New York Health Equity Reform (NYHER)

Transforming Medicaid Through New York Health Equity Reform

The New York Health Equity Reform (NYHER) Waiver amendment authorizes New York State to transform Medicaid through programs that improve population health, innovate and modernize care delivery and financing, and invest in the health-related workforce. It expands access to evidence-based services in areas like food/nutrition and housing, supports providers to transition to value-based care, and builds a strong and committed healthcare workforce. Additionally, NYHER leverages data and technology to enhance program delivery and efficiency in service of foundational Medicaid goals of improving quality, outcomes, and cost.

Goals include:

1. Transform care delivery through regional Social Care Networks (SCNs). Regional partnerships unite community organizations, providers, and insurers to seamlessly connect Medicaid members to social care services. All Medicaid members are eligible for social care screening and navigation to existing social care programs. Medicaid members with greater clinical and social care needs – such as those with chronic conditions, those with behavioral health needs, children at risk, pregnant/postpartum members, or those with housing instability – are eligible for enhanced care management, nutrition, housing, and social care transportation services. These partnerships ensure access to integrated, evidence-based services that improve social, behavioral, and physical health. SCNs rely on strong partnerships, shared data and technology, and aligned financial incentives to improve Medicaid member outcomes.
2. Grow and sustain the healthcare workforce. The Career Pathways Training (CPT) program focuses on career advancement through tuition assistance, educational and career support services, benefits navigation, language support, and job placement for individuals who commit to serving Medicaid and/or uninsured members. The student loan repayment (SLR) program provides loan repayment for professionals working in certain health-related workforce shortage professions, who commit to serving Medicaid and/or uninsured members. These programs create a reliable workforce pipeline to address health-related workforce shortages throughout the state.
3. Ensure Medicaid provider sustainability, quality of care, and encourage shift to value-based care. NYHER supports and incentivizes safety-net hospitals throughout New York State to maintain sustainable operations and invest in delivery system reform. This includes making investments to improve population health (including in services that address social and behavioral needs), enhance care quality, stabilize finances, and increase accountability for outcomes improvement through value-based payment models.
4. Facilitate coordination and continuous improvement. The Health Equity Regional Organization (HERO) will foster regional stakeholder coordination and evidence-based, data-driven action to address gaps in access and quality throughout the state. Using real-time qualitative and quantitative data, the HERO will also inform regional planning to ensure programs evolve to meet member needs and improve health outcomes.

Social Care Networks (SCNs)

Establishment of Social Care Networks (SCNs) is a core part of the NYHER Amendment. The role of the 9 regional Social Care Network Lead Entities will be to contract and coordinate with a network of Community-Based Organizations (CBOs) and other organizations providing health-related social needs (HRSN) services, and to coordinate healthcare providers (inclusive of behavioral health and primary care providers). Together, each network will be responsible for ensuring that there is a seamless, consistent, end-to-end process in their region for HRSN Screening, Navigation, and delivery of HRSN services.

For more information please visit the NYS Department of Health, Social Care Networks webpage.

Career Pathways Training Program

The Career Pathways Training (CPT) Program is an education and training program that was authorized under New York's 1115 Demonstration Waiver, as part of the New York Health Equity Reform (NYHER) waiver amendment (you can find New York's Special Terms and Conditions here). This program is designed to create a reliable workforce pipeline to address workforce shortages by funding education and training for health, behavioral health and social care workers throughout New York State.

For more inforamtion please visit the Career Pathways Training Program webpage.

Healthcare Access Loan Repayment Program (HEALR)

The HEALR Program aims to support recruitment and retention of high-demand health care workers, including psychiatrists (with an emphasis on child/adolescent psychiatrists), primary care physicians, dentists, nurse practitioners, and pediatric clinical nurse specialists. Applicants selected for student loan repayment will make a four-year commitment to maintain a personal practice panel or work at an organization that includes at least thirty percent Medicaid or uninsured individuals. More information about this program will be available in 2025.

For more inforamtion please visit the Healthcare Access Loan Repayment Program webpage.

Health Equity Regional Organization (HERO)

The Health Equity Regional Organization (HERO) will be wholly dedicated to closing health disparities across New York State through data-driven research by region. The HERO will convene stakeholders, including Social Care Networks (SCNs) and Workforce Investment Organizations (WIOs). More information about this program will be available in 2025.

For more information about this initiative please see the January 24, 2025 NYS Department of Health press release New York State Department of Health Launches State Medicaid Health Equity Regional Organization (HERO) Initiative

Primary Care Delivery System Model

The Primary Care Delivery System Model is a statewide investment to advance primary care and enable providers to move toward advanced Value Based Payment (VBP) arrangements. It aligns with the Center for Medicare and Medicaid Innovation (CMMI) Making Care Primary (MCP) and AHEAD model. This model will have a special focus on care for children and advancing primary care further toward VBP . More information about this program will be available in 2025.

For more information please visit the NYS PCMH Attestation FAQ webpage.

Medicaid Hospital Global Budgeting Initiative

The Medicaid Hospital Global Budget initiative will support incentive payments for financially distressed safety net hospitals, designed to lead to measurable improvements in outcomes and financial sustainability of hospitals that serve a high percentage of Medicaid members and uninsured individual. The initiative also supports the hospitals' transition to a global budget, as part of the Center for Medicare and Medicaid Innovation (CMMI) Advancing All-Payer Health Equity Approaches and Development (AHEAD) model, to incentivize and enable a focus on population health and health equity, improve quality of care, stabilize safety net hospital finances, and advance accountability.

For more information about this iniative please go here.