Care Management Services

Providing key stabilization services for some of the most vulnerable populations.

Adult Health Home Care Management Program

Adult Health Home Care Management Program provides care management services to ensure all those involved in an individual’s care are working together and sharing the necessary information in supporting a person’s goals to live a healthier lifestyle. Care Managers coordinate, advocate, navigate, and link individuals to resources to best help them reach these goals.       

Counties Served: Monroe and Montgomery

Eligibility: • Two or more chronic health conditions
• A significant Mental Illness OR
• Living with HIV/AIDs
• Be a Medicaid/Medicare recipient
• Have a social risk factor

Supportive Housing Rental Assistance Program

Supportive Housing Rental Assistance Program serves individuals diagnosed with serious mental illness age 18 and older obtain and maintain safe affordable housing of their choice. Rental assistance and case management services are provided to help individuals live independently while maintaining safe and affordable housing.

County Served: Monroe 

Diagnosed with serious mental illness
Over 18 years old
 All clients must be referred through Monroe County’s Single Point of Access (SPOA): Discharged from psychiatric hospital care, residential treatment facilities, children’s communal residences OR residents of OMH-licensed housing, adult homes, nursing homes, homeless shelters

Ibero staff help coordinate not just medical mental health and substance abuse services, but also the social service needs of the individual.

Ibero SMART Recovery Program ​​

IBERO SMART Recovery is a mutual peer support program in Spanish to help those who are recovering from all types of addiction. It has a scientific foundation and teaches increasing self-reliance, rather than powerlessness.

County Served: Monroe 

Recovering from addiction

Call now to learn more:

(585) 256-8900 x122

Community Health Workers

Community Health Workers are frontline health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a link between services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, health education, prevention, workshops, and community and street outreach.

County Served: Monroe