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ADULT: • Age 21 and older. • Medicaid recipient. • Two or more chronic conditions. Chronic conditions may include substance use disorder, asthma, diabetes, heart disease, being overweight, and others. HIV​/AIDS and serious mental illness also qualify. CHILDREN: • Birth to age 21. • Active Medicaid. • Two or more chronic conditions. Chronic conditions may include mental health, substance use disorder, asthma, diabetes, heart disease, being overweight, and others. HIV​/AIDS and having experienced significant trauma can also qualify.

Spanish

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Individuals at high risk of hospital re-admission.

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Spanish, English

Everyone who is a refugee, immigrant, migrant of undocumented status.

Somali, Swahili, Arabic, Dari, Spanish

Deaf refugees, asylum-seekers, immigrants, and those from US territories and family members.

American Sign Language

-Be a U.S. Citizen or permanent resident of the U.S. -Have a confirmed diagnosis of a chronic or life-threatening disease OR need screening services related to symptoms of disease. -Be in active treatment, had treatment within the past 6 months, or going into treatment in the next 60 days (at a facility in the U.S. or U.S. Territories)

Spanish

Call for information.

Spanish

None.

Resident of the area served. Services available to all who are in need.