DOH Selects Social Care Network Lead Entities for 1115 Waiver

(Aug. 13, 2024) The Department of Health selected 9 organizations, last week, to lead regional Social Care Networks aimed at integrating health care and social care under the State's Medicaid 1115 Waiver.  In a separate announcement, the Department solicited letters of interest for the Safety Net Transformation Program created as part of the 2024-25 State Budget. Both programs may create opportunities for LeadingAge NY members to create partnerships with community organizations and the broader health system to improve care for the people they serve; however, the nature of those opportunities remain unclear.  More information on the Safety Net Transformation Program is available here.

The social care network (SCN) lead entities will collectively receive a total of $500 million over the next three years for infrastructure development and to coordinate the delivery of social care services (e.g., housing, transportation, home-delivered meals and other nutritional supports, interpersonal safety, employment supports, educational supports, etc.) to Medicaid beneficiaries through networks of community-based organizations (CBOs).  SCN lead entities will conduct or arrange for screenings of Medicaid beneficiaries for Health-Related Social Needs (HRSNs) and determine eligibility for HRSN services and facilitate referrals to needed services. They will also collect and share data, submit claims for screenings, referrals and social care services, and pay CBOs for services.

LeadingAge New York members may find opportunities to participate as a CBO in an SCN, by providing screenings and the delivering services such as case management, housing supports, and/or nutritional supports.   Members that wish to explore opportunities such as these should contact the SCN lead entities in their regions.

The nine SCN lead entities selected are:

• Care Compass Collaborative:  Southern Tier  -  Broome, Chenango, Delaware, Otsego, Tioga, Tompkins Counties

• Finger Lakes IPA Inc.:   Finger Lakes -   Allegany, Cayuga, Chemung, Genesee, Livingston,Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, Yates Counties

• Health and Welfare Council of Long Island:  Long Island -  Nassau, Suffolk Counties

• Healthy Alliance Foundation Inc.: 

  • Capital Region -  Albany, Columbia, Greene, Rensselaer, Montgomery, Saratoga, Schenectady, Schoharie Counties

  • Central NY:  Cortland, Herkimer, Madison, Oneida, Onondaga, Oswego Counties

  • North Country     Clinton, Essex, Franklin, Fulton, Hamilton, Jefferson, Lewis, St. Lawrence, Warren, Washington Counties

• Hudson Valley Care Coalition, Inc.:  Hudson Valley - Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester Counties

• Public Health Solutions:  Manhattan, Queens, Brooklyn

• Staten Island Performing Provider System: Staten Island

• Somos Healthcare Providers, Inc.:  Bronx County

• Western New York Integrated Care Collaborative Inc.:  Western NY - Cattaraugus, Chautauqua, Erie, Niagara

In addition to infrastructure grants for start-up costs and information technology and performance-based bonus payments, SCN lead entities will be paid a per member per month amount for services delivered by the SCN and will in turn pay their network providers on a fee-for-service basis for the services they deliver.

The program is intended to provide HRSN screening for all Medicaid beneficiaries and referrals to services for those who qualify.  Screenings may be conducted directly by the SCN lead entities or by CBOs in SCN networks.  CBOs will also provide navigation to HRSN services and deliver Enhanced HRSN services.  Medicaid beneficiaries that present with HRSNs upon screening will be "navigated" (actively referred) either to existing HRSN services (Level 1) in their community (funded outside of the waiver) or to Enhanced HRSN services (Level 2) delivered by a network CBO. 

To be eligible for Enhanced HRSN services, the Medicaid beneficiary must be enrolled in Medicaid managed care and fall into one of the following groups:

• 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, 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 condition
• Substance Use Disorder
• Intellectual or Developmental Disability (I/DD)
• Serious Mental Illness

The extent to which dual eligibles will qualify for  services under the SCN Program remains uncertain at this time.  Preliminarily, it appears that they would be eligible for screenings and referrals to existing HRSN (Level 1) services.  Their eligibility for Enhanced HRSN (Level 2) services will likely depend on their enrollment in a Medicaid managed care plan and the type of plan. 

LeadingAge NY will provide additional information on the SCN Program and the waiver as it becomes available.

Contact: Karen Lipson, klipson@leadingageny.org.