Innovation Fund Awardees Are Listed in the Chart

Innovation Fund Awardees
# Organization Amount Requested PROJECT OVERVIEW
Brief Summary of Proposal
1 Elant at Goshen, Inc. $ 100,040 The project will create an Adult Day Health Care Dementia program to serve the needs of individuals in the community w/ Alzheimer's or dementia, and provide support to primary caregivers.
2 Corning Council for Assistance and Information for the Disabled $ 178,084 The project will provide a rapid-response crisis intervention team to older New Yorkers and people with disabilities who face immediate risk of institutionalization (whether medical, behavioral, environmental).
3 Jewish Home Life Care, NYC Chapter $ 221,712 The project will develop an enhanced adult day care rehabilitation service to include rehabilitative therapy targeting older people to allow transition from short-term rehabilitation and individuals being discharged by CHHA.
4 Tompkins County Office for Aging $ 223,365 The project will provide in-patient Transition Support and home healthcare services after discharge via medication management, education and Telehealth monitors to reduce readmissions and costs.
5 Regional Center for Independent Living $ 224,096 The project will create a transition coaching program to work with consumers with disabilities across seven counties in educating them on LTSS including housing.
6 Council of Senior Centers and Services of NYC, Inc. $ 275,178 The project will provide evidence based fall prevention services. It will conduct a falls screen in senior centers with high percentages of MA eligible members.
7 Rockland Independent Living Center $ 275,738 The project will serve as the bridge to a wide range of programs and services in the community for those in need of LTSS, and assist consumers in finding connections in the community that allow them to live as independently as possible.
8 Jewish Home Life Care, Sarah Neuman Center $ 282,995 The project is an overnight adult day care program to help cognitive and functionally impaired frail older individuals remain in the community.
9 Consumer Directed Personal Assistance Association of NYS $ 295,500 The pilot project is for peer mentoring services through CDPAP and is intended to provide consumers with the supports they need to successfully remain in the community. The organization will reach between 2,500 and 2,750 consumers. It will be sustainable if health plans adopt the service.
10 Visiting Nurse Association of Central New York $ 308,000 The project will provide outreach and transportation to increase access to primary care.
11 Menorah Home and Hospital for the Aged and Infirm $ 317,703 The project will increase services and participation in an ADHC in Brooklyn. The project aims to keep those at-risk for institutional care within the community for longer.
12 Visiting Nurse Service Association of Schenectady County D/B/A VNS of Northeastern New York $ 346,352 The project aims to provide palliative home care to 120 Medicaid recipients in the capital district. It will provide intensive home-health care assistance to individuals at high-risk of institutionalization and focus on maintaining them outside of institutional care and bolstering their quality of life.
13 Research Foundation for The SUNY, University at Albany, The $ 348,105 The Diabetes Self-Management Program (DSMP) and Lower Extremity Amputation Prevention exam (LEAP) will target 300-400 Bronx residents with diabetes through pre-intervention and self-management to help prevent hospitalization and reduce emergency room use.
14 Jewish Association for Services for the Aged (JASA) $ 367,259 The project will enhance Information and Referral Call Center options for seniors to include screening for Medicaid and in person assistance with Medicaid applications for the over 60 population.
15 Institutes of Applied Human Dynamics Inc. (IAHD) $ 368,394 The project will provide direct support, training, and communication to family members of older (40+) individuals with I/DD. Training includes: prophylactic health and wellness issues, aging considerations, futures planning, use of community resources and social and emotional supports.
16 Lifespan of Greater Rochester $ 374,236 The project will provide healthcare-focused service coordination and linkages to other community-based services for an estimated 100 Medicaid beneficiaries who have difficulty navigating medical and non-institutional LTSS due to barriers such as low health literacy, lack of caregiver support, transportation, finances, etc.
17 Niagara Falls Memorial Medical Center $ 376,613 The project will strengthen the role of family caregiving through training education and support. It will target caregivers of individuals with physical and behavior issue and educate discharge planners. The organization will partner with Senior Health Partners (MLTC) and Westchester Ambulette.
18 Chautauqua County Chapter, NYSARC Inc. d.b.a. The Resource Center $ 397,581 The project will increase case management, medication management, and diabetes management services.
19 Gods Love we Deliver $ 405,693 The project will increase capacity to deliver medically tailored food and nutrition services by educating MCOs about the benefit and expand into new counties.
20 Resource Center for Independent Living $ 422,101 The project will increase access to community-based LTSS through outreach, training and a strategy to reach underserved populations (i.e.. refugees and immigrants). It aims to reach 2,000 individuals.
21 Odyssey House, Inc. $ 444,763 The project will enhance support services for older adults transitioning out of intensive residential treatment for substance use by utilizing both intensive case management and peer-based recovery coaching. It is specifically targeted to older adults, and aims to connect individuals with community-based LTSS, increase engagement in recovery process, maintain individuals in their homes in the community, and improve social connectedness. Recovery coaches/peers are 50+. The project will be sustainable through a new Medicaid reimbursable category for peer counseling.
22 Selfhelp Community Services, Inc. - SHASAM $ 491,486 The project will engage residents in NYC and Long Island and motivate them to participate in their own care by taking advantage of the multitude of wellness options available on site, as well as other social services through the case management programs.
23 Total Senior Care INC $ 518,133 The organization runs NYS's only rural PACE program. The project plans to establish an adult social day care program for individuals in rural Allegany/Cattaraugus counties. No program currently exists in this rural area and services will target those at high-risk for institutionalization.
24 Family Residences and Essential Enterprises,Inc. - Sustainable Employment $ 530,069 The project will create a skill development program for individuals with disabilities designed to address barriers to LTSS. There will be a focus on improving functional performance in order to successfully maintain or secure employment. It will provide an opportunity for individuals, who have been unsuccessful in accessing extended waiver services through OPWDD because of an inability, to complete the 90 day supported employment services through ACCESS-VR.
25 United Cerebral Palsy of New York City $ 556,778 The project will assist Medicaid recipients who are either currently in, or at-risk of, institutionalized placement by making medically necessary environmental modifications in all five boroughs of NYC.
26 Catholic Charities of Broome County dba Roman Catholic Diocese of Syracuse $ 587,558 The project will establish a "Coordinated Specialty Care Team" directed at assisting individuals age 15-35 who have experienced their 1st episode of psychosis and assist them in establishing community supports in order to avoid hospitalization, institutionalization, ER/crisis visits, etc. The project uses early intervention in order to promote long term recovery and reduce disability.
27 Family Residences and Essential Enterprises, Inc. - Enhanced Mobile Crisis $ 599,041 The project will enhance mobile crises support to 200 Medicaid recipients with SMI and TBI. It will expand the number of I/DD individuals served, and enhance the scope of services.
28 NYSARC, Inc. Capital NYC Chapter $ 658,667 The project will provide at least 30 clients in NYC with technological devices (i.e. wearable devices, PDAs) through a collaboration with GE Global Research. The devices are meant to increase independence and reduce the amount or need of direct care supervision.
29 New Horizon Counseling Center $ 664,933 The project will improve case management for Medicaid eligible persons 55 and older in Queens.
30 Research Foundation for the State University of New York, The, University at Albany $ 701,335 The project will collaborate with 8 ILCs across the state to provide Diabetes Self Management programs (CDSMD)and CM to people with disabilities.
31 Erie County Dept. of Senior Services $ 738,276 The project will use the ADRC model that proactively engages discharge planners to transition individuals into the community. It will prevent utilization of inappropriate levels of care and failed discharges into the community.
32 Selfhelp Community Services, Inc. - Medicaid Safety Net $ 751,463 The project will replicate and expand a comprehensive case management program (currently only offered to their housing residents) to low income seniors who are on Selfhelp senior housing waiting lists at 5 housing sites (approx. 3,200 individuals). The program includes the following services: legal, food security, income-based benefits, housing-related, mental health and substance abuse, financial management, health care, and socialization.
33 Selfhelp Community Services, Inc. - Medicaid Care Transitions $ 821,976 The project aims to prevent hospital readmissions by targeting high-risk groups and supporting them through the discharge process to ensure a plan is in place and follow up is done. It will reach an estimated 1380 patients from 3 hospitals.
34 Center for Disability Services $ 822,168 The project will develop a conflict free case management model for individuals with I/DD and consolidate administrative infrastructure between the Center for Disability Services and Upstate United Cerebral Palsy in Utica.
35 St. Mary's Hospital for Children Inc. $ 928,668 The project will use remote patient monitoring for clinically complex children within the CHHA who are most at risk for institutionalization. It will use a telemonitoring initiative with an Interactive Choice Response system.
36 Parker Jewish Institute for Health Care and Rehabilitation $ 928,942 The project will create a Geriatric Mobile Care Management system to work with seniors in Queens County, delivering health services to reduce hospital/emergency services.
37 Mental Health Association of NYC $ 952,175 The project will facilitate independence/recovery/re-integration into the community through service coordination and planning tools.
38 New York Memory Center $ 954,402 The project will establish a community program for adults with dementia and expand hours of operation to accommodate working caregivers. The project aims to serve an underserved population, and address the needs of caregivers.
39 New Alternatives for Children $ 1,030,000 The project will transition Medicaid-eligible medically fragile, physically disabled, DD, emotionally and behaviorally challenged children currently hospitalized or institutionalized into family-based settings. It will prevent at risk children from hospitalization or placement and increase outreach to foster and adoptive parents. It will reach as many as 450 children.
40 Hebrew Home for the Aged at Riverdale, The $ 1,045,108 The project will develop LGBT culturally competent training curriculum for social adult day services program staff.
41 Kids Oneida, Inc. $ 1,131,548 The project will hire staff to connect youth with behavioral issues to community services across 7 counties, to allow youth to remain at home with caregivers. Staff will work with families to provide access to vocational/educational programs for youth, and increased family involvement.
42 Hillside Children's Center $ 1,177,541 The project will provide planned and emergency respite for high need emotionally disturbed kids in Monroe County. It will continue HCBS coordination, education, and medical and psychiatric services during respite to minimize transition issues.
43 Carter Burden Center for The Aging $ 1,424,628 This project is a hybrid adult day program integrated into a low income housing site. It will provide transition support for those transitioning into the housing site. The program includes tele-health monitoring.
44 New York Foundling Hospital, The $ 1,484,667 The project will create a Transition Development Team to connect 100 developmentally disabled children and young adults in NYC to community supports. It will use the NICH evidence-based model to provide families the skills necessary to keep their children at home and in the community. It will also create a self directed skill-development/ transition plan for each individual in the program.
45 Concepts of Independence $ 1,499,527 This organization is the pioneer of the CDPAP program and seeks to build that work to amend and enhance education and peer support services for individuals interested in self-direction and transitioning from institutional to community-based settings. Through established partnerships with 7 ILCs they will deliver a Supportive Training and Education to Participants in Skilled Nursing Facilities (STEPS), providing enhanced peer support services to 200 Medicaid individuals and their families.
46 Children's Home of Jefferson County $ 1,540,105 The project will stabilize and provide a safe, secure alternative to hospitalization of children with social and emotional disturbance by providing short term (<14 days) youth Therapeutic Crisis Respite and including follow-up care coordination.
47 Central Nassau Guidance and Counseling Services $ 1,894,004 The project will provide crisis de-escalation and prevention, out-reach and in-reach at facilities to promote transitions to the community, facilitate enrollment in health homes and LTSS, education about med management and case management for adults with SMI.
48 Services of the Underserved INC $ 1,942,164 The project will serve adults in Brooklyn with I/DD, and co-occurring disorders to transition those in institutions back to the community and divert those at risk of moving to institutional care. Transition to Independence teams will provide: care coordination, applied behavior analysis, social work expertise, medication management services, and family and residential/program staff liaison to support behavioral interventions.
49 Paraprofessional Healthcare Institute Inc. $ 1,958,592 The project will train aides to be part of care transition team that supports telehealth.

50 Coordinated Behavioral Care $ 2,236,925 The project will facilitate the transition to the community from inpatient and institutional settings of 160 NYC Medicaid beneficiaries 18 years and older, who face profound challenges due to disabilities resulting from SMI.
51 Buffalo Federation of Neighborhood services Inc. $ 2,312,510 The project will inform and bridge isolated and/or disenfranchised seniors to existing LTSS as appropriate by using the UAS Community Assessment and case management services for individuals age 50+ with a disability who do not otherwise qualify for a health home. It will increase access and utilization of community-based LTSS by setting up 5 Care Teams and hiring 8 Patient Navigators that will operate out of senior centers, subsidized apartment buildings and churches.
52 Albert Einstein Children's Evaluation and Rehab Center. Albert Einstein College of Medicine $ 2,403,654 The project will integrate health home services with behavioral health supports and case management services, and establish crisis and respite services.
53 Advanced Care Alliance of NY, Inc. $ 2,635,826 The project will provide medical triage service, urgent care teams, network of providers for next day/week appointments for I/DD individuals. The pilot project could inform service provision and the development of DISCOs.
54 Catholic Managed Long Term Care Inc. $ 2,980,012 The project seeks to enroll 150 nursing home eligible seniors with I/DD into a pilot PACE program particularly tailored to that population. The organization has experience running 3 other PACE programs and would hire and train staff to specifically serve older people with I/DD. The applicant ArchCare operates a clinic for the developmentally disabled, with 235 clients over age 55. Data from the program will inform capitation rates as well as future MLTC plans.
  TOTAL AWARDED: $ 47,456,389