge in maintaining healthy behaviors across a reproductive life span |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Empire Blue Cross Blue Shield |
Health First |
Fedelis Care |
WIB Inc. dba Chautauqua Works |
Katie Geise |
716–487–5116 |
kgeise@chautauquaworks.com |
www.chautauquaworks.com |
Chautauqua |
Assist job seekers in finding employment and assist businesses in filling their open positions. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
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WNY Rural AHEC |
Valerie Putney |
585–787–6275 |
vputney@r–ahec.org |
www.r–ahec.org |
Allegany, Cattaraugus, Chautauqua, Genesee, Livingston, Monroe, Ontario, Orleans, Steuben, Wayne, Wyoming, Yates |
We offer trainings to the healthcare workforce that increases their knowledge of SDH, how to recognize it, and how to direct customers to services. We are presently designing classes for care coordinators which will give them skills to advance their careers. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
we don´t provide direct services to the medicaid population |
|
|
Women´s Prison Association |
Wendy Eberhardt |
646–50–7859 |
weberhardt@wpaonline.org |
|
All NYC Counties |
WPA provides a range of services for women with or at risk for criminal justice system involvement including case management, alternatives to incarceration, employment support and placement, legal assistance in family law and other civil matters, HIV prevention services including testing, prevention services for families with child welfare system involvement, and housing for homeless women and families |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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Youth Action Programs and Homes, Inc. |
Robert Taylor |
(212) 860–8170 |
rtaylor@yayb.org |
www.youthaction.nyc |
New York, Kings, Bronx, and Queens Counties |
High School Equivalency and Post Secondary Education, Vocational Skills training, Wrap Around and Workforce Development services. |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
|
Not sure |
|
|
YWCA Cortland |
Kelly Tobin |
607–753–9651 |
kelly@cortlandywca.org |
www.cortlandywca.org |
Cortland and surrounding |
Mentoring, Child Care, Victims Services and Health and Fitness |
Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks |
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