Eligibility

• Must be on Medicaid (select plans accepted)

• Must live in a permanent residence in qualifying counties

• At least one Physical/Behavioral Health Criteria

  • Adults (e.g. having two or more qualifying health conditions cardiovascular disease or lung issues, chronic mental illness, or substance use disorder)

  • Pregnant Women (e.g., history of poor birth outcomes such as low birth weight)

  • Children, ages 0-3 (e.g., neonatal intensive care unit graduate)

  • Children, ages 0-21 (e.g., experiencing three or more categories of adverse childhood experiences)

• At least one Social Risk Factor

  • Homeless and/or housing insecure

  • Food insecure

  • Transportation insecure

  • Experiencing toxic stress