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New York Health Related Social Needs Inquiry Form

 

If you live in New York, are enrolled in Medicaid, and believe you may qualify for Health-Related Social Needs (HRSN) services, please complete the form below. We’ll email you helpful program information and help connect you with your local Social Care Network (SCN) to complete a screening. 

By submitting this form, the individual noted on this request consents to receive emails from Mom’s Meals and acknowledges that, based on their county, their information may be shared with a contracted agency in their Social Care Network for outreach over the phone. Submission does not guarantee eligibility or enrollment. Final eligibility is determined by the local Social Care Network.

*Required Fields – This information helps us expedite getting you the answers you need.