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Health Home Care Management for Children

“Every child is gifted. They just unwrap their packages at different times.” ~ Unknown

ENGLISH: Care Management and Coordination for Children
SPANISH: Manejo Y Coordinacin De Atencin Para La Salud Mental Infantil

MHAW’s Children’s Care Management Program is designed to align with the three core goals of the Governor’s Medicaid Redesign Taskforce:

* Improve care and health outcomes.
* Reduce preventable emergency room visits and hospitalizations.
* Lower cost of healthcare and social services.

This is achieved by emphasizing care coordination and care management for all children with physical and behavioral health needs.


Care Managers assist children with physical and behavioral health challenges to access and coordinate all of their healthcare and social service needs. Services include:

  • Develop a personal plan to meet one’s physical, mental health, chemical dependency, and social service needs.
  • Coordinate, monitor, and evaluate the ongoing effectiveness of the child’s care.
  • Provide follow-up from inpatient and emergency room care to help prevent re-admissions.
  • Assist children and families with access to important resources such as public assistance, housing, child care, food pantries, transportation, and more.
  • Provide physical and behavioral health education and support for the child, their family members, and other caregivers.
  • Ensure that all providers share vital information electronically to ensure the most safe and effective services.

Care managers work in teams to connect with children in their homes and at healthcare, education and social service sites across Suffolk County. Our teams also reach out to engage children and their families in hospitals and those referred by community agencies, families, schools, health/behavioral health providers, and other social services.

The effectiveness and quality of services provided by our program are monitored by the New York State Department of Health and the New York State Office of Mental Health.


MHAW offers Child Care Management Programs which is provided in coordination with lead Health Homes, Skyward Health and Northwell Health for those who are Medicaid eligible and who have: One Single qualifying condition such as:

  • Serious emotional disturbance (SED); or
  • Sickle Cell Anemia
  • Or, two or more chronic conditions, such as:
    • Alcohol and substance use
    • Mental health condition
    • Cardiovascular disease (such as hypertension)
    • Metabolic disease (such as diabetes)
    • Respiratory disease (such as asthma)
    • Complex Trauma
    • Children/or adolescents exposure to multiple traumatic events, often of an invasive, interpersonal nature

Ana Fernandez
Program Director of Children’s Care Management
631-471-7242 x1717

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