It’s not too late to connect with your regional Social Care Network (SCN)!
The NYS DOH 1115 New York Health Equity Reform (NYHER) Waiver Amendment (AKA “The 1115”) is a $7.5 billion investment designed to improve health outcomes, advance health equity, and reduce health disparities for NYS Medicaid members. There are multiple strategies to reach this goal, but the focus for this article is on the nine new regional Social Care Networks (SCNs) launched on January 1, 2025.
The 1115 NYHER amendment is a Medicaid Managed Care initiative with a requirement to screen all Medicaid members (fee for service and managed care) to determine if they have a social need, such as food insecurity, housing instability or lack of transportation. In this program, these social drivers of health are called health related social needs (HRSNs).
MYTH: People with intellectual and developmental disabilities (IDD) are excluded from “The 1115.”
FACT: All Medicaid members, including those with IDD, are eligible to be screened and connected to HRSN resources.
People with IDD, enrolled in a Medicaid Managed Care Plan who express a Health Related Social Need (HRSN) during screening are eligible for the new Enhanced HRSN Services (nutrition, housing, transportation). People with IDD enrolled in fee for service Medicaid are eligible to be navigated to other existing resources in the community.
For the 1115 NYHER, the IDD population eligibility is not the same as the OPWDD enrollment criteria. While the required conditions/diagnosis are similar, the 1115 eligibility is focused on the diagnosis/condition and not the other OPWDD criteria (IQ and other assessment results). People who are ineligible or maybe never tried to enroll with OPWDD may be eligible for assistance with this program.
MYTH: DD providers are not allowed to join the new Social Care Networks.
FACT: DD providers are encouraged to join the Social Care Networks!
Your organization has a new opportunity to support people with IDD. The 1115 NYHER is a demonstration program, meaning that the data that is collected from HRSN screenings and connection to resources during this waiver period through March 31, 2027, will be used to determine next steps. Together, we can work to make sure that people with IDD are screened, connected to helpful HRSN resources, and included in future NYS DOH plans. Contact information for the Social Care Networks and additional program information can be found at this here.
Please reach out to your Director of Provider Relations or to Kristen Scholl at Kristen.Scholl@ccany.org if you have questions.