Comunilife Community Engagement programs meet people where they are at with the goal of connecting & improving health outcomes.
Participants in Health Home program
Participants connected to services in ENGAGE
A Medicaid-funded care model for adults with complex medical, behavioral, and social needs — built around one care plan and a single point-person for care planning.
Free, accessible, culturally responsive short-term mental-health services for adults. No insurance required.
A statewide program for Medicaid members. Navigation and enhanced services for those facing behavioral health challenges, recent hospital release, or perinatal vulnerability.
The Care Coordination Health Home program is a Medicaid-funded care coordination model designed to support individuals with complex medical, behavioral health, and social service needs. The goal of the program is to improve health outcomes, reduce unnecessary hospitalizations, and ensure members are connected to the full range of services they need to live fully and independently in the community.
Within the Health Home model, some members may also qualify for Health Home Plus (HH+), which provides enhanced care coordination for individuals with serious mental illness who are at high risk for hospitalization, incarceration, or homelessness.
CORE 01
Ongoing assessment of a member’s medical, behavioral health, and social needs, along with the development and monitoring of a person-centered care plan.
ONE PLAN · REFRESHED REGULARLY
CORE 02
Coordination of appointments, follow-up after hospital or ER visits, medication support, and education to help members manage chronic conditions.
APPOINTMENTS · FOLLOW-UP · MEDS
CORE 03
Support during transitions between settings such as hospital to home, shelter to housing, or release from inpatient or residential care.
HOSPITAL → HOME · RE-ENTRY · HOUSING
CORE 04
Education, advocacy, and engagement of members and their support systems to ensure they are active participants in their care.
FAMILY-INCLUSIVE · ADVOCACY
CORE 05
Connection to housing, food assistance, benefits, transportation, employment supports, and other critical social services.
HOUSING · FOOD · TRANSIT · BENEFITS
CORE 06
Use of secure systems to share information and ensure all providers involved in a member’s care are aligned.
SECURE · INTEROPERABLE · ALIGNED
ENGAGE is designed to provide timely, strength-based support that reduces barriers to care and empowers clients to address immediate challenges while building skills for long-term well-being.
We’re built for the moments before therapy becomes a year-long commitment — when a short, focused conversation can change the next month of someone’s life.
ENGAGE provides free, accessible, and culturally responsive short-term services to adults experiencing mild to moderate symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), substance use challenges, and financial stressors.
Service A · IPC
A brief, four-session model in which a Community Wellness Specialist works collaboratively with clients to identify a primary interpersonal stressor. Sessions focus on developing practical strategies and skills to manage symptoms, strengthen coping, and improve functioning related to the identified stressor.
4 sessions · interpersonal focus
Service B · SPI
A single-session, evidence-based intervention in which the Community Wellness Specialist collaborates with the client to create a personalized safety plan — a step-by-step guide to help clients manage distress, reduce risk, and access support during times of crisis.
1 session · evidence-based
Service C · SBIRT/MI
A single-session intervention for clients engaging in risky substance use or at risk of developing substance-related concerns. This service supports clients in exploring motivations for change, engaging in change talk, setting goals related to substance use, and accessing treatment or community resources.
1 session · MI-based · no judgment
Service D · Financial
ENGAGE provides short-term support for clients experiencing financial stressors — exploring contributing factors and developing an individualized action plan to support financial goals. Clients are referred to the Financial Empowerment Center for free, one-on- one professional financial counseling and coaching..
Short-term · FEC referral
New York’s Social Care Network (SCN) is a statewide program created to help people live healthier lives by supporting their everyday needs — not just medical care. Things like having a safe place to live, enough food to eat, transportation, and emotional support all play a big role in our health. That’s where Comunilife comes in. As a trusted community partner, Comunilife provides housing and behavioral health services that help Medicaid members feel safe, supported, and stable.
The SCN program is based on each person’s needs — every member receives a yearly social check-in plus help connecting to community resources. Those facing the greatest challenges may also qualify for enhanced services for up to six months.
Level 01 · All members
A Social Care Navigator works with members to talk through needs, help apply for benefits and programs, and connect them to trusted community services. You don’t have to figure it out alone — someone walks alongside you.
Yearly check-in · benefits & resources
Level 02 · Higher-need members
If a member qualifies, Comunilife and partners may provide up to six months of short-term help — housing assistance, food and nutrition support, transportation help, medical respite, and youth & mental-health support.
Up to 6 months · partnered delivery
Support 01
Support finding safe and stable housing; help making homes safer — ramps, grab bars, mold remediation.
Find · stabilize · adapt
Support 02
Home-delivered meals designed for medical needs, fresh fruits and vegetables, and help getting basic kitchen items — like a refrigerator.
Medical · fresh · kitchen basics
Support 03
Transportation support for important appointments — housing appointments, job training, and other essential services.
Appointments · training · essentials
Support 04
Short-term housing through Comunilife’s Medical Respite Program — for people leaving hospital without a safe place to heal.
See Medical Respite →
Support 05
Comunilife’s Life is Precious™ — a program for adolescences who may be struggling. Wellness, emotional support, and suicide prevention in a culturally supportive environment.
See Life is Precious™ →
Support 06
Short-term mental-health support through ENGAGE — in English, Spanish, and French, with no insurance required.
See ENGAGE →