It’s easy to enroll with ACANY to receive care coordination services.

There are two ways to start:



By Phone

To have an ACA/NY team member call you, please contact the customer call center phone number below.

If you have questions before you get started or need assistance, call us at:

(833) MY-ACANY or (833) 692-2269

 

By Mail

  1. Please complete the Intake Form, Enrollment Checklist and appropriate Consent Forms, and the HCBS Plan Support Brochure for you or your loved one. Consent forms can be found below.
  2. Mail the form and completed documents to:

Advance Care Alliance of New York
1410 Broadway, 9th Floor
New York, NY 10018
Attention: Intake Department



Child (under18) Adult (18+)
Health Home Patient Information Sharing Consent Enrollment Form
Health Home Consent Information Sharing Form
Health Home Consent FAQ Form
Health Home Consent Enrollment Form
5-4 Basic HCBS Plan Support Consent/DOH 5059 - Health HOme Opt-out Form
State Paid Enrollment Form
Health Home Care vs. HCBS Plan Support Brochure
ROA - Member Rights Packet
Authorization for Release of Protected Health Information