Health Home

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Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that all of the patient's needs are addressed in a comprehensive manner.  This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room, and out of the hospital.  The health home services are provided through a network of organizations – providers, health plans, and community-based organizations.

BronxWorks is a partner in the Health Home initiative, as designed by New York State.  We have joined with Montefiore Medical Center and Bronx Lebanon Hospital to bring comprehensive services care to individuals faced with a chronic illness.  Our collaboration includes primary care physicians, hospitals, substance abuse providers, housing and entitlement programs, and more.

The chronic illnesses addressed by Health Home include (but are not limited to) HIV, diabetes, asthma, hypertension, heart disease, obesity, substance use, and mental health.  At this time only individuals 18 years and older with Medicaid qualify for the services.

We will work with you to:

  • ensure that you are linked to medical services
  • assist with medical appointments
  • seek out needed entitlements
  • assist with treatment adherence
  • provide housing assistance
  • and much more


For more information or to make an appointment, please contact:


Shauna Barry, LMSW Program Director
BronxWorks Community
Health Home (BCHH)
BronxWorks
630 Jackson Avenue, 2nd floor, office #201
Bronx, N.Y., 10455
Tel: 917-831-3369 ext: 134
Fax: 917-801-1597
sbarry@bronxworks.org 

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