Suffolk Health Care Management
Care Rooted In Connection
Care Management Eligibility
Children and youth who struggle with a mental health, behavioral health, substance abuse disorder or complex medical conditions.
Ages 0-21- Medicaid Eligible (or qualify through Department of Health)
- Live in NYC (five boroughs) or Long Island
Ready to get started? Contact us today to see how we can help your family!
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Care Management
At the heart of great care is connection. Our Care Management team coordinates all supports to align your family’s needs with your child’s goals. We take time to understand each child’s strengths and create a personalized plan that connects you with the right mix of services and community resources.
Through advocacy and navigation, we help families access and understand available systems and supports. With strong collaboration among providers and ongoing communication, we stay by your side—tracking progress, adjusting supports, and guiding you through each new stage. Care Management is where all the pieces come together, making services more coordinated, personal, and effective.
Care Management Services
We offer a range of Care Management that help children and families stay connected, build essential skills, and maintain stability at home while receiving the support they need.
Connection to Resources
- Identify and link families to appropriate medical, mental health, educational, and community-based resources
- Connect families to government programs including but not limited to : Medicaid services, SNAP, HCBS, transportation and other eligible programs
- Support referrals, applications, and service enrollment to ensure access to needed supports
Coordination Across Systems
- Connect healthcare, mental health, education, and community services
- Act as a central point of contact across the care team
- Coordinate communication between schools, doctors, therapists, and providers
- Keep everyone aligned around shared goals and responsibilities
Planning & Progress Monitoring
- Develop and update a clear, person-centered care plan
- Set measurable goals with practical action steps
- Track progress and identify what’s working vs. what needs to change
- Adjust recommendations as needs shift to keep supports effective and sustainable
Suffolk Primary Health
Care Management Process
At Suffolk Health, our care management process is built on coordination, progress, and patient centred care.
Referral & Eligibility
A child is referred, and eligibility is confirmed through diagnosis, Medicaid, and functional need.
Care Manager Assignment & Assessment
The family is matched with a Care Manager, who becomes their main point of contact and completes an in-person assessment to identify strengths and needs.
Plan of Care Development
Together, the Care Manager and family set goals, choose appropriate services, and create a plan tailored to the child’s unique needs.
Ongoing Monitoring & Support
The Care Manager maintains regular contact, tracks progress, and providers referrals and helps family access services.
Need Assistance? We’re Here to Help!
If you have any questions about our services and would like to learn more about our program, we are here to assist you — reach out anytime.
Our hours are 9AM–5PM Monday–Thursday and 9AM–12PM on Fridays.
Email support
Let us know what you need. We’ll get back to you as quickly as possible.
For email support, cmintake@sph.health.
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What can we help you with today?
Real Stories, Real Growth
Noah, Age 8 Months
When Noah was born with a complex heart condition, his parents were overwhelmed by appointments and medical decisions. Their Care Manager connected them to CFASS, where a provider offered education, organization tools, and emotional support. With this guidance, Noah’s parents gained confidence and hope while learning to manage his care.
Maya & Zack, Age 12
Twins Maya and Zack struggled with anxiety and daily chaos at home. Their Care Manager linked the family with CFASS, where a provider helped create structure, organize their space, and build calm routines. The home is now more peaceful and supportive for everyone
Maria, Age 16
Maria’s risky behavior had left her parents desperate for help. Her Care Manager connected her to Therapy Services and a Respite provider who used creativity and trust-building to guide her toward healthier choices. Today, Maria is expressing herself through art and making positive changes.