Recovery Services
in the Home or Community

In partnership with our clients, we establish goals that support community participation and independence. We strive to work in partnership with you, your managed care plan, service providers, plan members, and your family and government partner.  We work together to prevent and manage chronic health conditions and recover from serious mental illness and/or addictions.

All of our services are recovery-oriented, supporting a care plan that addresses physical, behavioral and mental health needs through evidence-based and data-driven techniques. This will encourage and provide hope to each person on their individual path to recovery. Dedicated staff members will provide these services in your home, out in the community, or at our Jay St. office.  We can also connect with you using tele-health technology.

The Home and Community Based Services we offer support Independence, Education and Employment.

Independence: Daily Living and Social Skills

• Habilitation: Gain and regain life skills
• Learn how to make or remake social connections. Learn how to budget. Learn how to advocate for yourself and negotiate relationships
• If needed, get treatment and rehabilitation services in your own home

Education and Employment

Education Support:

• Education support to start, return to, or graduate from school to learn skills to get or keep a job.

Employment Support:

• Choice of employment goal and benefits counseling
• Support in finding and keeping a job
• Support to help you stay on the job and start career planning

The specific HCBS Services we provide are: Education, Prevocational, Intensive Supported Employment, Ongoing Supported Employment and Habilitation Services.

The three CORE services we offer are:

Psycho-Social Rehabilitation (PSR)

• Assists individuals in improving their functional abilities to the greatest degree possible in settings where they live, work, learn, and socialize.  We encourage participation in recovery-oriented activities in order to support and restore social and interpersonal skills
• Develop coping strategies for effective functioning at home, work, and school
• Rehabilitation counseling, skill building, and psychosocial rehabilitation, psychosocial rehabilitation with education, and psychosocial rehabilitation with employment.

Empowerment Services: Peer Supports

• Non-clinical, peer-delivered services with focus on rehabilitation, recovery, and resilience.
• Develop coping strategies for effective daily living, while facilitating the use of natural supports and community resources.

Family Support and Training (FST)

• Offers instruction, emotional support, and skill building necessary to facilitate engagement and active participation of the family.
• We help individuals and families through a person-centered or person-directed, recovery oriented, trauma-informed approach.

These programs are available for individuals 21 and older, who are enrolled in a Medicaid-managed care plan called Health and Recovery Plan (HARP) or HIV-Special Needs Plan (SNP).

For HCBS services, members need to complete the New York State Eligibility Assessment with their care manager or recovery coordinator. For CORE services, members do not need to complete this assessment.

To receive CORE services, you can now use self-referral (you no longer need a Health Home or other Care Manager referral). We serve individuals living in Monroe, Cayuga, Chemung, Livingston, Ontario, Seneca, Schuyler, Steuben, Tioga, Tompkins, Wayne, and Yates Counties.

This program is paid for through Managed Medicaid already available to Health Home, and HARP eligible, clients. We also have contracts with the following health plans:

• Excellus
• Fidelis
• MVP
• United Health

Fill out this request form and a team member from HCBS and CORE Services will get in touch with you within a couple business days.

For more information:

• Email hcbsreferrals@dor.org
• Call (585) 546-7220 ext. 421

• Fillable Referral Form for HCBS and CORE Services
• Referral Process Letter for Providers