Medicaid Waivers by State: Findhelp and New York
More than 30 healthcare, health plan, nonprofit, and other organizations across New York have already implemented social care coordination platforms using Findhelp and are ready to hit the ground running with New York’s Medicaid 1115 waiver program, Medicaid Redesign.
Read on to discover how we can partner with you on your Medicaid Redesign lead entity application and browse some of our successful 1115 waiver program partnerships from around the country. Together, we can ensure a seamless delivery of goods and services to Medicaid members while tracking claims to report back to the State.
What Are Medicaid 1115 Waiver Programs?
Section 1115 of the Social Security Act gives states flexibility to update and improve their Medicaid programs by providing waivers authorizing experimental, pilot, or demonstration projects. Many states focus their 1115 waiver program projects on improving health outcomes by addressing Medicaid enrollees’ unmet health related social needs.
At Findhelp, we have both a history of successful Medicaid 1115 waiver program support (example: California) and deep relationships across the state of New York and beyond.
Our technology supports:
- Capturing eligibility and authorization needs for 1115 waiver programs
- Reporting on services rendered, codes, and data needed for invoicing and claims
- Invoicing paying entities and facilitating payment to community organizations and vendors
New York’s 1115 Waiver Program: Medicaid Redesign
On January 9, 2024, CMS approved New York State’s section 1115 Waiver Amendment Request through March 27, 2024 – providing $6.7B in funding to improve the health of New Yorkers. The Medicaid Redesign program will award up to 13 social care network (SCN) lead entities.
Given our singular experience creating these programs, Findhelp is here to support your NY 1115 waiver program initiatives, from application to implementation.
Partnering to Support New Yorkers
From housing and food security to transportation, employment, education, and more, Findhelp has the tools and expertise to build your trusted network and empower informed decision-making. As lead entities begin to apply for the NYS 1115 waiver program, they’ll need to outline their plans for reliable networks of contracted community-based organizations (CBOs) to better enable HRSN screening and the delivery of social care services.
Leverage Findhelp’s expertise in designing successful waiver programs, honed through collaborations with state leaders nationwide. Our proven workflows simplify complex regulations, maximizing your program’s impact.
We’re here to assist you with your NYS 1115 waiver program lead entity applications to ensure greater coordination of social care services for NY Medicaid members. Our products and services support every aspect of the program, from eligibility checking to claims generation and reimbursement.
Medicaid Waivers by State
Since 2019, we’ve been partnering with our customers and trusted community partners to support Medicaid 1115 waiver programs across multiple states. We collaborate with payers, managed care organizations, accountable care organizations, and community-based organizations to configure workflows and payment processes to fit the requirements of each state’s program.
Massachusetts: Flexible Services
In response to increasing needs surrounding food, housing, and behavioral health, Massachusetts’ department of health, MassHealth, launched their 1115 demonstration waiver program, Flexible Services, in 2019.
Under Flexible Services, MassHealth pays for health-related nutrition and housing supports for certain members enrolled in an Accountable Care Organization (ACO). These ACOs pilot evidence-based approaches that address a member’s health-related social needs with the goal of improving health outcomes and reducing the total cost of health care for the member.
- Starting in 2020, Findhelp partnered with Mass General and Brigham and Women’s Health to launch Flexible Services pilots with 10 community-based organizations.
- Midway through 2020 we expanded our partnerships to include Boston Medical Center and SouthCoast Health and trained 7 additional community organizations to improve food and housing outcomes across the state.
- Today, we are partnering with several Flexible Service ACOs to support navigation assistance for areas with higher volumes of eligible patients. In the first year of Flexible Services, 99% of patients reported that their participation improved their overall health.
California: CalAIM
On January 1, 2022, the California Department of Health Care Services launched the California Advancing and Innovating Medi-Cal (CalAIM) program, an 1115 waiver program to make Medi-Cal more equitable, coordinated, and person-centered. The program covers one-third of Californians and perinatal care for half of annual births and will impact the lives of over 14 million Californians.
- CalAIM expands community-based approaches to addressing complex care for high-needs populations, such as individuals experiencing homelessness, serious mental illness, or substance use disorders, or children involved in the child welfare system. Designated navigators coordinate members’ physical and behavioral care, as well as access to critical social services.
- Through 14 services such as Asthma Remediation and Housing Navigation Support, CalAIM encourages Medi-Cal managed care plans to address social determinants of health (SDoH) and offer preventative upstream interventions.
- Findhelp partners with MCPs across the state like Aetna Better Health, Health Net (Centene), and Alameda Alliance for Health to support CalAIM. We enable MCP staff and ECM to order more than 445 different social services from community partners.
Looking Ahead
Findhelp has experience partnering with customers across the country to address needs like food, housing, transportation, and more, whether it’s via our fulfillment program, Marketplace, by establishing Trusted Networks of community service providers, or by collaborating with organizations like Uber Health.
We look forward to joining forces with our existing customers and community partners to advance the work of the New York State Department of Health and the goals of the upcoming NYS Medicaid 1115 waiver to connect people in need to the programs and services that can help them.
Partnering for Success
You don’t have to start from scratch with your pilot demonstrations; chat with one of our team members to learn how we can collaborate with your organization to successfully implement New York’s 1115 waiver program, using established best practices and our proven strategies.
- Prospective Customers: connect with our Director of Enterprise Sales, Rachel Harris ([email protected]).
- Community Organizations & Customers: reach out to our Director of Customer & Community Success, Geoff Gamm ([email protected]).
- Policymakers: connect with our Regional Director for Government Relations, CG Niquette ([email protected]).
