Adult Single Point of Access (SPOA)


Referral Form for Assertive Community Treatment (ACT) Services NEW!!!!

ACT is a licensed, community-based service for individuals with mental illness that have intensive needs and have difficulty engaging in traditional clinic based services.  Monroe County had a recent influx of ACT slots and currently has two ACT teams available, one at Strong Ties and one through Rochester Regional Health System.  An additional ACT team is anticipated to be available at Strong Ties in early 2016.  Click on the link above for "Assertive Community Treatment (ACT) Services" to download a PDF referral form. 

Referral Form for Adult Residential Services  NOTE - This form is now a fill-able PDF as our online site has been disabled!

Click on the link above for "Adult Mental Health Residential Services" to access the PDF referral form.  This form should be downloaded and can then be completed electronically (Use Save As to save the copy) and submitted via secure email OR can be printed for manual completion and submitted via secure e-mail, fax or regular mail.  Please do not use this link to make care management referrals.  If a referral to both residential and care management services is desired, you must complete both forms. 

Referral Form for Adult Behavioral Health Care Management

All referrals for adult behavioral health care management (including Health Home care management and non-Medicaid care management) should be submitted using the new Monroe County Community Referral for Care Management.  Click on the link above for "Behavioral Health Care Management" to download a fillable PDF to be submitted via secure e-mail, fax or regular mail.  

Eligibility for Adult Behavioral Health Care Management

Individuals must meet all eligibility requirements to be considered for enrollment.

Behavioral Health Care Management Health Home Care Management
  1.  Individual is not eligible for Health Home Care Management services because:
  • Individual is not eligible for Medicaid; OR
  • Individual does not meet DOH eligibility criteria;


  1. Individual meets the NYS DOH eligibility criteria of:
  • two chronic conditions, OR
  • HIV/AIDS and the risk of developing another chronic condition, OR
  • one or more serious mental illnesses;


  1. Individual has a primary mental health diagnosis; AND
  1. Individual currently has active Medicaid OR Medicaid and Medicare; AND
  1. Individual resides in Monroe County; AND
  1. Individual resides or receives services in Monroe County; AND
  1. Individual has significant behavioral, medical or social risk factors which can be addressed through care management.
  1. Individual has significant behavioral, medical or social risk factors which can be addressed through care management.

Community Referrals for Behavioral Health Care Management and Health Home Care Management are now being accepted in Monroe County from providers, community organizations, individuals and/or family members.

  • Behavioral Health Care Management is being triaged through the Monroe County Office of Mental Health for individuals with mental health and/or chronic substance abuse disorders who are not eligible for Health Home Care Management.
  • Health Home Care Management is being provided by Greater Rochester Health Home Network (GRHNN) AND Health Homes of Upstate New York - Finger Lakes (HHUNY - Finger Lakes) for eligible Medicaid and Medicaid/Medicare dual eligible persons.

If you have questions about the process to submit a referral, contact the Monroe County Single Point of Access (SPOA) office at (585) 753-2874.


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