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Draft Health Home Application to Serve Children June 30, 2014Page 1 of 38DRAFT 6.30.14 Health Home Application to Serve Children Introduction The New York State Department of Health and its State
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Gather all necessary information and documents required for the application.
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Who needs health home application to?

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Individuals who have complex medical conditions and require coordinated care from multiple providers.
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People with mental health or substance abuse issues who need additional support and coordination of services.
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Individuals with chronic illnesses who need help managing their treatment and medications.
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Patients who have been discharged from hospitals or other healthcare facilities and need ongoing care and support.
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The health home application is a request for enrollment in a health home program, which provides coordinated care for individuals with chronic conditions.
Individuals with chronic health conditions who seek to access comprehensive care coordination services are required to file a health home application.
To fill out a health home application, individuals must provide personal information, details about their health conditions, and any supporting documentation required by the health home program.
The purpose of the health home application is to apply for enrollment in a health home program that offers coordinated services to improve health outcomes for individuals with chronic health issues.
The health home application must report personal identification information, health history, current medications, and any service needs related to the individual's chronic conditions.
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