New York State’s 1115 Medicaid Waiver Approved: Amplifying Social Care Networks and Advancing Health Equality

January 9, 2024 marked a significant stride toward a stronger, healthier New York as the Centers for Medicare & Medicaid Services (CMS) approved a monumental amendment to the 1115(a) Medicaid Waiver. This groundbreaking approval marks an additional investment of $7.5 billion into the state’s healthcare framework, with a significant investment for a strong data infrastructure.

The core goals behind the waiver is to increase health equity among all New Yorkers and build on the healthcare gaps uncovered during the pandemic. Central to handling the waiver goals is the establishment of Social Care Networks (SCNs) tasked with screening, referring, and coordinating Health Related Social Needs (HRSN) services to eligible Medicaid beneficiaries. These SCNs will cultivate crucial partnerships with Community-Based Organizations (CBOs), ensuring comprehensive service delivery. The Statewide Health Equity Regional Organization (HERO) will guide this initiative, providing support through crucial data analysis, regional needs planning, and program analyses.

The waiver brings forth crucial initiatives and commitments, each playing a pivotal role in shaping a more integrated healthcare system for New York:

  • Workforce Initiatives Funding: Includes Student Loan Repayment and Career Pathways Training, aimed at recruiting and retaining healthcare professionals in high-need fields serving Medicaid members.
  • Medicaid Hospital Global Budget Initiative: Newly introduced and designed to support safety-net hospitals, ensuring their active participation in waiver-related deliverables. 
  • IMD Waiver for SUD Services: The waiver includes an Institutions for Mental Diseases (IMD) waiver for Substance Use Disorder (SUD) services
  • Commitment to Medicaid Provider Payment Rates: New York State demonstrates a steadfast commitment to sustaining and enhancing Medicaid provider payment rates, a crucial step to fortifying access to essential services.

As part of the 1115 Waiver, SCNs will benefit from infrastructure funding for technology, business and operational practices development, workforce development, and outreach. Furthermore, SCNs will be reimbursed for delivering HRSN services on a fee-for-service basis, per the State-published fee schedule. They are responsible for screening, referring and determining Medicaid beneficiaries’ eligibility for new waiver services, which include navigation and linkage to existing State and Federal Social Services (Level 1) and enhanced HRSN services like case management, nutrition support, housing support, and limited transportation (Level 2). 

Another key component of the waiver is to track outcome data from service delivery to ultimately transition target populations from a fee-for-service basis to be included in risk bearing value based payments (VBP) arrangements. The state will be using critical service data to design these arrangements. 

Empowering Social Care Networks (SCNs) to Navigate the 1115 Medicaid Waiver Landscape:

The release of the waiver opens the opportunity for organizations to become Social Care Networks. There will be nine (9) SCNs selected to represent the communities in New York and organizations will need a strong data partner with experience to put themselves in the best position to be awarded the SCN. Foothold has both the experience and expertise to partner with organizations from the application process through service delivery.

Why Foothold Technology?

  • Proven Expertise: Foothold’s Care Coordination platform supports over 70% of health home members in New York, and offers tailored case management and fee-for-service billing solutions for nearly 100 agencies across the state. Drawing from over a decade of experience in care coordination and Social Determinants of Health (SDoH), our industry knowledge equips Social Care Network (SCN) applicants with a solid foundation to success. 
  • Data & Interoperability: Our centralized data solutions empower SCNs to gain a comprehensive view of their network, report on Social Determinants of Health (SDoH) outcomes, and seamlessly share necessary data with important entities, such as with the soon to be established Health Equity Regional Organization (HERO). Foothold can coordinate with all your essential tools to enable efficient data sharing and coordination within your SCN.
  • Regional Understanding: Benefit from a deep understanding of your region’s healthcare needs. Foothold is uniquely positioned to assist SCNs in their transformative journey. Our solutions go beyond technology; they are tailored to the specific nuances of New York’s healthcare landscape.
  • Coordinated EHR System (CEHRS): Due to our unique position of providing both care coordination solutions and electronic health record (EHR) solutions, Foothold offers unique solutions to compile data from existing systems. An invaluable tool to understand and compile outcome data from screening to service delivery. 

Through the complexities of the 1115 Medicaid Waiver, Foothold Technology isn’t just a software provider — we’re your strategic partner. Ready to empower your organization to thrive in the changing healthcare landscape, our commitment is to ensure that your Social Care Network is well-equipped to deliver effective and equitable care to those in need.