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Make a Referral to CHHUNY

The Children’s Health Home of Upstate New York (CHHUNY) is accepting referrals from the community (community organizations, individuals and/or family members) for enrollment of eligible children/youth into Health Home Care Management Services.  

Eligibility Requirements

All Children/youth must meet the following eligibility requirements to be considered for enrollment.

1. Child/youth currently has active Medicaid and be under 21 years of age.

AND

2.    Child/youth resides in one of the following Counties:  Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Rensselaer, Rockland, Saint Lawrence, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming, Yates.

AND

Have two or more chronic health conditions OR one of the following single qualifying conditions:

   ● HIV/AIDS
   ● Serious Emotional Disturbance 
   ● Complex Trauma

AND 

Potential enrollees must also demonstrate that they would benefit from Health Home Care Management Services. CMA Provider Name has experts on staff that will work with you to determine if a child is eligible.

How to Refer a Child


1. Complete the electronic Community Referral Application Form below, including as much detail as possible to allow CHHUNY to verify eligibility for health home care management services. The information is stored in a secure site.  If you are unable to complete the electronic version and prefer to downloado our PDF Referral Form, you can find the printable form here: DOWNLOAD THE CHHUNY REFERRAL FORM FOR HEALTH HOME CARE MANAGEMENT SERVICES FORM HERE (.pdf).

If you believe the child/youth has complex trauma, the Complex Trauma Referral Cover Sheet and the Complex Trauma Exposure Screen available from the DOH website must also be completed and attached with the CHHUNY referral form. 

2. Approved children/youth will be assigned to a Care Management Agency who will conduct outreach and attempt to engage the child/youth in health home care management services. Health Home services are voluntary and the youth and/or parent/guardian will be asked to consent during the outreach and engagement process.

If you have questions regarding the completion or status of this application, please contact: CHHUNY Community Referral Coordinator at 855-209-1142.

Questions? Contact Us.