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Health Homes and Children

The New York State Health Home Program was launched in 2012. While children who meet the Health Home eligibility requirements have been eligible for Health Home enrollment since that time, it has been the intent of the State to work with existing Health Homes and other providers to tailor New York State's Health Home Model to better serve children and to recognize the important differences in the approach to care management and planning for children and adults. The links below provide webinars and important information that is being developed by the State (e.g. The New York State Department of Health, the Office of Mental Health, the Office of Alcoholism and Substance Abuse Services, and the Office of Children and Family Services) in consultation with Health Homes, Managed Care Plans, children's advocates and other stakeholders to tailor the Health Home model to better serve children. The State expects to work and collaborate with stakeholders over the next several months to tailor New York's Health Home model for children and anticipates that it will begin to phase in the enrollment of children in Health Homes on October 1, 2015.

Health Home Application to Serve Children and Attachments

Letters of Interest by Region - Ended July 30, 2014

DRAFT Forms and Templates For Health Homes Serving Children

Please submit any comments to these forms to hhsc@health.ny.gov All submitted comments should include “Your Organization Name: Comments to Consent” in the subject line.

Health Home Consent Frequently Asked Questions (FAQ) For Use with Children and Adolescents Under 18 Years of Age (DOH xxxx)

  • This form should be given to children and adolescents who are less than 18 years of age and who are eligible to enroll in a Health Home, and to their parents, guardians or legally authorized representatives. This form should be reviewed with them prior to completion of Forms A and B. However, children and adolescents who are parents, pregnant, and/or married, and who otherwise are capable of consenting, should not be given this form. They should be given the Health Home Patient Information Sharing Consent form (DOH 5055) to review and complete.

Health Home Consent Enrollment (Form A) For Use with Children and Adolescents Under 18 Years of Age (DOH xxxx)

  • This form must be used to enroll children and adolescents who are less than 18 years of age into a Health Home and must be signed by the child’s parent, guardian, or legally authorized representative. The Health Home Information Sharing Form (Form B) must also be completed after this enrollment form has been completed and signed by all necessary parties. However, children and adolescents who are parents, pregnant, and/or married, and who otherwise are capable of consenting, must consent for their own enrollment into a Health Home. They should do this by completing the Health Home Patient Information Sharing Consent form (DOH 5055). Legally authorized representative for enrollment in a Health Home is defined as: “a person or agency authorized by state, tribal, military or other applicable law, court order or consent to act on behalf of a person in making health care decisions”.

Health Home Consent Information Sharing (Form B) For Use with Children and Adolescents Under 18 Years of Age (DOH xxxx)

  • This form must be used for children and adolescents less than 18 years of age who have been enrolled in a Health Home using Form A*. This form outlines what, and with whom, health information can be shared. Section 1 of this form should be completed by the child/adolescent’s parent, guardian, or legally authorized representative. Section 2 of this form is completed separately by the child or adolescent with the care manager. Legally authorized representative for the purpose of sharing health information is defined as “a person or agency authorized by state, tribal, military or other applicable law, court order or consent to act on behalf of a person for the release of medical information”.
  • *[Please note, children and adolescents who are parents, pregnant, and/or married should not use this form to consent for health information sharing. Rather, they must use the Health Home Patient Information Sharing Consent form (DOH 5055)].

Children's Health Home Work Group

Resources