Join Your Regional Social Care Network

The New York Health Equity Reform (NYHER) 1115 Waiver Amendment was approved by the Centers for Medicare and Medicaid Services (CMS) on January 9, 2024, for $7.5 billion. It is effective until March 31, 2027.

The existing New York State 1115 Waiver is a Medicaid Managed Care waiver called the New York State Medicaid Redesign Team (MRT) waiver. Periodically, the state seeks waiver amendments (for example, DSRIP) to test the effectiveness of new initiatives and determine whether they should continue or end with the demonstration period. The goals of the 1115 NYHER waiver amendment are to advance health equity and improve access to Health-related Social Need services.

While the NYHER 1115 Amendment has many components that are summarized in this NYS webinar, the focus for this communication is on the emerging Social Care Networks (SCNs) and HRSN services as they relate to people with intellectual and developmental disabilities (IDD) and IDD service Providers.

Social Care Networks

One Social Care Network will be selected for each of the nine regions designated by New York State (map included in the link above). SCNs will be lead entities for cooperative regional networks of community-based organizations (CBOs) providing HRSN screenings and referrals to HRSN Services. SCNs will contract with Medicaid MCOs (Managed Care Organizations) in their region, manage those funds, and pay CBOs for HRSN services rendered. SCNs are also responsible for the CBO network and capacity building for the specific HRSN services covered under this program. IDD Provider agencies and CCOs are considered CBOs for the waiver.

Health-Related Social Needs Services

HRSN Services will include HRSN screenings for all Medicaid beneficiaries and referral to services according to eligibility criteria. Covered HRSN services include housing, nutrition, transportation, and case management.

New York State has released a Request for Applications (RFA) and is in the procurement process to select the SCN for each region. Responses are due April 5, 2024. As part of the application process, SCNs request that interested CBOs complete a brief survey and submit a Letter of Interest. If your organization provides (or is interested in) Housing, Nutrition, or Transportation services as described on page 14 of the NYS Webinar Summary, please contact the SCN applicants in your region. In some regions, there are multiple SCNs bidding for this role. New York State will announce the final SCNs in June 2024.

A small number of people receiving OPWDD-waiver services are enrolled in mainstream Medicaid Managed Care. HRSN services under this 1115 amendment are available to people enrolled in Medicaid Managed Care who meet qualifying clinical or social care criteria, including people with IDD. People with IDD not enrolled in Medicaid Managed Care are eligible for HRSN screening and referral to existing federal, state, or local programs.

Important Fact

New York State has identified thousands of people enrolled in Medicaid Managed Care with an IDD diagnosis (that are not currently supported by OPWDD services). There is an opportunity for us as the IDD Provider community to screen and provide services and supports to these people.

LIFEPlan proposes to each SCN applicant in its geography that the CCO will be the CBO to provide HRSN screenings, navigation to HRSN services, and case management for people with IDD. In this role, we will facilitate increased referrals to the OPWDD system and IDD Providers in the SCN networks that provide HRSN services.

If you have questions or want to know more, contact your Director of Provider Relations or Kristen Scholl, VP of Integrated Care Initiatives.

Reach out to the SCN(s) in your region to let them know your interest or submit a Letter of Intent.