English 
Español Care Management Services
Providing key stabilization services for some of the most vulnerable populations.
Adult Health Home Care Management Program
Care management services help ensure all involved in an individual’s care are working together and sharing the necessary information in supporting a person’s recovery: medical, mental health, substance abuse services, social service needs.
Eligibility:
• Two or more chronic health conditions
• A significant Mental Illness OR
• Living with HIV/AIDs
AND
• Be a Medicaid/Medicare recipient
• Have a social risk factor
Supportive Housing Rental Assistance Program
The 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.
Eligibility:
• 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
Rochester Regional Health has partnered with Ibero SMART Recovery program, a mutual support group in Spanish. It is bringing access to care to those in need—and by working together, we can provide the comprehensive care and encouragement needed for a successful recovery. SMART Recovery is a mutual peer support program to help those who are recovering from all types of addiction. It has a scientific foundation and teaches increasing self-reliance, rather than powerlessness.
Eligibility:
• Recovering from addiction
Managing During the COVID-19 Pandemic
Since the beginning of the COVID-19 pandemic, our care managers have become creative best serve our clients. Some members of our staff have been dropping off food for clients who were struggling due to their limitations. In order to maintain social distance while filling out health documents, our care managers have found it best to put their documents in their clients’ mailbox, call the client to go over them as they sign, and have them return the consents in the mailbox while our care managers wait in the driveway.
In the past several months we have seen a reduction in hospitalizations and ER visits for some of our clients due to receiving more phone calls from our clients. Our care managers have shown the clients that they are willing to go above and beyond to assist them despite the pandemic.