1115 Medicaid Redesign Team Waiver: Public Hearing

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July 31, 2026

Good afternoon. My name is Amir Bassiri, I'm the Medicaid Director, and this is our first public hearing on our renewal of the 1115 demonstration waiver. It's been a while since we've done one of these in person, so it's great to see all of you. Many of you I saw yesterday in New York City. Thank you for coming up and look forward to all of your comments. We have a pretty good agenda today. Simone Milos is going to lead us through the agenda and take you through an overview of our demonstration, what we're planning to renew. And I think everyone, many of you in this room will be very pleased. We're trying to continue the great work you're doing. And this is the first of two public hearings that we'll have. The next one will be August 11th, and that one will be virtual. Please do share that link to your colleagues or peers that are not able to be here, but we're very grateful that you are and look forward to hearing your comments. So, I will turn it over to Simone and, just want to say thank you.

Thank you, Amir. Alright, thank you everyone for joining us today. Today we'll discuss what the waiver has allowed the State to achieve over the last five years and how New York plans to build on that momentum moving forward. And then we'll leave time for public comments. Next slide, please.

Today's agenda has four sections. We'll open with a quick overview of the hearing format, then discuss the current Medicaid Redesign Team or MRT waiver and what the State is requesting in our extension. We'll cover 1115 waiver background, the NYHER amendment, continuing and discontinuing initiatives, and our Social Care Network's health-related social needs work. From there, we'll walk through the submission timeline and public comment process before opening the floor to comments. Next slide, please.

Today's public hearing is the first of two scheduled hearings for the extension request. The purpose of today's hearing is to provide information on the proposed 1115 waiver extension and give the public an opportunity to share comments. Beyond hearing from our community and receiving direct feedback on the waiver and proposed policies, we're hosting this meeting to comply with federal guidelines. Public hearings are required by federal regulations and are detailed in New York's Special Terms and Conditions, or STCs, which is the agreement between the State and the Centers for Medicare and Medicaid Services, or CMS, governing the 1115 waiver. A recording and transcription will be available on the 1115 waiver website following the hearing and notification will be sent out via the MRT listserv. Language translation is available upon request. Next slide, please.

Section 1115 demonstration waivers grant flexibility to states to implement innovative projects that advance the objectives of the Medicaid program. Under Section 1115 of the Social Security Act, these waivers authorize the Secretary of Health and Human Services to waive certain Medicaid program provisions and regulations and allow Medicaid funds to be used in ways that are not otherwise allowed under federal rules. For example, making certain investments eligible for federal match. These waivers are typically approved for three to five years, during which time they can be amended, as the State did in 2024 with the New York Health Equity Reform, or

NYHER waiver amendment. They can also be renewed for an additional term, and this is what New York is in the process of doing now. Next slide, please.

New York's 1115 waiver is called the Medicaid Redesign Team, or MRT waiver, formerly known as the Partnership Plan. This waiver has been in effect since 1997. With each demonstration period, the State has built on its prior learnings. The waiver was most recently renewed on April 1st, 2022, and is effective through March 31st of 2027. New York's MRT waiver is organized around four goals. The first is to improve access to healthcare for the Medicaid population. The second, to improve the quality of health services delivered. The third, to expand coverage to additional low-income New Yorkers using resources generated through managed care efficiencies. And the fourth, to advance health equity, reduce health disparities, and support the delivery of health-related social need or HRSN services. This fourth goal was added in 2024 with the NYHER amendment. Next slide, please.

The NYHER amendment introduced four interconnected programs, each targeting a different dimension of health equity. Together, they represent a significant expansion of what New York's 1115 waiver is designed to accomplish. The first is the health-related social needs initiative. In just two years, the State has built a first-of-its-kind statewide infrastructure called Social Care Networks, or SCNs, connecting eligible Medicaid members to direct support for housing, nutrition, transportation, and care management. Through the efforts of the SCNs, over 1.5 million members have already been screened for these needs. This is a significant milestone for a program still in its early stages. We'll dive deeper into the program later in the presentation.

The second program, the Medicaid Hospital Global Budget Initiative, supports the financial sustainability of 12 safety net hospitals that disproportionately serve Medicaid members and uninsured New Yorkers. The State has been working closely with CMS to evaluate steps to align with the federal model requirements, which will transform approximately five billion in healthcare payments to support hospitals and primary care providers. Third, the Health Equity Regional Organization, or HERO, coordinates regional stakeholders and uses data, including Medicaid claims, HRSN services, and regional input to identify gaps in access, quality and outcomes across physical health, behavioral health, and HRSN services. Finally, the workforce initiatives support education and loan repayment for health, behavioral health, and social care professionals who commit to serving Medicaid populations, helping to address staffing shortages across the State. The Career Pathways Training Program offers tuition, educational expense coverage, and support services. Over 13,000 participants have enrolled to date. The Healthcare Access Loan Repayment Program has received 890 applications. Awardees will be notified later this summer, with awards distributed in the fall. By helping train and retain healthcare workers, these investments are expanding access to care and strengthening the healthcare workforce and communities across the State. Together, these programs continue to strengthen how Medicaid serves New Yorkers, improving access to care, addressing social determinants of health, supporting providers and communities, and advancing health equity. Next slide, please.

This slide provides an overview of how current MRT waiver initiatives fit into the proposed extension. On the left are the programs the State is proposing to continue without major changes. And on the right are the initiatives proposed to continue with targeted amendments.

For HRSN services, the State is proposing to continue all current services with two modifications, removing brokerage fees and simplifying the eligibility categories for children into a single group. There will be more detail provided on financing updates later on in today's presentation. For the Medicaid Hospital Global Budget Initiative, the State will continue working with CMS to evaluate steps to align with the federal model requirements and support hospital readiness. For the HERO, the State is proposing to shift the program's focus from public health research to advanced analytics and program integrity. For workforce initiatives following the federal guidance received last year, the State is requesting only the limited funding needed to monitor existing service commitments and close out the programs. Finally, the State is proposing to continue eligibility for the Home and Community-Based Services Expansion,

Institution to Community and Family of One Children demonstration populations, while discontinuing the Temporary Assistance for Needy Families Adult demonstration population because that demonstration authority is no longer needed under the current Medicaid eligibility framework. Next slide, please.

While many initiatives are proposed to continue, the State is also proposing to discontinue several authorities. In all cases, steps will be taken to ensure continuity of care and orderly transitions for impacted members. First, the State is proposing to discontinue continuous eligibility for children up to age six and 12-month continuous eligibility in accordance with federal guidance released last year indicating that CMS does not anticipate extending these initiatives. Today, all beneficiaries of these initiatives have either been re-enrolled into Medicaid if they remain eligible or transitioned to another program if they no longer qualify. Second, the State is proposing to discontinue the Behavioral Health Home and Community Based Services that were not transitioned to Community Oriented Recovery and Empowerment, or CORE. Specifically, Education Support Services, Pre-Vocational Services, Transitional Employment, Intensive and Ongoing Supported Employment, Habilitation, and Non-medical Transportation. At this time, fewer than 31 members are still enrolled in these Behavioral Health HCBS services. Every Medicaid member receiving these services will receive an individualized transition plan and will be connected to appropriate alternative services. Third, as noted earlier, the Temporary

Assistance for Needy Families' Adult demonstration population is proposed to be discontinued as the State is planning a structural change, whereby Medicaid eligibility will no longer be derived from the temporary assistance determination. Fourth, the State is not requesting additional HRSN infrastructure authority as we expect to fully utilize funding already approved and we do not anticipate CMS approving additional funding at this time. Fifth, the State is proposing to discontinue demonstration authority for three targeted behavioral health services under Mainstream Medicaid Managed Care, those being Residential Addiction Services, Crisis Intervention Services, and Licensed Behavioral Health Practitioner Services. These services have been incorporated into the Medicaid State Plan and will remain available to members.

Finally, the State is proposing to discontinue authority for the Self-Direction Pilot, which never drew down federal funding and will continue operating through State funding. Next slide, please.

Next, I'll turn it over to Emily Engel to discuss HRSN services and Social Care Networks in more depth.

Thank you. Hello, everybody. Okay. Sorry, I love when there's a clicker. Okay, so the Social Care Network program, we can go to the next slide.

As you know, the Social Care Network program has been a core part of the 1115 waiver demonstration. In this section, I'm going to share with you a brief background on the Social Care Network program and the achievements to date. The program was established through the 1115 waiver to help address health-related social needs, such as access to nutritious food, stable housing, transportation, and social care management. Across the nine regional networks, healthcare providers, behavioral health providers, community-based organizations, and other local partners. They work together to identify unmet social needs and connect eligible members to health-related social needs services. Since the program launched, we've built a really strong statewide infrastructure that is needed to support this work, including IT systems, data, payment systems, and provider capacity. Next slide.

So, today we have 1.5 million Medicaid members that have been screened for unmet needs across the nine Social Care Networks. The screening rate among Social Care Networks has grown 4.8 times in the past 12 months. And there's approximately 3,200 Social Care Navigators, including Community Health Workers covering the 62 counties. The Social Care Networks consist of over 1,400 organizations that are contracted to provide screening, navigation, and the enhanced health-related social needs services. Of those 600 plus providers, many provide more than one service, and approximately 600 community-based organizations have received capacity funding to expand and participate in the waiver providing health-related social needs services to Medicaid members. This waiver has allowed the State to set up comprehensive and regional networks. They have a technology backbone that enables consistent service delivery across the state, and it supports localized delivery of services on a community level. The ecosystem partners work together in real time to connect members to services and track outcomes. Since August 2024, the State has connected 9 lead entities, 3 Social Care Network IT platform vendors, 6 qualified entities, and a little over 25 Medicaid Managed Care Organizations, and the 1,400 CBOs and partners all to do this work. And it's pretty amazing that's been done in such a short amount of time. This infrastructure underpins a robust data ecosystem that supports high-quality program evaluation, accountability, and transparency.

Thank you.

So, when we look at the waiver renewal, you know, building on the momentum of the current program, the State is proposing largely to maintain the current set of services offered. So first, the State is requesting to continue all of the existing health-related social needs services with the exception of brokerage fees. New York City passed a Fairness in Apartment Rental Expenses Act, which would prohibit such fees from being charged to tenants and therefore that service is not used. The State is also requesting to roll over all unspent, unclaimed DSHP funding to pay for the health-related social needs services and to maintain a current non-risk payment approach for one more year, and then transitioning Social Care Network lead entities, not the community-based organizations, to value-based payment models, which would be at risk, capitation approach in 2028. In addition, the Social Care Network is also proposing to add a new population category called high-risk children under 18. This just combines our three existing populations of children just to make it a little bit more streamlined and clear. And finally, the State is not requesting the continued expenditure authority for the health-related social needs infrastructure funding. The infrastructure funding is projected to be spent out. And as Simone mentioned, this is not something we expect CMS to continue.

So, turning to the services, you are all probably very familiar with this slide by now. So, all of these services will remain under the waiver renewal. So, we have the screening, use the Accountable Healthcare Community Screening Tool, the navigation, the nutrition supports, care management, the housing services, including medical respite, the rental subsidy provisions, asthma remediation. One change is under the community transitional services, that's where brokers’ fees are, and that's what would be proposed to be removed. And then the health-related social needs transportation to connect members to health-related social needs services would also continue. Looking at the enhanced population, again, under this proposed waiver renewal, the populations also remain the same. To ensure that these services reach members with the greatest need, member eligibility to receive enhanced services will continue to be based on the combination of factors of (1) having an unmet need, (2) being enrolled in Medicaid Managed Care, (3) meeting one of the enhanced criteria populations and then also having that additional clinical criteria for certain specific services that do require it. So again, this is really what we're already doing, put into the waiver renewal, no big changes. I do have highlighted here in purple, the children under 18, which is the only change and it's more definition than actual change. We can go to the next slide.

I wanted to end just with the impact that we're hearing from Medicaid members and providers. Beyond the numbers, these are testimonials that highlight what the Social Care Network program means for people in the communities that it serves. Members describe receiving support that helps them access stable housing and utility assistance, nutritious food, employment resources, and other essential services. These supports, they say, have made it easier to focus on their health and well-being. Providers also describe how the program has helped them reach otherwise hard to engage communities and address critical health-related social needs services. The Social Care Networks have built a really strong capacity and will continue to grow as part of this 1115 waiver renewal. Thank you.

Thanks, Emily. We'd now like to turn to next steps in the waiver extension process. Next slide, please.

Okay, the public comment period for the waiver extension opened on July 8th and will run through August 21st. A second public hearing will be held virtually on August 11th. This public hearing will also serve as the State's annual 1115 public forum. At the close of the public comment period, we will incorporate public comments and finalize the waiver extension for submission to CMS at the end of September. Not shown on this slide but after formal submission, there will be a federal public comment period that will likely run from mid-October through mid-November. The exact dates are still to be determined. This will be another opportunity for you to provide feedback on the waiver. And then finally, the current waiver period is set to expire on March 31st of 2027. Next slide, please.

Okay, so this brings us to the end of the presentation for today's public hearing. I'm going to pass things over to my colleague, Brianna Rowe, to walk through the public comment portion. Thank you.

Thank you. Good afternoon. Before we begin, next slide, please.

Before we begin the public comment portion of today's hearing, I will share some resources we have curated to give more detailed information on the MRT waiver and the current extension application, which are listed on this slide. The first is New York's 1115 waiver website, which contains more information on the 1115 waiver and the programs under it. There's also a link to the current STCs, or Special Terms and Conditions, and a link to the official 1115 MRT waiver extension application. If you have any questions or would like further information on the 1115 waiver, you can reach out to us over email at 1115waivers@health.ny.gov. And again, these slides from today's hearing will be posted on the 1115 waiver website. Next slide, please.

Now I'll provide some guidelines for participating in the public comment process. We have a list of pre-registered commenters, and those individuals will be called on today in the order in which they registered to speak. Comments will be timed, so please limit your comments to five minutes in order to keep the public hearing moving smoothly. My colleague, Jessica Powers, will be keeping time. She will notify each speaker when there is one minute remaining, and then when time is up. Written comments will also be accepted through August 21st by email at 1115waivers@health.ny.gov or by mail at the address on the screen, Department of Health, Office of Health Insurance Programs, Waiver Management Unit, 99 Washington Avenue, 8th Floor, Suite 826, Albany, New York 12210. Next slide, please.

If you have any further questions that were not answered here, or comments, please contact us at the email on the screen. Again, that is 1115waivers@health.ny.gov. And with that, we will welcome up our first registered speaker to the microphone here in the center of the room, and that is going to be Jill Chodak. Thank you, Jill.

Can you hear me? Okay, cool. Hi, my name is Jill Chodak. Thanks for having me here. I'm a registered dietitian and the Director of Food-Based Healthcare at Foodlink, a Rochester-based food bank that serves ten counties in the Finger Lakes region. Last year alone, we delivered 28.8 million pounds of food and 2.4 million meals from our community kitchen, which was the most in our history. I came to Foodlink last year after seven years of seeing patients at an outpatient clinic in Rochester. I made this career change because my patients reminded me every day that they could not make the necessary dietary and health changes that they wanted to make without the resources and actual access to food. My patients often had to choose between buying groceries or paying rent, utility bills or for critical medications. That's an impossible choice that no one should ever have to make, and it broke my heart as a clinician and as a mother to hear about the circumstances our neighbors face in our communities. As healthcare providers, we can preach all day long about making healthy choices to improve health outcomes, but nothing will change if our neighbors can't access or afford healthy food and other critical resources. In New York State and across the country, there is growing recognition that health equity extends beyond physical and behavioral health and into health-related social needs. I joined Foodlink team to lead our work on the 1115 Medicaid waiver because this is a one-of-a-kind opportunity to use Medicaid dollars to close health equity gaps, and to provide consistent nutritious food to at-risk families. This work has been a dream come true. For the past year, Foodlink has been a leading provider of nutrition services under the waiver in the Finger Lakes region. We offer services such as nutrition counseling, cooking supplies, food vouchers to our curbside market locations, Food Rx food boxes, and pantry stocking for pregnant, postpartum women and high-risk kids in three rural counties in our service area. The work truly demonstrates that food is medicine and gives community members a more equitable shot at improving their health. As a trauma-informed dietician entrenched in doing this work and serving our waiver program members daily, I am seeing firsthand how these services are changing the lives of families mentally, physically, clinically, and socially. Members receiving our food and nutrition services report weight loss, lower blood sugars, and more peace of mind knowing they don't have to worry about where their food is coming from this week.

Better yet, and frankly, it's something I live for as a clinician, I get to see them come back to life. It really is working. Yet we need an extension. The impactful work that we are doing now took a long time to plan and execute. Foodlink has been connected to the waiver since its original application. We were in good position to hit the ground running because we had the infrastructure, staffing, and acumen to do this work. But we did not serve our first Medicaid members until July of 2025, because the regional and state infrastructure was still being built. So, while we have been working in overdrive and expanding our services by leaps and bounds this past year, the truth is, is that our work is just getting started. We've only just scratched the surface of how this work can truly drive change in our communities. And as we all know, true change takes time. We strongly support a five-year extension of this transformational program. More time allows us all the opportunity to impact thousands more households with nutrition-related services, and to produce the results we all know are coming, improved health outcomes, lowered healthcare costs, and more collaborative support for some of our most vulnerable neighbors. Thank you.

Thank you, Jill. All right, our next speaker is Jeffrey Yoskowitz.

Hi, good afternoon, and thank you for the opportunity to testify. My name is Jeffrey Yoskowitz, and I'm the Managing Director of Policy and Technology at Met Council, America's largest Jewish charity dedicated to fighting poverty. Met Council provides a wide array of support to over 350,000 New Yorkers annually across every denomination and demographic. As a contracted partner in all three Social Care Networks serving New York City, Met Council serves every borough, touching the lives of many New Yorkers, from seniors aging in place to young families. Community-based organizations like Met Council have earned the trust of over our 50 plus year history serving New York's neighborhoods and communities, and that trust is what brings people into this program. I want to start with what our organization has actually delivered. This program changed how we work. Historically, New Yorkers found Met Council when they needed food or social services. Through the Social Care Network, we built something new. An outreach arm that goes out and finds New Yorkers in need before they ever have to ask. This year alone, we've screened and enrolled more than 35,000 of them across all five boroughs.

That's allowed us to provide Medicaid members with a full spectrum of services, including medically tailored and clinical meals, including many that meet kosher and halal dietary needs, as well as food pantry boxes, cooking supplies, asthma and mold remediation, and home modification services that prevent falls. Here is what this looks like for just one person. This past spring, just before Passover, a young woman walked into our Brooklyn hub that last year served 13,397 people in southern Brooklyn and said she needed help. Her child was diagnosed with celiac disease. Keeping him safe meant more than the family's own kosher kitchen could provide. The child required a dedicated set of cooking supplies kept completely free of gluten.

We enrolled the child in the program, and through it, the family received both groceries and the cooking supplies needed to keep that kitchen safe. For the first time, that boy was able to eat the holiday meal together with his family. No other benefit or emergency food program would have offered this. This is what screening and enrollment do well: connect people who trust us to the support that cannot get anywhere else. For Medicaid members overall, this program is low lift, high reward. It asks little of members and delivers services that are often unavailable to them through any other channel that support positive health outcomes at no cost and without stigma. This is proof that community-based organizations can do this work and do it better than anyone else. Which brings me to why we're here today. I'm here to join my colleagues in urging the State and federal government to work together to protect what we have built through the Social Care Network. We have three concrete asks to maintain the success of this program and the stability of the contracted CBOs doing this work. First, advance the five-year extension, including the one-year no-cost bridge, so this network doesn't lose a single day of continuity while the full renewal is finalized. Second, keep community-based organizations like Met Council at the center of delivery, especially as the State moves towards capitated risk-adjusted payment. Third, and most urgent, sustain infrastructure and capacity funding for CBO partners through this transition. The outreach arm that reached those tens of thousands of New Yorkers this year didn't exist before this program. Met Council built it because we invested more than one million dollars of our own funds in the staffing and systems behind it, because we believe in what this program does for New Yorkers, and that investment only pays off if the network stays standing long enough to use it. Public Health Solutions, our lead entity for Manhattan, Brooklyn, and Queens, has been instrumental in helping us build the infrastructure to deliver at scale.

Continued investment in that partnership will let us expand this infrastructure further and extend our impact even more broadly. That's a worthwhile investment. Fewer than one in five CBO partners in the system can cover their costs through fee schedule payments alone. While Met Council, as the largest Jewish charity in the country, has the scale to absorb that gap, we're concerned about most CBOs that don't. We built something that works, executing the vision your department has led for years, and we're proud of that. Now we're asking you to protect the partnership between us, the CBOs, the Social Care Networks, the New York State Department of Health, and every other partner that made this possible. Thank you.

Thank you. All right, our next speaker is Erica Schwartz.

Good afternoon. My name is Erica Schwartz. I'm the Associate Executive Director of Community Based Programs at St. Catherine's Center for Children located here in Albany New York. We serve the greater Capital Region of the State of New York since 1886. So, in partnership with Healthy Alliance, the lead Social Care Network for the Capital Region, St. Catherine's is contracted to provide HRSN services, including screening, navigation, enhanced care management and housing services under the 1115 waiver. I'm here today to support and advocate for a five-year extension of the 1115 MRT waiver as was recently requested by the

New York State Department of Health. Due to the lengthy planning, infrastructure building, capacity building and rollout period that the undertaking of a project of this scope requires, the program has had what feels like very little time to actually operate and provide the much-needed services that it was intended to for some of the neediest community members across the state. I also wanted to share a few very brief success stories that we've had the opportunity to witness through the work of the 1115 waiver. At St. Catherine's we call our staff who provide these services Community Health Navigators, and most of them are related to housing. Over the span of just a few months, we've been able to assist with moving a young mother and her son out of a very dangerous and abusive situation because of domestic violence into a place of their own, with furnishings, so that their new apartment isn't empty and they both have a bed to sleep in, furniture to sit on, and a table to eat meals at without worrying about their physical and emotional safety on a daily basis. We've also been able to assist another mother and her teenage son with staving off an eviction, catching up on back rent and staying stably housed by providing six months of rental assistance so that this mother no longer has to sell her plasma and her body in order to keep her family housed on a month-to-month basis while an eviction loomed over both of their heads. And we've been able to help an elderly gentleman get his own apartment for the first time in many years with furnishings and household items and small appliances so that he was able to be housed and cook his own meal for the first time he could remember this past Christmas. He told his Community Health Navigator that that was all he wanted for Christmas and that he even invited a friend over to spend the day with and he was so proud to have a place of his own. None of this would have been possible without the 1115 waiver and these are just three examples from one very small program. So, I'm here to advocate that that be extended. My concern is if it isn't, there's just so many people who will never get to benefit from these services that they are in fact eligible for and that would be a tragedy. Thank you.

Thank you. Our next speaker is Brandy Loveland. Okay, Brandy's not here. Our next speaker is Erica Coletti.

Hi everyone, I think I'm a little short for this, but my name is Erica Coletti and I'm the Chief Executive Officer of Healthy Alliance. Thank you for the opportunity to be heard. Healthy Alliance served as a legacy Performing Provider System under DSRIP and now serves as a Social Care Network lead entity covering 24 counties in upstate New York. Since this waiver period began, we have screened close to 120,000 Medicaid members, delivered more than 260,000 services to members with health-related social needs, and paid more than 33 million dollars to our Social Care Network partners for services. I strongly support this extension for one simple reason. Through this waiver, New York has built the foundation for a more coordinated, preventative, and accountable Medicaid system. And now we need time to stabilize that work, evaluate its impact, and build on the progress already underway. First, the waiver has created something New York did not have prior to 2025, a statewide infrastructure that reaches Medicaid members across urban, regional, and rural communities with the support they need to stay healthy. When you step back and look at what has been built in such a short period of time, the progress is remarkable, but the work is not finished. To sustain that momentum, New York requires continued investment in both the infrastructure and the organizations that make it work. This funding is not simply administrative overhead. It supports the systems and partnerships that connect members to care while also helping community-based organizations build the operational capacity needed to participate and succeed in this model. Many of these organizations are trusted providers in the communities they serve, but they still rely on technical assistance, operational support, and capacity building opportunities to provide it through the SCNs. Without continued investment, New York risks destabilizing both the infrastructure and the trusted community partners that make this model work, leaving Medicaid members without support until challenges become more complex, costly, and difficult to address. Second, New York needs more time to integrate health-related social needs, or HRSN, services into Medicaid delivery, embedding them into managed care, provider workflows, community partnerships, and ongoing evaluation. This aligns directly with CMS priorities: better outcomes, lower avoidable costs, stronger accountability, and a more coordinated approach to care. HRSN services are about more than reducing emergency department visits or hospitalizations. They promote long-term wellness by addressing the food, housing, transportation, and care management needs that shape daily life. With more time, New York can demonstrate which interventions improve health and stability and how social care investments support a more sustainable and cost-effective Medicaid program. We see this in members like Connor, whose nutrition support and access to cooking supplies helped him prepare healthy meals, gain independence, and build confidence as he transitioned to college. Lindia, whose housing support helped her regain stability, earn her GED, and move toward economic security for herself and her young daughter. And Trayva, whose rental assistance helped her go from couch-surfing to stable housing and ultimately find employment within our Social Care Network. Their stories underscore what this model is truly about, helping people stay healthy, remain connected to their communities, pursue opportunities that might otherwise be out of reach, and avoid costly crises before they occur. Third, New York needs this waiver extension to sustain the workforce that makes HRSN service delivery possible. The extension would continue to support the more than 3,000 Social Care Navigators now operating across the state, a workforce made possible by the waiver.

Navigators are the people who turn the waivers infrastructure into real access for members. They help individuals navigate the system, connect to services, complete required documentation, and stay engaged in care while allowing clinicians to focus on medical needs. The result is greater clinical capacity, less administrative burden, and stronger connections to coverage and care. In the wake of H.R.1 work requirements, navigators will become even more important, helping individuals understand new requirements, address barriers to participation, and avoid losing coverage because of paperwork or documentation challenges. That matters for members and it matters for providers. When eligible New Yorkers stay covered, they stay connected to care, providers are less likely to bear the cost of unreimbursed services, and the entire healthcare system is better positioned to serve those who need it most. For these reasons, I urge approval of New York State's 1115 waiver extension request, but an extension alone is not enough. Continued investment will be essential to sustain SCN lead entity operations and community partner capacity through the transition to value-based care and ensure that no communities are left behind. This extension will protect the infrastructure already built, give the State and its partners time to demonstrate what works, and sustain the momentum, workforce, and partnerships necessary to improve health outcomes for people like Connor and Lindia and Trayva. Thank you.

Thank you. Our next speaker is Natasha Pernicka.

Hi, good afternoon, I'm Natasha Pernicka. The New York State Food is Medicine Coalition represents over 130 stakeholders across the state, including community-based organizations, nonprofit and for-profit nutrition service providers, as well as healthcare, academic, agriculture and lived experience. We fully support extending the New York State waiver to integrate nutrition care into healthcare delivery. To ensure the continued success, growth, and sustainability of nutrition services under the waiver, our coalition collectively recommends the following. Support ongoing infrastructure and capacity investment. We strongly urge the State to maintain or develop new, external to waiver, health-related social needs infrastructure and capacity building funds to ensure CBOs and other nutrition providers can scale effectively alongside, alongside growing member enrollment. The screening of 1.5 million members, 82 percent of whom reported unmet nutrition needs, demonstrates both powerful early momentum and the immense need ahead for the remaining two million members that have not yet been screened. Sustaining infrastructure funding is essential to completing this build-out and securing long-term program impact. Establish standardized yet flexible reimbursement tiers create standardized reimbursement tiers for all nutrition services across regions to eliminate arbitrary regional inconsistencies while embedding flexibility into reimbursement rates to account for geographic cost variations and seasonal food prices. Fund cultural inclusivity and language access. Streamline real-time eligibility verification, integrate automated eligibility checking tools and rapid status updates directly within IT platforms to eliminate the operational dilemma wherein HRSN providers must choose between using staff time on constant manual re-checks or absorbing financial losses by delivering unbillable services to members whose coverage lapsed. Simplify reauthorizations and step-down roadmaps, reduce the administrative burden of completing a full screening for eligibility to ensure continuity of service delivery. Establish clear roadmaps when members transition between service levels and mandate wraparound referrals. Standardize operational workflow across Social Care Networks in order to ease administrative burden and duplication of work. Establish standardized processes and workflows, including eligibility and reauthorization timelines, claims documentation requirements, and claims approval timelines across all SCN regions, including clear change logs for any updates to the Social Care Network Operations Manual. Facilitate increased communication between HRSN providers. Overcome healthcare provider bottlenecks. Address low medical provider awareness of waiver services through targeted provider outreach and streamlining of burdensome provider attestation requirements that currently leave eligible members unserved. Pair food interventions with MNT and education. Increase the low uptake of stand-alone nutrition counseling by systemically pairing all food packages with registered dietitian services. Update service guidelines to fill current gaps, explicitly approve chest freezers as cooking supplies, allow shelf stable and canned proteins in pantry stocking boxes, and increase food box portion sizes for multi-person households with children. Ensure the 1115 waiver evaluation measures nutrition service specific health and food security outcomes, member experience, service completion rate, and total cost of care ROI to build actuarial evidence for future sustainable provider reimbursement rates. Food is medicine is healthcare. We urge New York State Department of Health to partner with CBOs and other service providers to maintain capacity funding, simplify administrative pathways, and build a truly sustainable and integrated food is medicine ecosystem in New York State. Thank you.

Thank you. Our next speaker is Al Cardillo. Thank you.

Good afternoon and thanks for this opportunity today. I'm here on behalf of the Home Care Association. We appreciate this opportunity to speak to the waiver, and to offer our very strong support for the waiver and its renewal. We're a statewide health association comprised of providers and health plans that are certified or licensed to provide care in the home in New York State. We're also a 501c3 corporation that is heavily involved in cross continuum initiatives and I'm going to reference some of those in my comments today because I think they represent some ideas for you, for purposes of the waiver. So again, while we fully endorse the renewal of the waiver, we do feel that the waiver should be amended to deal with one of the glaring gaps in it, which is the absence of really any structural programming or involvement for home health agencies and hospices. We really feel that given the role in the system, the challenges with access across the state, it's really hard to fulfill the waiver’s goals without a key pillar of the system particularly as home care functions as a partner to hospitals, physicians, and others. One of the things I want to point out in that regard is that the current condition of home care agencies in the state is really very dire. In their statistics, Amir, in the packet that will point out the fact that in the last 5, 6 years, 20 percent of the agencies have closed. Since the early teens, over 100 Long-Term Home Health Care programs no longer are able to receive referrals. Nearly 60 percent of CHHAs, LHCSAs, managed care plans, and hospices are in negative margins, and that's all from the cost reports in the M-COR. So that's reported there. What we're seeing at the ground level is something like 30 to 50 percent of home health agencies are not able to accept referrals as they need to come into the agency. So, there's delays and there's access issues that really affect the system across the way. So, what we really recommend is that there be some reflection on who is included in the waiver in terms of opportunities to both contribute to the goals of the waiver and for essential support to preserve access. I just want to take a few minutes and talk about just several initiatives, 30 seconds for each, I promise. So, in these, there's also opportunities for key State savings and revenue. In the amendment, as you go to continue the provisions of 4403F, I think it would be important to take look at the care coordination component where the enrollment mandate applies to MLTC or other care coordination models, including models like the Long-Term Home Health Care program. Our recommendation is that you look at potential restored targeted access for long-term care patients in CHHAs and in Long-Term Home Health Care and I'm going to explain the data on that. One of the things that that happened, as a result of the MRT, is the system became highly Medicaid-focused. When you had individuals in CHHAs and long-terms, there was an opportunity for Medicare coverage of those services. In the ten years prior to the MRT, the State earned 1.7 billion dollars, very close to that, in Medicare reconciliation revenue because you had patients in CHHA's, and especially long-terms, where the State and the provider could claim against Medicare for services. In the last eight years it's 64 million, that reconciliation.

That's a lot to leave off the table because you don't have the capacity in the current models for Medicare eligibility. So, let me move quickly because I do want to cover a few other items for you. And also, you'll see in the testimony a comparative analysis of the Medicaid impact of that. It's very, very substantial in terms of the lost savings to the State on the Medicaid side. I want to speak to a model that we've developed in seven regions of the state. They're called collaborative models of community medicine, and we've developed these with financial support over five years from the Cabrini Foundation. In these seven models, which bring together hospitals, home health, physicians and EMS, we're seeing rates of hospitalization reduction at 76 percent and rates of ED reduction of 69 percent. And in these models, and one of the reasons it works is because they incorporate the social determinants heavily along with medical comorbidities. We really believe we have an application in for funding in 2027, but we think if you took a look at these models they might represent access, quality, and cost savings goals for the waiver. Do I have a couple minutes? A couple more or we're done? Time’s up. Okay. I'll just say, in the material there are references to a primary care FQHC partnership, which has been very successful, a hospital home care physician disparities initiative off a bill the governor signed two years ago, and virtual senior services, some things like that to take a look at and to consider. Thanks so much for your time.

Thank you. Our next speaker is Zach Hennessey.

Hi, good afternoon. Thank you for the opportunity to speak today. My name is Zach Hennessey. I'm the Chief Strategy Officer at Public Health Solutions, where I lead WholeYouNYC, the State's largest Social Care Network, serving Queens, Brooklyn, and Manhattan in New York City. We represent nearly a third of the State’s Medicaid membership through more than 200 community-based organizations. I want to begin with appreciation. Two and a half years ago, almost none of what I am about to describe existed. Today, New York has nine regional Social Care Networks, more than 1,300 contracted service providers across 62 counties and over 3,000 trained Social Care Navigators. More than 1.5 million Medicaid members have been screened for unmet health-related social needs. Together we built a statewide technology backbone connecting our networks to 6 qualified entities and more than 20 managed care plans and created the Social Care Encounter, a first in the nation standard for documenting our work. That was done in 22 months. That is not the normal pace for healthcare reform. Here is what that looks like in our region. As of Monday, WholeYouNYC has screened more than 700,000 members. Through 42 million dollars in capital investment in our community partners, we have delivered over 250 million dollars in services. More than 200 million of that is food is medicine for people living with nutrition sensitive conditions. And here is the number I would ask you to hold on to. When our community-based partners screen someone, they are currently identifying unmet need 62 percent of the time. That rate of disclosure reflects trust. Met Council, one of our partners, has served older adults in the same neighborhoods for decades. When their staff member asks a home-bound senior whether she has enough food this month, she answers honestly because she knows who is asking. That is the premise of this program and the evidence is sound. Which brings me to our concern. Section 3.12 does not seek to continue expenditure authority for HRSN infrastructure. I understand the reasoning. The 500 million cap will be reached and the infrastructure is, as the application puts it, established. However, although the technical infrastructure is established, the human infrastructure is not there yet.

The State's independent evaluators report issued earlier this month documents more than 80 million dollars in capacity building funds awarded to community organizations and what those dollars supported: staff, systems, the ability to participate. One of your key informants put it directly, community organizations, they said, can't just jump into something like this. They need those startup funds to really be able to have an active participation. That same evaluation finds that the shift from grant funding to reimbursement remains difficult and that providers are still worried about sustainability staffing this model. That mirrors what we see. As of today, only a fraction of our network partners can sustain themselves on service fee payments alone. Lead entities like PHS are being asked to carry both operational and reconciliation risk on a three percent administrative rate. Which will not leave room for us to support capacity building from our budget in 2027. My ask is simple and I offer it as a partner in this reform work. Before this application is finalized, we request that you identify a continued mechanism to sustain SCN operations and community partner capacity through the 2028 transition to value-based care.

Without that support, critical populations and geographies of vital importance to the reform will be left behind. These populations and their trust in this work are essential to success in a risk adjusted model and to help pave the way for value-based care. I am proud to say that we have built together something remarkable and we've done it so quickly. We are now asking you to protect the partnerships that have made us so successful. Thank you for your time and for your work.

Thank you. Our next speaker is Eric Rochman.

Thank you for the opportunity to comment on New York's 1115 waiver extension request. My name is Eric Rochman, and I serve as Chief Operating Officer of God's Love We Deliver, a non-profit New York-based community-based organization. For over 40 years, God's love has delivered medically tailored meals and nutrition services to New Yorkers living with over 200 different diagnoses, such as HIV, kidney disease, heart disease, diabetes, and cancer. While God's Love started as a small, New York City-focused organization in the 1980s, we now provide more than 3.6 million medically tailored meals annually to individuals across New York State and over 40 million meals since we were founded. Medically tailored meals are nutritious, individually tailored meals designed by a registered dietitian nutritionist to meet the specific needs of each person's illness, treatment, and preferences. Recognizing the importance of nutrition to an individual's health, particularly those with chronic conditions like our clients, God's Love has long partnered with the State Department of Health and Medicaid plans to find ways to cover and integrate medically tailored meals and other food and nutrition services into the Medicaid program for eligible enrollees. We've done this through the State's Managed Long-Term Care and Medicaid Advantage program, where medically tailored meals is a covered benefit as part of value-based payment arrangements that began under the State’s DSRIP program, under In Lieu of Services authority with a handful of health plans who understand the value of medically tailored meals for their members and outcomes. And most recently, as a CBO in the State’s NYHER waiver, participating in all nine Social Care Networks. Our commitment on the waiver request reflects this experience and commitment to partnership. We appreciate New York's continued focus on covering health-related social needs services and specifically providing access to food and nutrition services through Medicaid. God's Love strongly supports the State's request to continue health-related social needs services in the next waiver period and has four recommended refinements to the program to ensure its future success.

Recommendation one is to empower CBOs in HRSN service delivery. Community-based organizations make it the backbone of HRSN service delivery. CBOs have spent decades serving New York communities and building trusted local relationships, well before waiver funding arrived, and will be the ones who continue to serve these communities long after waiver funding dries up. The State's vision for the NYHER waiver was to empower local CBOs and enable the funding and integration of their services into Medicaid enrollees’ healthcare in support of whole person care. Unfortunately, many non-profit CBOs like God’s Love have been sidelined by new market entrance. For-profits, and companies from out-of-state who have flocked to New York as the waiver provided funding opportunities. This has occurred despite the fact that current waiver policy directs HR center referrals to go to nonprofit CBOs, except in cases where there's not sufficient CBO capacity. God's Love has seen firsthand that CBO's have capacity for, and in some cases, many more referrals, but yet referrals often go to for-profit providers. In its upcoming waiver, we strongly encourage New York State to reinforce the role of local CBOs in HRSN service delivery. Recommendation two is to streamline connections to HRSN services to improve enrollee's experience. HRSN screening and navigation should connect people to services, not create additional barriers. Today, referral pathways for these services can involve multiple handoffs, repeated screenings, and duplicative steps before an enrollee receives MTM or other services. In some cases, enrollees referred to God's Love if they've been screened as many as ten times before receiving services. In the next waiver period, success should be measured by whether eligible individuals receive HRSN services quickly, seamlessly, and consistently. The State should reduce friction by creating a simpler, more coordinated pathway from identification of enrollee need to service delivery.

Recommendation three is to increase program accountability and transparency. New York should establish clear, consistent performance expectations related to navigation, referrals, service utilization and outcomes, and performance data should be shared regularly with all implementation partners, including CBOs, other HRSN service providers, and health plans to support coordination and identify barriers earlier. As the program matures, the State should also ensure that HRSN service providers meet appropriate standards and deliver services consistent with the State's service descriptions. Together, these steps will support continuous improvement and help evaluate the impact of these services on Medicaid enrollees' health and wellbeing.

Recommendation four is building a thoughtful path to sustainable financing. God's Love strongly supports efforts to sustain coverage for food and nutrition services in the long run, as we see firsthand how effective these services are in improving outcomes or reducing medical and other costs. This includes the rollover of 1.5 billion of the DSHP funding to continue the work we have started. However, the State's waiver request is not clear on if it envisions these services or the Social Care Networks being sustained beyond the period of the next waiver. We believe that value-based payment service arrangements between the plans and SCNs may be part of the State’s planning, but it remains unclear whether and how this could be effective. We encourage the State to apply lessons learned from DSRIP as it develops its approach to long-term sustainability. One possible approach that has been utilized in other states and has more limited capacity here in New York is In Lieu of Services authority. New York has an approved In Lieu of Services program for medically tailored meals today, though it is underutilized given overlapping waiver coverage. As a starting place, the State should align the In Lieu of Services eligibility criteria for medically tailored meals with the waiver eligibility criteria, which would support continuity of care for enrollees to reach their waiver services limit, but continue these services, and take steps to increase participation in the lieu of services. Thank you.

Thank you. Our next speaker is Jamaica Tyler. Jamaica? No. All right, our next speaker then is Albert Blankley.

Good afternoon. My name is Albert Blankley, and I am speaking on behalf of the newly combined entity of Common Ground Health, the Finger Lakes Performing Provider System, and the Rochester RHIO. We appreciate the opportunity to comment on New York State's proposed extension of the Medicaid section 1115 demonstration waiver. Our combined entity strongly supports the State's request and commends the Department of Health for building on the momentum established through the NYHER waiver. That ongoing demonstration represents one of the nation's most ambitious efforts to advance health equity by addressing health-related social needs, strengthening the workforce, and improving population health through coordinated regional action. We've been proud to support these efforts as partners with the United Hospital Fund, advancing the statewide HERO initiative, and as a designated Workforce Investment Organization, or WIO, implementing the Career Pathways Training program across the 18-county Finger Lakes Southern Tier, and Western New York regions. Our commentary today relates to both components of the waiver extension request, and I'll begin with the HERO component. As those efforts have progressed, we have seen firsthand the value of creating stronger connections among the healthcare providers, public health agencies, community-based organizations, social service partners and Medicaid beneficiaries. The HERO model was designed to functionally bridge public health, social services, and health care delivery, creating a more coordinated approach to addressing the social needs that often drive poor health outcomes and excessive health care costs and we're excited to see that effort proposed to be continued through the waiver extension request and focus on program integrity and analytics.

One of the most promising aspects of the NYHER framework is its focus on regional collaboration and accountability. Continued support for the HERO infrastructure at the regional level will help to ensure that local stakeholders can use data effectively, identify disparities, coordinate interventions, and measure progress in ways that are meaningful to communities. One proposed requirement of the HERO in the extension request does raise concerns from our perspective. Proposing an amendment to the scope of the HERO to refer identified instances of for potential fraud, waste, or abuse to the Office of the Medicaid Inspector General seems misplaced, in the renewal request given the current scope and goals of the HERO. While protecting the Medicaid program from fraud, waste, and abuse is and should continue to be a top priority for New York State, we respectfully recommend that this function be housed elsewhere in the State's extension request and encourage New York to explore how else this may be accomplished going forward. The HERO effort has created opportunities for healthcare organizations, local governments, public health entities, and CBOs to work together in new ways. These partnerships take time to develop and mature and continuing those efforts via this proposed extension will allow regions to build on existing relationships, rather than disrupting progress, a, just as those collaborations are beginning to demonstrate their full potential. And we very much appreciate the inclusion of the effort in the proposed extension. Shifting to the Career Pathways Training Program, in the Finger Lakes and Western New York region, we know that thousands of individuals have gained access to education, training, support services that prepare them for careers in health, behavioral health, and social care professions, helping to build a stronger and more sustainable workforce for Medicaid-serving providers across New York State. In our region, the program has served almost 2,500 students. We appreciate the State's request for a closeout expenditure authority to support the monitoring and close-out of both the CPT and HEALR initiatives implemented under the current demonstration. We do have a recommendation related to the authority to spend down those committed funds that relates to a key strength of that CPT program, specifically its comprehensive student support model. In addition to funding, tuition, and educational expenses, the program provides educational case management, academic support, career navigation, tutoring, licensure, and certification preparation, and workforce placement services that help participants successfully complete their programs and transition into employment. These wraparound services have played a vital role in supporting the student persistence, graduation, credential attainment, and workforce entry. In fact, those support services have proven to be the most impactful to the overall success of the CPT program. Indeed, 90 percent of students have that have already graduated have utilized CPT support services offered after graduation. As the program approaches its final phase, we're proud to report that we have 2,470 enrolled students. We anticipate the largest concentration of graduates will complete their programs during the spring of 2027. Nearly a thousand participants are expected to graduate in that cohort. And this last group of students represents a significant opportunity to further strengthen New York's healthcare workforce. To realize the benefits of the CPT program, we, especially for this last cohort of students, respectfully recommend the State propose extending CPT participant support services beyond spring of ‘27. We in addition, we respectfully recommend that New York State reconsider the proposed three-year service commitment for Community Health Workers, certified medical assistants, and patient care managers. While workforce retention is a shared priority, a mandatory three-year commitment does not reflect the realities of those workforces where employment is often influenced by grant funding cycles, organizational capacity, career advancement, and evolving community needs. In closing, our combined entity fully supports the Department's proposed application to extend the waiver through March 31st, ‘27. The waiver’s investments in social care integration, workforce development and regional collaboration align closely with the needs we see across our region and throughout New York State. We believe that continued implementation will create a more efficient, effective and sustainable Medicaid system for the people of New York. Thank you.

Thank you. Our next speaker is Dan Bosley.

The Pharmacist Society of the State of New York going forward known as PSSNY, appreciates the opportunity to comment on New York State's request to extend the Section 1115 Medicaid Redesign Team demonstration. My name is Dan Bosley. I am a pharmacist. I am former pharmacy owner, and I am currently the President of PSSNY, who knows firsthand the hardship that comes to a community when a pharmacy closes. PSSNY represents pharmacists practicing in every setting throughout New York State, including independent and chain community pharmacies, hospitals, long-term care, ambulatory care, academia, and industry. Pharmacists are among the most accessible healthcare professionals serving patients in every community without appointments during evenings and weekends, and often in areas where access to other healthcare providers is limited. Reinvesting in the success of Medicaid reform into patient care. New York has demonstrated national leadership in modernizing its Medicaid pharmacy benefit. The transition to the NYRx fee-for-service pharmacy program has improved transparency, strengthened oversight of the pharmacy benefit, and enhanced the State's ability to manage prescription drug spend. In her 2026 State of the State, Governor Kathy Hochul highlighted the success of these reforms, noting that the transition to the streamlined NYRx pharmacy benefits has garnered New York more than 600 million dollars in new drug rebates. PSSNY applauds these accomplishments and believes they demonstrate that thoughtful Medicaid reforms can both strengthen the program and produce meaningful financial benefits for the State. As New York considers the next phase of the MRT demonstration, PSSNY encourages the Department of Health to reinvest a portion of these financial gains into preserving and strengthening patient access to pharmacy care. Although New York has realized significant financial benefit through NYRx, access to care is under increasing pressure. Between January 1, 2023, and December 31 of 2025, 930 pharmacy licenses were discontinued across New York State, and I might add those do not include my two pharmacies. Every pharmacy closure represents the loss of an accessible healthcare destination where patients receive medications, vaccinations, medication counseling, chronic disease support, and other essential healthcare services. While pharmacy closures occur for a variety of reasons, sustainable Medicaid reimbursement is an important part of ensuring that patients continue to have access to care in their communities. The success of Medicaid reform should not be measured by the savings it generates, but also by its ability to preserve and strengthen access to care. PSSNY has three recommendations.

Recommendation one, reimburse pharmacists for non-dispensing clinical services. As demonstrated during the COVID-19 pandemic, pharmacists’ success, successfully accessed, sorry, successfully assessed patients, gave them access to us, provided clinical services, administered millions of vaccinations, and became an integral component of New York's healthcare delivery system. Pharmacists continue to provide medication management, chronic disease support, preventative care, medication counseling, point of care testing, where authorized, contraceptive prescribing and other patient care services that improve outcomes and increase that access to care. Numerous studies have demonstrated that pharmacists provided medication management improves patient outcomes while reducing overall healthcare expenditures. Published analyses have found returns on investment ranging from 3:1 to 5:1 with some programs demonstrating a return as high as 12:1. Comprehensive medical medication management has also been associated with the reduction in annual medical costs of approximately $1200 to 1800 per patient. Despite these demonstrated benefits, New York Medicaid generally reimburses pharmacists for dispensing medications, but not for many of the clinical services we provide. Without sustainable reimbursement for these services, patients cannot fully benefit from pharmacists' expertise. PSSNY respectfully requests that New York establish reimbursement mechanisms for pharmacists provided clinical services under both Medicaid fee-for-service and Medicaid Managed Care when those services are within pharmacists' legal scope of practice. Recommendation two, modernize the Medicaid professional dispensing fee. In a nutshell, we have been operating for the last eight years with absolutely no increase in Medicaid reimbursement despite all the increase in costs.

Recommendation number three, continue building on the success of NYRx through strategic reinvestment. The governor's announcement that NYRx generated 600 million dollars in new drug rebates demonstrates that meaningful Medicaid reform can improve both fiscal stewardship and patient care. The next step should be reinvesting a portion of those benefits into pharmacy services that further strengthen the Medicaid program. Thank you for your time today.

Thank you. Our next speaker is Chad Shearer.

Good afternoon, I'm Chad Shearer, Senior Vice President for Policy and Program at United Hospital Fund. I want to thank the Department for the opportunity to comment today on the 1115 extension request. We commend the State for its request to continue the remaining expenditure authority for the Health Equity Regional Organization, and though we obviously have a vested interest in seeing it continue, our experience facilitating the HERO during the demonstration period to date provides strong evidence of the value of continuing to support this unique combination of quantitative and qualitative insights under one roof in support of waiver goals, evidence-based decision-making, and population health improvement. We strongly believe that the HERO is a vital conduit for ensuring that on the ground intelligence on HRSN service delivery and Medicaid service utilization trends statewide are continuously ingested and assessed to meet the State's overall goal of mitigating the harms associated with not addressing health-related social needs. Over the past year, UHF has convened over 1,000 stakeholders across the State focused on better understanding the health and social needs of waiver populations across every region and targeting screening to the enhanced populations most likely to benefit from HRSN services. These convenings highlighted not only the deep commitment of individuals and organizations across the State to better serving Medicaid members, but also the value of bringing those people together in working sessions focused on effective delivery of HRSN services. Participants in the convenings engaged in data-driven group activities purposely focused on moving beyond system and operational challenges to forward-thinking solutioning. For example, the recent Spring convening series resulted in groups developing dozens of targeted actions designed to improve screening rates for each of the enhanced service-eligible populations. An extension of HRSN services would provide needed time and support for SCN lead entities and their CBO networks to effectively implement targeted actions that will increase the efficiency and effectiveness of services for each of the enhanced populations. The HERO role in the extension period would be to continue leveraging UHF’s stakeholder engagement and data analysis capabilities to assess what's working on the ground and why, share promising practices across the State, and indicate which interventions might be ripe for taking to broader scale. As with any large waiver implementation, the ability to make evidence-based decisions at all levels, whether that be from member-facing interventions, to statewide operational and payment policy really relies on the availability of quality data and the ability to analyze that data in the context of what's happening on the ground. The HERO, through its combined access to HRSN administrative data and Medicaid enrollment and claims, is perfectly positioned to support evidence-based decision-making at all levels during the proposed extension. As the amount of available data grows with service provision and longer-term claims experience, the HERO will transition from descriptive to outcome-focused analysis in support of identifying those best practices, finding and addressing disparities in care delivery, and eventually the shift to risk-based payment. Given the extension's request to continue HRSN services and shift to capitation in April 2028, the HERO's role leveraging quantitative and qualitative insights to make recommendations and develop options for incorporating HRSN into VBP methodologies must continue. UHF has already conducted a comprehensive landscape analysis of existing HRSN VBP approaches, interviewed key informants across the State and country, and developed an analytic plan to assess cost, utilization, and equity differences between Medicaid members who received enhanced HRSN services and comparable members who are not receiving those services. We are also about to launch a series of workshops to engage stakeholders on VBP readiness and design. The waiver extension request provides an opportunity to leverage the combined power of screening and assessment data with the potential longer-term outcomes emerging in the cost and utilization data. UHF's ability to apply its analytic plan to more data collected over a longer period of time will help ensure that the transition to risk-based payment models is informed by the most recent and robust data analysis possible, and that payment models are finely tuned to support providers in delivering the services that drive improved outcomes. At the end of the day, this waiver extension is about continuing to help New Yorkers on Medicaid get the services and supports they need to live healthy and productive lives. The unique statewide relational and analytic infrastructure UHF has developed in facilitating the HERO activities under the waiver are imperative, to continued achievement of those goals. Thank you.

Thank you. Our next speaker is Ellie Wilson.

Good afternoon. The New York State Academy of Nutrition and Dietetics, referred to typically as NYSAND, is an affiliate of the Academy of Nutrition and Dietetics, the world's largest organization of food and nutrition professionals. We represent more than 3,000 registered dietitian nutritionists and dietetic technicians registered in New York State. Our members are committed to ensuring all New Yorkers have access to high-quality nutrition care, education, and evidence-based interventions. NYSAND really values our ongoing partnership with New York State Department of Health to expand and actually create access to registered dietician nutritionists through the CMS 1115 waiver. Together we are improving access to evidence-based nutrition services that help New Yorkers prevent and manage chronic disease while advancing health equity. We remain committed to supporting New York State Department of Health in achieving its prevention and chronic disease goals through sustainable, high-impact nutrition interventions. The Academy of Nutrition and Dietetics defines food is medicine as food-based interventions delivered alongside medical nutrition therapy. This integrated approach combines evidence-based nutrition care with access to healthy food through interventions such as medically tailored meals, medically tailored groceries, produce prescription programs, and culinary medicine. RDNs have been long-standing leaders in food is medicine, translating nutrition science into practical, measurable health outcomes. By pairing nutrition care with appropriate food supports, these interventions complement medical and pharmacological treatment, strengthen patient self-management, improve clinical outcomes, reduce health care and personal care costs and enhance quality of life. At every level, from individual patient care to health system design, RDNs and DTRs help ensure food is medicine programs deliver meaningful value across New York's medical and social care systems. The recommendations outlined here will be expanded with technical and operational details submitted directly to the Department of Health. Our recommendations include the waiver extension should include both food security and nutrition security screening. These both provide measurable data points to monitor the impact of waiver services. The nutrition security screening would assist navigators with appropriate and effective referral to RDN services and nutrition interventions. NYSAND also strongly recommends increasing the allotted time allowed for these complex food and behavioral care services. The current time available for RDN assessment and prescription of nutrition service is two hours per each six-month waiver service interval, increasing time available to create trust, identify needs and problem-solve participants, a lot of what we heard yesterday, will ensure standards of care are met, providing high-quality, evidence-based care is top priority for our members. In keeping with the U.S. Preventive Services Task Force guidance for behavioral change for healthy diet, nutrition counseling and education hours under the waiver should be increased to a minimum of six hours. Nutrition and food standards supply chain development for these programs is critical, particularly to expand procurement options through New York State Agriculture and Processors. Standardization of food and meal options can be built on existing clinical nutrition guidelines and successful examples already tested, such as those from the Food is Medicine Coalition based in New York City. Allowing flexibility to adjust the meal quantity per week for individual needs is recommended, and flexibility to adjust food prescription boxes or meals based on serving sizes for children should also be considered per feedback from participants. The opportunity to offer these comments is very timely. The current waiver does not have a direct measure identified for nutrition care services. This was partially due to the lack of coding support in federal regulations and healthcare IT systems.

Good news. As recently as last week, the Office of National Coordinator for Health Information Technology published the final United States CORE data for interoperability version seven, formally adding nutrition assessment and nutrition orders as recognized national health data elements within the U.S. CDI framework. This milestone establishes a standardized approach for documenting, exchanging, and using nutrition-related information across certified health IT systems and care settings. In addition, it is feasible to consider adding the established malnutrition care score to waiver services as CMS financial year 2027 IPPS final rule expected in August, next week, will finalize the mandatory reporting provision proposed in April. MNT is a service currently covered by Medicaid. As such, it should be added as a level one service.

Medicaid members that do not qualify for enhanced services can still benefit from medical nutrition therapy for nutrition interventions to address chronic disease prevention and treatment. Across all services, additional reimbursement for translation services is imperative to providing accessible care to all. Translation services take additional time and resources and should be accounted for properly. They are noted as available in the eMedNY Dietitian Manual, but not part of the fee schedule. Thank you very much.

Thank you. Our next speaker is Lidia Virgil.

Good afternoon, everybody and thank you for the opportunity to come and very strongly support this 1115 waiver and particularly the Social Care Network extension and waiver renewal. I am here on behalf of the people of New York more than anything. I am Lidia Virgil, Chief Operations Officer at SOMOS. SOMOS is a network of over 3,000 providers, both medical providers and community-based organizations serving the people of New York. We are the Social Care Network lead in Bronx County. As of today, we have performed over 300,000 screenings and have been able to provide numerous different interventions with these screenings. Now, SOMOS Community Care is a product of the 1115 waiver. We came together during DSRIP to form SOMOS PPS, Performing Provider System. And through the years of DSRIP, which was all of five years, we were able to integrate medical providers, specialists, hospitals into the program. We were able identify and address social determinants of health at the time. The program was very successful, but five years even was not enough. But we were able to, from there, start building this value-based payment system. And today we stand as the only value-based provider innovation system with 95 percent with total cost of care risk. And we've proven, right? We are proof that this works. And where we are today with the Social Care Network is even more proof that the system works. During DSRIP, as I said, we were able to address some of the social determinants of health. But then DSRIP ended. And we did find during COVID, which we continued to work through, setting up testing sites and vaccination sites over to vaccinate over two million New Yorkers during COVID that if anything we learned from COVID, we learned the stress of the social determinants of the health- related social needs on our healthcare system. And I applaud the State, I applaud CMS, for having put together this Social Care Network and addressing the health-related social needs. So, when I say I'm here on behalf of the Social Care Network and I am here on behalf of Teresa, one of our Social Care Network, members that has received service. Teresa is a mother that we found through our connections with the school system with three asthmatic children, one with hydrocephalus. She herself has asthma. They were living in an apartment that has one bedroom full of mold, full of lead. She was worried at the time about losing her SNAP benefits. She had received letters and things saying she would receive SNAP. And she was very upset because her children at this point were constantly in the ER. They were constantly out of school. She was constantly stressed cause she has to take care of all three. And she was worried that even the SNAP that she was getting was not enough to feed her family. And now she was being threatened that she going to lose it. The Social Care Network came in. We were able to help her. We were able to connect her, refer her. I spoke to her today. She's very grateful. She sends her regards and her thanks for you putting this network together. She is able to feed her children. Her child with hydrocephalus is getting better. She is able to pay attention. He's starting to walk. Her children are not missing school anymore. They have not been to the emergency room since her screening and her social needs being addressed. I am here on behalf of her. I am here on behalf of Arlenis, who was another member, with two autistic children who lived in a studio apartment, lives in a studio apartment with her mother and her children. They were not able to feed properly. We went there one day. We went with the service provider that was going to bring the food because we randomly go out to see how things are going. And the food provider brought her the cooked meal and said, all you have to do is put this in the microwave. And guess what? I don't own a microwave, she said. I said, you can put it in the oven. She said, the oven here hasn't worked for years. So, the Social Care Network was able to bring solace to her. So again, Arlenis, when I spoke to her, said thank you and thank the State for having put this program together. We found a mother through one of our school connections three days ago had received a letter that she was getting evicted with her children. She was gonna end up in the street. The first member that the parent advocate at the school brought to us. We were able to stop that eviction and make her better. Now here we are today and we have these testimonies, but if this program goes away what's going to happen, right? So, we are here to strongly support and to advocate for the extension and the renewal of this waiver because if we've learned anything is that indeed three years is not enough, we cannot abandon people. There is much more to do. 300,000, 1.6 million. There's still so many more people that need help. Thank you very much.

Thank you. Our next speaker is Yanaris Castillo.

Good afternoon, everyone. My name is Yanaris Castillo, and I am the Community Services Manager at Fifth Avenue Committee, where I lead our implementation of the WholeYouNYC Social Care Network. Fifth Avenue Committee is a non-profit based in South Brooklyn that has served New Yorkers for nearly 50 years. We advance economic, social, and racial justice through affordable housing, community organizing, policy advocacy, and services to help people build stable lives. We began providing services through the WholeYouNYC Social Care Network in January 2025. In just over a year, we have screened over 200 Medicaid members, provided navigation services to more than half, and delivered enhanced services to 60 household members with the greatest needs. Through this program, we have been able to provide over 600,000 in immediate financial support to keep families safely housed, keep utilities on, and furnish new homes for formerly homeless New Yorkers moving into permanent homes. The people we serve tell us this support has reduced their stress and anxiety and helped them feel more stable during difficult times. I'd like to share the story of one participant, Ronnie Belgrade, who has lived in Fifth Avenue Committee housing since 2019. He gave us permission to share his experience because he wants you to understand what this program has meant for him. Here are Ronnie's words. I struggle with depression and substance use, mental health, and hypertension. After my mother's passing in 2020, it has been very challenging to manage my health. I fell behind on my rent and my Con Edison bill, and I was stressed and scared because I didn't want to lose my home. I reached out to my case manager, Diana, at Fifth Avenue Committee because they had helped me before with my benefits, Section 8, and other services. I was about 1,000 behind in my rent and almost 1,500 behind on my utility bills. Thankfully, Diana screened me for the WholeYouNYC Social Care Network and I was found eligible, qualified. The program paid my rent and utility arrears and that took a huge weight off my shoulders. Now I can focus on my mental health and know that I can stay in my home. This program helps people when they need it most. Many people are facing eviction, falling behind on bills, or trying to get back on their feet after a difficult time. I hope the federal government approves this extension so more people can get the same support I received. Ronnie's story reflects what we see every day. When people have stable housing and their basic needs are met, they are healthier. Changing to a new payment system now would interrupt services and make it harder for New Yorkers to get the help they need. Ending this program would leave New Yorkers like Ronnie without critical support when they need it most. Urge the federal government to approve the extension to the NYC Social Care Network so that we can help more New Yorkers stay healthy, remain stably housed, and get the support they need to thrive. Thank you for your time and consideration.

Thank you. Our next speaker is Eva Levi Lopez.

Thank you. Good afternoon, my name is Eva Levi Lopez, and I am a Community Health Worker at Fifth Avenue Committee. I'd like to share the story of one of my participants who received support through the WholeYouNYC Social Care Network. Hello everyone, my name is Ariel Gutierrez, and I live in Brooklyn, New York. I've been a Fifth Avenue Committee participant since 2022. And Fifth Avenue Committee is a member of the WholeYouNYC Social Care Network. In January of 2026, I was served with an eviction notice for rent arrears in almost 10,000 dollars.

Unfortunately, in early 2025, my father in Mexico was diagnosed with dementia and now was no longer able to care for himself. I became financially primarily responsible and had to hire someone in Mexico to care for my dad. I also had unexpected travel to Mexico because he was admitted to the hospital due to a fall. I was extremely depressed, anxious, and felt hopeless because I was navigating caring for my dad from a distance and struggling financially. I shared my struggle with Eva Levi Lopez from Fifth Avenue Committee because she has helped me in the past to assess benefits and services. She screened me for Social Care Network and through my daughter, who is a highly Medicaid utilizer, I was found eligible to receive financial support. I was beyond grateful because I was able to get my arrears paid immediately and avoid eviction. Since then, through The Fifth Avenue Committee, I have connected to financial coaching services to work on my budget and make sure I don't fall behind again. I ask that this extension is approved and continue supporting the WholeYouNYC Social Care Network and organizations like Fifth Avenue Committee so more people can get the same support I did.

Thank you for listening. Thank you.

Thank you. Our next speaker is Jamaica Tyler.

Good afternoon. Sorry about being late, the rain, nervousness. So, I want to start off by introducing myself. My name is Jamaica Tyler. I have two small, well, they're not small. Sorry. Is this better? Yeah, okay. My name is Jamaica Tyler. I have Imari Green and Ijor Green here today. I am the founder, CEO of IRIC Incorporated, that services, services Onondaga County, IRIC stands for Inspiring Responsibility in Spite of Crisis. On October 29th, 2016, the father of seven children, but two of my children here, he was shot in the head, with a shotgun in front of me. I was also shot. During that time, unfortunately, I was not okay. It wasn't just housing, it wasn't just food, it was everything, me as a person. It's been ten years since that happened. I have had many organizations, in Onondaga County try to assist us and unfortunately capability that they had was limited because of the trauma, because of the resistance, because of my stubbornness saying I was okay, because that's what I've learned to do. And so that is the reason why me and my children decided to do something in the honor of their father. He died making sure we lived, and so in the community that we serve in Onondaga County, you see the people and they still have hope in them. Unfortunately, sometimes we don't always see that in them, the consistency that is needed is a lot. It burns us out and sometimes people are not getting through, and I had like this whole spiel put together, respectfully, but just coming from the heart. I'm on the ground a lot consistently, in my community, I'm struggling myself, I don't have it all. Me and my family are going through our own rough times. Who isn't? Respectfully, when we go into the communities, we're providing the information that, hey, here's this program that was put into place, that helps. And no, they don't want anything. You know, that's a lot of the stigma. Like, hey, what do we have to do? And so right now, realistically, while I'm on the ground in the community, there's nobody on the ground with me. I'm not saying they aren't, because that would be wrong to say, but I don't see anybody else out there. So, when me, the people who are a part of IRIC Incorporated are out there, they’re pushing back, right? And so, our understanding of the waiver is to alleviate some of that stress of the hospitals. Right, cause a lot of the high acuity utilizers are going to the hospital because they're not getting that consistent check-in. And it's a lot, but that is what is being observed. I know sometimes that's not what people would like to hear. We need more help. This waiver is awesome. It's awesome, we need this extension. We need more community-based organizations who are willing to be on the ground. And a lot of people, a lot of organizations are saying that's just not where we're at. We would like to be, and stay, where people are willing come to you. They're willing to come to the office. I have an office in my home, but I'm on the ground. We need the help, that intervention. I believe the community still has hope in it. I know Syracuse does. I know Onondaga County does. We still have hope in this community. And so, reaching out to people saying, hey, this is what we need. The goal overall for me being here, because I sacrificed, my children sacrificed, is to say, hey, IRIC Incorporated is here. There are some other organizations who are here, that may take the information that I'm saying, and they may be able to do better for us. Please keep this waiver going. Please continue to fund community-based organizations who want to do the work. We need this. We need this a lot. Our community needs it. I'm thankful. Thank you for the time. I appreciate it. Thank you.

Thank you for your comment. So, that concludes our list of pre-registered speakers for today. I will now open the floor if there was anyone else who wishes to provide comment that didn't pre-register outside. If anyone wishes to speak, please raise their hand, and I will call you up to the microphone. Is there anyone else that did not register to speak that decided that they have any comments they wanted to provide today?

All right, with that then I will turn it back over to Simone Milos for closing remarks. Thank you guys so much.

Thank you so much, everyone, for joining us today. It's wonderful to hear the experiences you've all had with our waiver programs. Just a reminder, we do have another public hearing, this one will be completely virtual on August 8th or August 11th. Excuse me, sorry. The information can be found on our website. We encourage you to attend and join and continue to share your stories. Thank you so much for the time today.