nys 1115 waiver amendment

things to know

On January 9, 2024, CMS approved New York State’s 1115 Waiver Amendment Request through March 27, 2024 – providing ~$6.7B in funding to improve the health of New Yorkers.

A QUICK OVERVIEW

WAIVER GOALS:

Advance health equity, reduce health disparities, support the delivery of health-related social need (HRSN) services, promote workforce development and SUD demonstration authority, and strengthen access to high-quality care for all those with Medicaid coverage.

SOCIAL CARE NETWORK (SCN):

A fundamental part of the Waiver is the role of the lead entity for the SCNs – charged with building reliable networks of contracted community-based organizations (CBOs) to better enable HRSN screening and the delivery of social care services.

HRSN SCREENING FOCUS AREAS:

Housing/utilities, food security, transportation, employment, education, and interpersonal safety.

HOW OUR NETWORK FITS INTO THE WAIVER:

NYS will award up to 13 SCN lead entities across nine regions. With years of experience in this space, we are deeply familiar with the SCN responsibilities and will complete the lead entity application for multiple regions to ensure our network can continue helping more community members. If a community-based organization is part of more than one SCN application, that’s okay! The goal among each SCN is the same – to keep the community member at the center of everything they do.

THE TIMELINE:

April 16, 2024 | SCN Lead Entity Request for Applications (RFA) Due

June 1, 2024 | Anticipated Award Date

August 1, 2024 – March 30, 2027 | Waiver Contract Period

WONDERING WHAT THIS MEANS FOR YOU?

Send us your questions! Email [email protected]

FACT CHECK

HOW WE’RE ALIGNED TO THE SOCIAL CARE NETWORK ROLE

SOCIAL CARE NETWORK

HEALTHY ALLIANCE

ELIGIBILITY

Be a 501(c)(3) non-profit organization

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Have at least three years of experience working with community-based organizations (CBOs) in the applying region(s)

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Be pre-qualified in the New York State Grants Gateway or Statewide Financial System

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PROPOSED RESPONSIBILITIES

Create and maintain a network of contracted CBOs with the capacity to screen all Medicaid members for HRSNs, in collaboration with regional health care partners, and provide services to address community members’ HRSNs.

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Ensure greater coordination of social care services for populations identified in the 1115 Waiver Amendment.

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Build CBO’s capacity to participate in the network through direct investments to support hiring staff, new equipment, or through trainings and technical assistance. 

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Improve the experience for Medicaid members seeking social care services through screening and navigation.

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Establish a sustainable and viable social care network post-waiver period.

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Promote more equitable delivery of social care services and address the health, racial/ethnic, socioeconomic, and geographical disparities in existing access and quality.

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Develop and maintain operations across the following functions: social care service navigation, CBO network management, partnerships and strategic initiatives, data and IT, finance and accounting, human resources, communications and external engagement, and vendor management.

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DID YOU KNOW?

New York State called out Healthy Alliance as a model social care network (previously referred to as social determinant of health network) in
the 1115 Waiver Amendment concept paper.

FROM THEN TO NOW

OUR TIME AS A SOCIAL CARE NETWORK

Working hand in hand with our partners since 2015 to improve health and empower the underserved, we’ve moved the needle on social drivers of health. Over the years, we’ve grown in scope and scale – and continue to be at the forefront of change for the health of New Yorkers.
COVERAGE AREA
  • THEN: 6 COUNTIES IN THE CAPITAL REGION
  • NOW: 25 COUNTIES IN THE CAPITAL REGION, CENTRAL NY, + NORTH COUNTRY

With offices in Schenectady, Syracuse, and Glens Falls, our team lives and works in the regions we serve.

PHYSICAL PARTNER LOCATIONS

  • THEN: ~200, offering ~340 programs and services
  • NOW: ~1,300, offering 2,305 programs and services

REFERRALS SENT THROUGH OUR NETWORK

  • THEN: 980+
  • NOW: 90,000+

COMMUNITY MEMBERS SERVED BY THE NETWORK

  • THEN: ~500
  • NOW: ~275,000

COMMUNITY MEMBERS CONNECTED TO SERVICES

  • THEN: 400+
  • NOW: 35,000+

COMMUNITY MEMBERS SCREENED FOR HRSN

  • THEN: ~100
  • NOW: 11,000+

INTERESTED IN OUR NETWORK?

READY TO JOIN OUR NETWORK?

IN NEED OF SERVICES?

RESOURCES

approval letter

NYS 1115 MEDICAID WAIVER INFORMATION PAGE

PRESS RELEASE FROM CMS

CMS Approves New York’s Groundbreaking Section 1115 Demonstration Amendment to Improve Primary Care, Behavioral Health, and Health Equity

PRESS RELEASE FROM NYS

Governor Hochul Announces Groundbreaking Medicaid 1115 Waiver Amendment to Enhance New York State’s Health Care System

ACCOUNTABLE HEALTH COMMUNITIES MODEL

More information about the standardized screening tool we’ll need to use.

OVERVIEW ON 1115 WAIVER AMENDMENT

Watch the webinar overview from the State.

NEW ENGLAND JOURNAL OF MEDICINE CATALYST: CASE STUDY ON HEALTHY ALLIANCE'S IMPACT AS A NETWORK

Breaking Down the Barriers Between Health and Social Care Services: Implementing a Social Determinants of Health Network

Written in collaboration with Stanford University, CEK RN Consulting, and IPH – based on findings from the Robert Wood Johnson Foundation grant.

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