State Shares 1115 Waiver Social Care Network Initiative with MLTC Plans

(May 14, 2024) At a meeting with managed care plans last week, the Department of Health (DOH) shared information about the new 1115 Waiver Program and its Social Care Network (SCN) initiative to address health equity reform.

The Department reviewed the regional SCNs’ responsibilities to be established in nine regions of the state. SCNs will contract with managed care plans to facilitate payment to community-based organizations (CBOs). SCNs will receive a per member per month payment for managed care members and bill fee-for-service (FFS) for those who are not enrolled in managed care plans. They will pass payments on to CBOs for services rendered.

SCN responsibilities include:

1. Building a network of CBOs in their community
2. Setting up a social care information technology (IT) platform
3. Organizing and coordinating a CBO network to deliver Health-Related Social Needs (HRSN) services
4. Collaborating with partners (health care providers, care management providers) to annually screen members for HRSN (housing and utilities, food security, transportation, employment, education, and interpersonal safety)
5. Validating eligibility, providing navigation, and closing loops on referrals

Following HRSN screening, Medicaid members will be navigated to social care services that most appropriately meet their needs.

If a member does not meet the criteria for Enhanced HRSN services, they will receive Level 1 services, which will entail navigation to pre-existing state, federal, and local programs to address HRSN.

An individual will receive Enhanced (Level 2) services if they are enrolled in a Medicaid Managed Care plan, they screen positive for an unmet HRSN, and they meet one of the following criteria:

• Medicaid high utilizer (defined by emergency department, inpatient, or Medicaid spend or transitioning from an institutional setting)
• Individuals enrolled in a designated Health Home, which currently includes HIV/AIDS, serious mental illness, sickle cell disease, serious emotional disturbance or complex trauma (children only), or those with two or more chronic conditions (e.g., diabetes and chronic obstructive pulmonary disease)
• Pregnant persons/up to 12 months postpartum
• Post-release criminal justice-involved population with serious chronic conditions, substance use disorder (SUD), or chronic hepatitis C
• Juvenile justice-involved, foster care youth, and those under kinship care
• Children under the age of 6
• Children under the age of 18 with one or more chronic conditions
• SUD
• Intellectual or developmental disability (I/DD)
• Serious mental illness

All Medicaid members will be screened using an NYS-standardized version of the Accountable Health Communities (AHC) screening tool to assess member needs across a range of HRSN domains (i.e., housing and utilities, food security, transportation, employment, education, and interpersonal safety).

A PowerPoint provides an overview of the program including:

• Mapping of the screening process
• HRSN flow of funding
• Network data and IT architecture
• Timeline for implementation 
• Architecture of program and roles of partners/providers
• SCN HRSN services
• Screening questions

LeadingAge NY is trying to ascertain if dual eligibles who do not have a mental illness, SUD, or recent incarceration will be eligible for Enhanced HRSN services. There may be a role for aging services providers, including home and community-based services (HCBS) providers, to establish new service lines under this program.

LeadingAge NY will provide more information on this initiative as it becomes available.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871