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Adult Medicaid recipients including managed care and dual-eligible – Medicaid and Medicare. Receiving the majority of their care in Monroe County, and the following: significant mental illness or serious emotional disturbance HIV​/AIDS complex trauma, if under 21 two or more chronic health conditions (i.e. asthma, diabetes, heart disease, mental health condition, substance use disorder, etc.

Can accommodate other languages as needed.

Resident of area served, for children ages 3-17 years old. Child must be in permanent housing.