1115 Medicaid Redesign Team Waiver: Public Hearing

• Transcript is also available in Portable Document Format (PDF)

August 11, 2026

Good afternoon, everyone. Thank you for joining us for the second public hearing on New York's 1115 Medicaid Redesign Team waiver extension and 1115 waiver annual public forum. My name is Simone Milos. I work in Strategic Operations and Planning in the Office of Health Insurance Programs here at the Department of Health. Thank you again for joining us today. Today, we'll discuss what the waiver has allowed the State to achieve over the last five years, how New York plans to build on that momentum moving forward, and then open the floor to comments from the public. Next slide, please.

Today's webinar session includes accessibility features for those who would like to use them. Closed captions are available. To activate closed captions, find the CC icon in the lower left-hand corner of your screen. Then, click on the show closed captions button to enable the feature. Next slide, please.

We have two ASL interpreters joining us today, Alita and Lori. They will be switching on and off throughout the presentation. If you'd like to have the interpreters right next to the presentation during today's session, you can move them to your stage. To do so, simply right click on the interpreter's video icon and select "move to stage". This will expand their video screen and keep them right next to the presentation. Next slide, please.

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

Today's public hearing is the second of two scheduled public hearings for this extension request, also serving as the annual 1115 public forum. The purpose of today's hearing and forum is to provide information on the 1115 waiver and proposed extension request and give the public an opportunity to share comments. Beyond hearing from our community and receiving direct feedback on the waiver and proposed policies, the State is hosting this meeting to comply with federal guidelines. Public hearings and public forums 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, to govern the 1115 waiver. A recording and transcription will be available on the 1115 waiver website following the hearing with a notification to be sent 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 rule. 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 with the New York Health equity reform, or NYHER, amendment in 2024. Waivers can also be renewed for an additional term, which 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, 2027. New York's MRT waiver is organized around four goals. First, to improve access to healthcare for the Medicaid population. Second, to improve the quality of health services delivered. Third, to expand coverage to additional low-income New Yorkers using resources generated through managed care efficiencies, and 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 as part of 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 this program later on in the presentation. The second program, the Medicaid Hospital Global Budget Initiative, supports financial sustainability of twelve 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 health care 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 repayments 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, and over 13,000 participants have been 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 health care workers, these investments are expanding access to care and strengthening the healthcare workforce in 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 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 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 released last year, the State is requesting only the limited funding needed to monitor existing service commitments and close out the program. Finally, the State is proposing to continue eligibility for the Home and Community-Based Services Expansion, Institution to Community and Family of One 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, the 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 twelve month continuous eligibility in accordance with federal guidance released last year, which indicated that CMS does not anticipate extending these initiatives. Today, all beneficiaries of these initiatives have either been re-enrolled in 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. Specifically, Education Support Services, Prevocational 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 Home and Community Based 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. We can go to the next slide.

So, the Social Care Network program has been a core part of the 1115 demonstration, and in this section, I'll share with you a brief background on the Social Care Network program and the program's achievements to date. The Social Care Network 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 nine regional Social Care Networks, health care providers, behavioral health providers, community-based organizations, and other local partners, they work together to identify the unmet social needs and connect eligible members to the health-related social needs services. Since the program launched, New York has built a really strong statewide infrastructure that's needed to support this work, in a very short amount of time, this includes IT systems, data and payment systems and provider capacity. Next slide.

To date, we have screened over 1.5 million Medicaid members for unmet needs across the nine regional Social Care Networks, and this screening rate has grown 4.8 times over the past twelve months. Approximately 3,200 Social Care Navigators, including Community Health Workers, cover the 62 counties of New York and are connecting members to

health-related social needs services. The SCN consists of over 1,400 organizations that are contracted to provide screening, navigation and enhanced health-related social need services. Of those, 600 providers provide at least two or more health-related social need services and approximately 600 community-based organizations have received capacity funding to be able to expand and participate in the waiver to provide health-related social needs services under the networks. This waiver has allowed the State to set up a comprehensive regional network and technology backbone that enables consistent service delivery across the State and 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 the nine Social Care Network Lead Entities, 3 Social Care Network platform vendors, 6 qualified entities, and approximately 25 managed care organizations in addition to the more than the 1,400 CBOs and partners all together. Again, this has been a short time, but a tremendous amount of work to set up these networks and provide people with connections and services in their community. This infrastructure underpins a robust data ecosystem that supports high-quality program evaluation, accountability, and transparency. Next slide.

So, building on the momentum of the current program, the State is proposing to largely maintain the current set of services offered. So, we are first requesting to continue all of the existing health-related social needs services, with the exception of brokerage fees. This is in alignment with the city's Fairness in Apartment Rental Expense Act, which prohibits such fees from being charged to tenants and therefore it's an unused service. The State is also requesting to roll over all unspent and unclaimed DSHP funds to pay for the health-related social needs services and maintain the current non-risk payment approach for one more year before transitioning the Social Care Network Lead Entities, not the CBOs, but the Lead Entities to value based payment models which would be at risk capitation payments and that we would like to start in April of 2028. In addition, the State is proposing to add a new population category called high-risk children under 18. This combines the three existing child populations into one single group. Then finally, the State is not requesting to continue expenditure authority for HRSN infrastructure, as the infrastructure dollars have been established and we do project those to be spent out. We also don't anticipate that that's something that CMS will reauthorize.

If we go to the next slide, here is probably a familiar slide to everyone. These are our

health-related social needs services. So again, these are proposed to stay the same under the waiver. We'll continue with the screening, with the Accountable Healthcare Communities tool, the navigation services to local, state and federal existing resources, and then again with that enhanced population. Getting the services which are in this dotted line, bucket to your right. The nutrition supports will stay the same. The care management staying the same. Housing. The one caveat again is under community transitional services. We would be removing broker fees and then also keeping the same services under the transportation to health-related social needs. Next slide.

The eligibility criteria under the proposed waiver renewal again is staying pretty much the same as we currently have established it. We want to ensure that these services reach members with the greatest needs and member eligibility to receive the enhanced services is based on a combination of factors. So, we are proposing to continue with (One) the screening and someone having to demonstrate an unmet need. (Two), the enrollment in Medicaid managed care. (Three) having meeting one of our populations of focus. I will highlight here, in purple, the change just combining those children's population into one, titled High-risk Children under 18. Otherwise, it's not adding anything new there, just a different, more simple naming convention. And then (four), there's sometimes, and we would keep this additional criteria for specific service under the enhanced population, those folks that don't meet Medicaid managed care or are Medicaid managed care, and don't meet the enhanced population would still receive the navigation service. Next slide.

I want to end to talk about the impact on Medicaid members. So beyond, you know, the numbers and the waiver, these testimonials really highlight what Social Care Network program means for the people in the communities it serves. We have members that have described receiving the support to help 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 have also described how the program has helped them reach otherwise hard to engage, communities and address critical health-related social need issues. The Social Care Networks have built a really strong capacity, and it will continue to grow and be a part of this new 1115 waiver renewal. Thank you.

Thanks, Emily. Next slide, please.

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

The public comment period for New York's 1115 waiver extension opened on July 8th and will run through August 21st. 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 comment period that will likely run from mid-October through mid-November. The exact dates to be determined. This will be another opportunity for you to share feedback on the waiver. And then finally, the current waiver period is set to expire on March 31st of 2027. Next slide, please.

That brings us to the end of the presentation of today's public hearing and public forum. I will pass things over to my colleague Brianna Rowe to walk us through the public comment portion and also share some resources. Thank you.

Thank you, Simone. Good afternoon. 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 speakers. Those individuals will be called on today in the order in which they registered to speak. If you did not pre-register but would like to provide comment, you can raise your hand and we will add you to the speaker list. We will call your name, and your line will be manually unmuted to allow you to provide your comment. We are timing comments, please limit your comments to five minutes in order to keep the public hearing moving smoothly. Written comments will also be accepted through August 21st by email at 1115waivers@health.NY.gov or by mail at the address shown here, and that is Department of Health, Office of Health Insurance Programs, Waiver Management Bureau, 99 Washington Ave., 8th floor, Suite 826, Albany, New York, 12210. Next slide, please.

Again, if you have any further questions that were not answered here, or comments, please contact us at the email on the screen, 1115waivers@health.NY.gov. Next slide, please.

As I mentioned, we are timing public comments today. If this slide shows up, it's just to alert the speaker that there's one minute remaining of their five-minute presentation time, and the last slide will just alert the speaker that their time is up. So, with all of that being said, we do have some speakers that pre-registered. Our first speaker today is Nikki Kmicinski. And we will go ahead and unmute your line.

Hi, can you hear me?

Yes, we can. Go ahead, Nikki. Thank you.

Good afternoon. My name is Nikki Kmicinski. I'm the Chief Executive Officer at Western New York Integrated Care Collaborative, which is the lead entity for the Social Care Network in the Western New York region encompassing four counties: Cattaraugus, Chautauqua, Erie, and Niagara. Through the current waiver, the Western New York Social Care Network has scaled to 148 contracted delivery partners ranging from local small partners, community-based organizations, FQHC's, hospital systems, and behavioral health partners. Collectively we've screened over 65,000 members in our region. 94 percent of our partners have reported that the waiver has made an impact on the populations they serve in their organization. Over 100 of our partners have received capacity building funding, and we do encourage the State to find a way to continue capacity funding however you can because the year and a half to get them up and running and be sustainable they need a little more time. 75 percent of the folks we screened have at least one social care need. 58 percent have a need of food followed by housing, transportation, education, career, and public safety. This aligns with our service delivery, with our largest services being in food, followed by housing, followed by transportation.

We've collected hundreds of success stories across all four counties such as the gentleman who was calling EMS for a ride to the hospital 15 times a month, that worked with a navigator who enrolled him in a behavioral health program and reduced his visits to the hospital to one a month. Or the number of young mothers who have received food and nutrition, education, to support and stabilize their young families. We really want to encourage the State to look at the administrative percentage rate out of the PMPM payments that the SCNs receive. The current rate of three percent is not sufficient to supporting the administrative work we have to do and to risk mitigate against any reconciliations. We appreciate the collaborative efforts of the State to really work with all the SCNs and really work with us through this and hope that will continue and really encourage more collaborations with the other SCNs if some region is doing something well, how can we all learn from each other without reinventing the wheel? We would appreciate a streamlined flexibility for provider attestations. Could a claim lookup be done by the SCN or something else where it doesn't require the provider to sign off on something? We also really appreciate the collaboration with the app with all the healthcare plans the MCOs. We encourage increased collaboration between the HEROs and the SCNs to review data and really see the impact that's happening in our regions, and would encourage the State to align with other New York State Department of Health initiatives, the Social Care Network infrastructure that's built such as rural health transformation programs, value based payment, falls prevention, behavioral health initiatives, as well as national initiatives such as CMMI projects, such as the AHEAD program, the LEAD program, the Aspire program, the GUIDE model, and others. And overall, just truly thankful for this program and really support its continuation, thank you.

Thank you for your comment. Our next registered speaker is Richard Bennett. Good afternoon, can you hear me?

Yes, we can.

Great, good afternoon. My name is Richard Bennett and I'm the Co-Founder and CEO of Epicured, a food is medicine company that uses evidence-based nutrition to improve patient outcomes and reduce the cost of care. For nearly a decade, our team has prepared medically-tailored meals for thousands of New Yorkers managing chronic disease from our production kitchen in Glen Cove, New York. Over the past 18 months, Epicured has participated as a provider of health-related social needs services under the waiver. We operate across eight of the nine Social Care Networks, delivering screening, navigation, and care management, as well as medically-tailored meals and food prescription boxes. To date, we have provided eligible New Yorkers more than 13 million meals worth of food under the waiver. The waiver has proven to be a powerful mechanism for addressing health-related social needs in the State and has demonstrated the widespread demand for nutrition interventions to advance population health. Epicured has responded to this demand through significant operational investments. To date, our registered dieticians have developed more than 250 customized menus. We've expanded our operation to include food prescription boxes and now deliver healthy groceries to more than 6,000 New Yorkers each week. We have invested in and built a 30,000 square foot distribution center on Staten Island and expanded our pre-existing production kitchen on Long Island, all employing more than 150 members of the local community and counting, while also building strong partnerships directly with the Social Care Networks and with CBOs contributing staff and resources to bolster their capacity. Our care coordinators have contacted more than 25,000 unscreened individuals on behalf of our partners, and our partnership with Second Chance Opportunities, an Albany-based CBO, has become a model for our statewide activity, where we provided training and connected their team to other local organizations already serving Medicaid members, but not qualified yet to screen. With this support, that partnership connected nearly 1,000 individuals with nutrition services. With more than two million Medicaid members still awaiting screening, this work is far from complete. Epicured strongly supports the proposed five-year extension of the waiver and the associated funding framework for HRSN services. In addition, we respectfully urge the Department of Health to consider the following three improvements to the existing waiver framework. First, expand the role of for-profit organizations in achieving the waiver's health equity goals. Epicured's experience illustrates how private investment can complement public infrastructure. Over the past 18 months, we have demonstrated measurable impact through investments in local communities, workforce development and partnership with Social Care Networks and CBOs, all without drawing on state capacity funding. For-profit providers can offer the agility and private capital needed to supplement the State's limited infrastructure dollars and help connect more New Yorkers to services through scale professional operations.

With no additional infrastructure funding contemplated as a part of the waiver extension, this support will be even more critical. All stakeholders, regardless of tax status, should be empowered to contribute to these positive outcomes. Second, ensure that nutrition services provided under the waiver remain clinically rigorous, and focused on measurable outcomes. This waiver is more than a food insecurity initiative. It matters what patients eat, why they eat it, and how nutrition affects their health outcomes. Epicured's approach reflects this principle. Our registered dieticians apply research-backed clinical guidelines to each box we produce and work with members to accommodate their preferences without compromising clinical rigor. Third, improve data sharing to strengthen accountability and transparency. Limited data connectivity between Managed Care Organizations, healthcare providers, CBOs, and HRSN service providers hampers our collective ability to demonstrate the waiver's cost and outcome efficacy. All that being said, the available data tells us when collaboration with Dr. Joseph Conte, Executive Director of SIPPS, where we've seen Epicured's meal help the SCN drive a 30 percent reduction in preventable ER visits and hospitalizations. Improved data sharing is essential not only to demonstrate the waiver's success but also to enable CBOs and other HRSN service providers to prepare effectively for the MCO benefit model under consideration.

Thank you very much.

Thank you for your comment. Our next speaker is Autumn Cross. Hi, can you hear me?

Yes.

All right. Good afternoon and thank you for allowing me the opportunity to speak today. My name's Autumn Cross and I'm here as a foster parent to a medically fragile child who's been in my care since she was two days old. I'll be adopting her within the next few weeks. I am here because I need you to understand that what I have experienced over the past two years is not simply frustration with a program, but profound disappointment in a system that was created to serve medically fragile children yet repeatedly failed one of its most vulnerable members. My daughter was born with a rare genetic condition called Hypohidrotic Ectodermal Dysplasia. This is not a condition caused by foster care trauma or neglect. It's a lifelong genetic mutation that affects nearly every aspect of her daily life; hair, skin, nails, teeth, respiratory system, and lack of sweat glands. A large majority of her infancy was spent in emergency care every two to three weeks because of respiratory complications. Her first tooth erupted at 16 months old, and they break into cone shaped pieces. Because of this, she's depended on pureed food pouches. Equally concerning is that she lacks sweat glands. She cannot cool herself the way that most people can. She's medically vulnerable to hypothermia and access to air conditioning is not a convenience, it's a medical necessity. As foster parents we're taught to advocate, we're trained in prudent parenting and encouraged to seek every available resource to meet the medical needs of the children that are entrusted to our care. This is exactly what I do every single day. In April 2025, I contacted Healthy Alliance per the children's health home CNY food bank and county caseworker. They informed me that the Social Care Network could potentially assist with medically necessary supports. I requested help with what I thought were very basic needs. Assistance obtaining pureed food pouches for her, her inability to safely chew and assistance replacing our failed air conditioning unit because of her inability to regulate her body temp. What followed was over two years of delays, barriers and repeated failures. No one returned my initial calls. Everyone points their finger at fault. Not one social worker or care manager has connected to assist this child with her medical needs. Supposably none of these providers had the resources or authority to meet this child's needs, which would then make Medicaid the payor of last resort. A child who was screened and identified to have unmet social care needs and determined eligible. However, I was told that they had no provider network available to actually deliver those services. So, I was able to find them a local provider who was willing to participate, but the SCN did not engage. Imagine hearing that your medically fragile child qualifies for help, but there's no system in place to provide it. I was informed that Healthy Alliance contacted the county caseworker requesting I no longer communicate with them. Later, the county advised me to keep advocating. I was informed that Healthy Alliance advised this program was not intended to resolve immediate safety concerns and that home modifications would not be considered because foster homes are viewed as temporary residence. Yet the SCN operations manual specifically discusses modifications to rental properties, with landlord approval. The food pouch example is an example of a low hanging fruit. The SCN identified nutrition assistance but failed to execute, no referrals, no linkages, no assistance, no nothing. She required protein pouches, three per sitting, three times a day, $3.99 a pouch, roughly $1,200 a month. Interesting that the same manual identifies foster children explicitly as part of an enhanced population eligible to receive services. Instead of meaningful assistance, I'm handed a 16-page list of local food pantries and advised to go buy a blender, with a referral back to the Social Care Network. This recommendation demonstrated a complete lack of understanding for my daughter's medical condition. Food insecurity was never the issue. Her inability to chew because of a congenital dental abnormality is the issue. I finally withdrew the money from my own retirement savings to install central air to protect her. Yet, she's denied, not because she lacked medical need, not because she failed eligibility but because she's a foster care child. How can a program created to address health-related social needs deny medically necessary supports to a child who has a medical condition that clearly meets its own published criteria? How does eligibility exist without access and how is advocacy discouraged instead of welcomed? I'm now asking for accountability. I'm asking you all to examine whether your policy's implementation and oversight are truly serving the medically fragile children that this program was designed to protect. Sometimes advocacy has to be loud, and this is one of those times. Thank you.

Thank you for your comment. Our next registered speaker is Beth Williams.

Thank you for having me today. My name is Beth Williams, New York State Policy Director of Hunger Free America, a nationwide direct service and advocacy organization that is headquartered in New York. At our office in the Bronx and throughout New York City, we help individuals apply for SNAP and WIC benefits and provide Medicaid recipients with vital services through the Social Care Network program. Through the Social Care Network program pilot phase, our team has assisted approximately 1,250 cases across all 5 boroughs. These cases represent people of all ages and a diverse range of backgrounds and circumstances. Through the program we connect Medicaid members to a wide range of services, including food assistance, kitchen equipment, rental and utility assistance as well as referrals to other critical resources such as childcare, social work, and other community-based services. The program is having a meaningful and lasting impact. We believe that the support provided through these services can change the trajectory of a Medicaid member's life and have an impact that extends well beyond the immediate need. The stories we hear every day illustrates the vulnerability that many Medicaid members can experience during difficult moments in their lives and how connecting them with the right support at the right time can help regain stability, security, and hope. One example is Courtney, a mother of two boys, one of whom has special needs. Courtney is a sole provider for her family and had recently been diagnosed with a chronic condition requiring at-home dialysis. When our team connected with her, the family was at risk of eviction because of unpaid rent. Courtney had no one else to turn to and her application for an HRA one shot deal had been denied because she could not demonstrate her ability to repay the assistance after having to stop working due to her condition. Our team worked with her to identify a path forward and we were able to secure rental assistance to cover the arrears, allowing Courtney and her children to remain safely housed during an extremely vulnerable period. We also helped her begin the process of applying for affordable housing. We also worked with Alfredo, a client living with stage four cancer who needed medically-tailored meals. Until we were able to connect him with medically- tailored meal delivery services, his wife who works full time, including weekends, had to prepare and leave meals for him in advance. As his primary caregiver and the mother of their young son, she was already carrying an enormous amount of responsibility. Having access to medically-tailored meal delivery reduced some of that burden and gave the family one less challenge to manage during an incredibly difficult time. Then there's Uma who had recently lost her husband in an accident while she was pregnant. At a time of profound grief and uncertainty, she was overwhelmed by the challenge of caring for herself and preparing for the arrival of her baby. She shared how unbelievable it felt that this program was available to her and her family at a time when they needed support so urgently. Through the program she was able to access services including food delivery, kitchen equipment, and utility payment assistance. By connecting Medicaid members to these services as part of their healthcare experience, we can address some of the underlying social needs that directly affect their ability to stay healthy and stable. This approach allows healthcare providers and care teams to see the whole person and not just a diagnosis or medical need, and to connect members with practical support that can make a real difference in their lives. These stories remind us that social care is an essential part of healthcare. We can meet people where they are and connect them to the right resources at the right moment. We can help families move from crisis toward stability and ultimately toward better health and well-being. Our work with the Social Care Network program is directly improving public health for New Yorkers. Through this work, we can do what Hunger Free America excels at, connecting individuals to food through SNAP and WIC and get even more of their needs, needs met beyond hunger. Nutrition benefits navigation is imperative to any sort of public health and improving general welfare work. An individual cannot get their needs met and begin to improve their circumstances in health if they are hungry. It's crucial that all future versions of the Social Care Network program have funds for nutrition benefits navigation. With the Social Care Network program functioning as a fee-for-service model, the infrastructure capacity building funds have been crucial for our organization to provide this service to our clients. The initial infrastructure funding was incredibly helpful and allowed us to bring on two staff members. While these staff get reimbursed for each individual client they serve, we are unable to provide things like paid PTO and paid leave if they are not working and helping clients. It's crucial that we can provide these benefits to our employees if we want to keep high-quality workers in these roles who are experienced in helping clients with these programs. We hope that the State will reverse its decision and continue to provide infrastructure funds to its program participants and that all future versions of the Social Care Network program include funds for nutrition benefits navigation. Thank you for the opportunity to submit testimony today.

Thank you for your comment. Our next speaker is Rasheed Ford.

Do we have Rasheed on today? Okay. Doesn't look like it we can maybe circle back at the end. So, our next speaker is Dr. Joseph Conte.

Thank you. Thank you for the opportunity to present the public comment today. I am Joe Conte, the Executive Director of the Staten Island PPS Social Care Network that is responsible for 500,000 members in Richmond, Kings, and Queens County. We are honored to serve the Medicaid community. Medicaid matters. And this waiver, the most expansive in the country, is paying dividends in quality of life and health to members. For instance, our Social Care Network has achieved over 25 percent overall reduction in emergency room and hospital visits for those receiving Social Care Network food services. For high-risk populations, the data is even more impressive. Pregnant and postpartum individuals a 36 percent reduction. High utilizers over 35 percent reduction. Asthma and chronic conditions, those with under 18 and chronic conditions likewise incredible improvements. This impact is sustainable if the waiver is extended and embedded in the Medicaid program. Enabling Social Care Networks to maintain the coordination between providers, CBOs and Managed Care, that led to these results. Medicaid matters and NYHER matters. Our Social Care Network is a veteran of Medicaid waivers, dating back to the DSRIP program, implemented in 2015. We are one of the handful of remaining PPS organizations that continues to pay dividends on the CMS Department of Health investment. Our organization is highly analytic and innovative. From day one of the NYHER program, the SIPPS has led the State in per capita screening, navigation and service delivery. Leading means utilizing innovations like food lockers, predictive analytics, hot spotting, overdose prevention, and focusing on high-need populations. But it also means developing trust. Trust is the oxygen of health-related social needs. Our partners have developed strong relationships with the community they serve and have earned that well-deserved trust. That trust enables people to open up about their lived experiences to our network of Community Health Workers. Our social care was intentional in considering the cultural, linguistic, religious, and behavioral characteristics of the communities we serve and sought out Community Health Workers and CBOs to serve them with cultural competency. Beginning in January of 2025, over 200 organizations were rapidly contracted, onboarded and educated. Our social care network promptly distributed capacity building funds for the not-for-profits that form the core of the community-facing part of the network, we organically aligned CBOs with strong clinical partners. These included our FQHC, hospital partners, private practices of every type; behavioral, pediatric, adult, family medicine, IDD, and subspecialties. Those organic relationships have yield these high impacts. Another key feature of the success of SCNs is the use of interoperable social care platforms. The information exchange between the QEs and NYeC enables the State Department of Health to quantify the needs and resources required to address disparities. Our assessment data shows that over 50 percent of Medicaid members have at least one unmet need. For instance, over 41,000 are receiving food and nutrition services in our SCN. This includes nearly 5,000 receiving medically-tailored or clinically appropriate meals. Nearly 3,000 unique services related to asthma and home remediation have been provided. Nearly 2,000 unique members are receiving rent and utilities. Why is this data important? Because each and every member impacted by this waiver has a story. I'm gonna read one from a member who became part of our team. "My journey to the Social Care Network started as a fulltime student with a part-time job and three kids at home. I received an email one day stating that Medicaid members qualified for a free class at the college of Staten Island to become Community Health Workers. Being hired by the SIPPS as a Social Care Navigator means everything to me. I'm proud to be part of the network that not only serves the community, but also uplifts and empowers like people, like me every day." Thank you for the opportunity to speak.

Thank you for your comment. Our next speaker is Dr. Fred Ferguson. Hi, good afternoon. Can you hear me ok?

Yes.

Okay, good afternoon. My name is Dr. Fred Ferguson. I am a Pediatric Dentist, distinguished teaching Professor Emeritus at Stonybrook University, and Assistant Director of Pediatric Dentistry at One Brooklyn Health. I'm speaking today solely in my personal and professional capacity as a clinician, educator and researcher. My comments are my own and do not necessarily represent the views or position of one Brooklyn Health, Stonybrook University, or any other institution. Thank you for the opportunity to comment on New York's proposed section 1115 Medicaid demonstration extension. I support New York's commitment to improving quality, advancing health equity and strengthening person-centered care, and expanding value-based care. I'm not recommending a new Medicaid benefit or another clinical program. I'm recommending a standardized two-part oral health data set that helps New York State MRT identify health risk earlier. Today's healthcare is excellent at documenting disease after it occurs. It's much less effective at identifying people at risk before disease develops. The earliest opportunity to improve health outcomes is before disease develops. We need to see risk early. Oral health provides one of the earliest measurable signals of future health. Oral health reflects the impact of nutrition, access to care, health literacy, and other social factors, long before more costly disease develops. I recommend a standardized two-set oral health data set. The first part captures standardized information reported by the Medicaid member or caregiver. The second captures standardized clinical findings recorded during routine dental examinations. This information is highly linked to what the member reports.

Together, these two sources provide earlier, more actionable information than claims data alone. They strengthened core care coordination, support value-based care and give Medicaid members a meaningful voice in their own healthcare working with healthcare providers. Instead of being passive recipients of care, members become active partners in protecting their health. This is the transition from patientship to partnership where members and healthcare providers are working together in health promotion. I respectfully encourage the Department to consider this approach as another tool for advancing New York's section 1115 goals. Oral health is not a destination. It is one of the earliest measurable signals of future health, well-being and quality of life. Helping New York see risk early will advance the goals of the New York State MRT to reduce cost, improve integration, collaboration, and health outcomes. Thank you for your consideration.

Thank you for your comment. Our next speaker is Silvia Posada. Hi, can everyone hear me?

Yes, we can.

Awesome. Okay. This is actually Sabrina. Silvia was unfortunately not able to join us today, but I will be speaking in her place. So good afternoon, everyone my name is Sabrina Scuria, and I am the Associate Director here at NYReach which is the New York Research Education and Community Health. We are a community health organization born and rooted in the Bronx. So, I'm here today to speak in strong support of the continuation and expansion of the Social Care Network program under the New York State 1115 Medicaid waiver. The Bronx is one of the most medically underserved communities in the entire country. We have the highest rates of poverty, food insecurity, and diet related chronic illness in New York City. Our residents deserve a healthcare system that meets them where they are, and that is exactly what the Social Care Network allows us to do. Since joining this program, NYReach has screened over 25,000 Bronx community members for health-related social needs, things like food insecurity, housing instability, and lack of access to transportation. These are the barriers that no prescription can fix, but that determine whether a person truly gets well and stays well. Of these 25,000 people, over 9,000 have been connected to home delivered meals or groceries. Many of them seniors living alone, many of them managing diabetes, heart disease or other chronic conditions made worse by hunger. For these neighbors, this program has been life changing. We have seen mothers who no longer have to choose between paying rent and feeding their children. We have seen elderly residents isolated and food insecure, gain not just a meal but a connection to someone who checks them regularly. We have seen Medicaid members who have, who had never been connected to benefits they were entitled to finally get support they deserve. And we hear it directly from the people we serve every day. Every day our navigators come back with stories from members, who are real New Yorkers, telling us how much this program has meant to them. We hear from seniors who say that receiving a meal delivery was the first time in months someone had knocked on their door. We hear from families who tell us they finally feel seen by a healthcare system that previously felt out of reach. We hear from members who have called our office simply to say thank you because they did not know, know help like this existed, and they want us to know it has made a difference. That feedback is not a footnote. It is the most important data point we have. It tells us that beyond the screenings and the referrals, and the deliveries, we are restoring something that too many vulnerable New Yorkers have lost.

The feeling that someone is in their corner. That is the power of this program. And the impact does not stop at the Bronx border. New York is now, oh NYReach is now proud to serve residents across all five boroughs; the Bronx, Brooklyn, Queens, Manhattan, and Staten Island. Reaching New Yorkers in every corner of the city who are navigating poverty, illness, and social need at the same time. We have built a sustainable, community-rooted workforce of over 30 full-time employees. Navigators who reflect the cultural and linguistic diversity of the communities they serve. Many of them are from the Bronx

themselves. They are not just employees, they are neighbors, advocates, and trusted faces in communities that have historically been overlooked. The Social Care Network is not just a program; it is a promise to New Yorkers that their social needs matter just as much as their medical ones. The data shows how it works. The people we serve know it works, and they are counting on us to make sure it continues. So, yeah, please support the continuation and full funding of the 1115 Medicaid waiver and the Social Care Network. Thank you.

Thank you for your comment. Our next speaker is Shana McCormick.

Hi, Shana? You've been unmuted. Can you hear us? Okay, Angela, maybe we can move on to the next speaker and we can circle back.

Our next speaker is Renee Weinberger. Hi all, can you hear me?

Yes, we can.

Hi, my name is Renee Weinberger, and I'm the Director of Tower Community Support, a CBO participating in New York health-related social needs program. As a community-based organization, we have the privilege of speaking directly with individuals and the families receiving these services. So rather than only talking about programs and policies today, I want to share some of what we are hearing from people we serve. Again and again members tell us that the support is making a meaningful difference in their lives. We hear from parents that tell us that having access to nutritious foods has changed what they are able to put on the table for their families. One mother shared with us how happy she was that her children were beginning to reach for veggie sticks instead of chips. Other parents have told us that they are now able to regularly purchase fruits, vegetables, grains, and proteins that their families enjoy and will actually eat. Members have shared with us that since making these changes to what they're eating, they feel better and stronger. Some families have told us that they notice improvements in their digestive health. Those are their experiences, and as a CBO it's incredibly meaningful for us to hear them. But these stories aren't only about food. They are about what happens to a family when one major source of stress becomes a little more manageable. One of the most powerful things parents have shared with us, is that when they are not constantly worrying about how they will afford nutritious foods for their families, they have more ability to focus on the future. They can focus on their jobs, they can focus on their finances, they can focus on their children. They can focus on building greater stability for their households. For me, that captures so much of what health-related social need services are intended to accomplish. Healthcare does not exist in isolation from the circumstances of a person's everyday life. A person can receive medical advice about nutrition, pregnancy, a child's health or managing the health condition, but following that advice may be much more difficult when the resources needed to do so are simply out of reach. HRSN helps create a

connection between those two worlds. It connects healthcare with what is actually happening in someone's home, and community-based organizations are an important part of that connection. The people we serve, aren't case numbers to us. They are mothers we speak to; they are fathers trying to provide for their household, they are pregnant women trying to take care of themselves and their growing families. They are parents trying to give their children the healthiest start they can. Because CBOs are embedded within the communities we serve, we have an opportunity to understand barriers that may not always be visible from the outside. We understand the languages people speak. We understand cultural and dietary needs. We understand the communities and the families. And perhaps most importantly, we have the opportunity to build trust. A member may tell us something about what's happening in their homes, that they would not know what to do for. We come with them, help them understand the resources available to them, and help connect them with appropriate services. That human connection is an important part of HRSN. I also want to recognize the important role of the Social Care Networks in making this work possible. Tower Community Support has had the opportunity to work closely with the Staten Island Performing Provider System. And that part, that partnership has been incredibly valuable to us. Implementing a program of this size and complexity requires constant communication and collaboration. As a CBO, having an SCN that we can work with, one that listens to what we are seeing on the ground, helps us navigate questions, provides guidance, and works alongside us to resolve challenges, makes an enormous difference. Our experience working with Staten Island PPS has shown us what can happen when the Social Care Network and community-based organizations truly work as partners towards the same goal. Making sure eligible New York, New Yorkers can access the services they need.

There's an enormous amount of work happening behind every member who ultimately receives a service. There are trainings, assessments, referrals, coordination, technology training and countless conversations. That infrastructure matters and the collaboration between the SCN and CBO is a critical part of making the work. An enormous amount has been built to make these connections possible. And communities have learned that they are somewhere where they can turn to when a health-related social need is affecting their family. We should build upon that foundation. When I think about the future of HRSN, I keep coming back to the individual stories. The mother who tells us that the children are eating vegetables, the better digestive health, the family that can actually choose nutritious food. Okay, my time is up so I'm gonna leave it there.

Thank you for your comment. Our next speaker is Brandy Loveland. Hello, can you hear me?

Yes, we can.

Wonderful. Good afternoon. My name is Brandy Loveland, CEO of Harvest House Buffalo, and I'm here to speak in strong support of the 1115 Medicaid waiver program. At Harvest House, we have seen firsthand how important these services are to the people and

families we serve. Through the 1115 waiver, we are able to provide critical services in transportation, housing, and pantry stocking. Three areas that represent some of the greatest needs we see in our community. These resources have allowed Harvest House to expand our capacity at a time when the need for our services continues to grow. In 2025 alone, we served approximately 45,000 people. But the impact of the waiver goes beyond the number of people who walked through our doors. It has also allowed us to build partnerships that help fill the gaps in our safety net. One example is our partnership with Fresh Flavor RX, which provides medically tailored meals. This partnership has been particularly meaningful for the older adults we serve at Frederick Douglass Towers, right next to our building. The 1115 waiver gives organizations like ours the flexibility, capacity, and resources to respond to what people actually need. Not just address one problem, but to connect people to services and supports that can help them become stable and independent. While numbers are important, numbers don't compare to the success stories. I wanna share one with you. We recently worked with a young mother who was experiencing housing insecurity. She had a young child and was struggling with rent arrears, putting her family's housing stability at risk. Through our housing services, we were able to address those arrears, but it did not stop there. We were also able to connect her to additional services and supports through our level one services, helping her address some of the underlying challenges that were keeping her from stability. And then something powerful happened. About a month later, she was able to secure a better job and today she's doing well and moving forward with greater stability for herself and her child. That is what these services make possible. It isn't simply about paying an overdue bill, or providing a ride, or putting food in somebody's pantry. It's about creating a bridge from crisis to stability. The 1115 waiver gives community organizations the ability to meet people where they are, address immediate needs, and connect them to resources that can change their trajectory of their lives and at Harvest House we see that impact every day. I strongly support the 1115 waiver program and its expansion, and I encourage you to continue investing in the community-based services that help New Yorkers not just survive a crisis but move beyond it. Thank you for the opportunity to speak today.

Thank you for your comment. Our next speaker is Ann Selfridge.

Okay, doesn't look like Ann is on right now, we will circle back. Our next speaker is Shannon Willis.

I don't think we have Shannon on either. Our next speaker then is Kathy Staples. Can you hear me?

Yes, we can.

Fantastic. My name's Kathy Staples, and I'm based here in the Southern Tier Care Compass Collaborative region. We're a community-based organization. I work for an organization called Truth Farm. Our role in our general day to day is we educate and

advocate to reduce the harms of substance use. So, when we heard about the 1115 waiver and it was going to be coming out and all the things they could do to help our community members, we were very excited. A lot of times our folks who struggle with substance use are never included as part of the enhanced population, even though so many of the things are stacked against them on a regular basis. So, since the beginning of the waiver we've been involved, we trained, we did everything. We're a very small organization so for a while there was three of us performing Social Care Network services as part of the 1115 waiver. We have over 1,000 community members that we've connected to services. We've sent out over 1,200 referrals to outside organizations for those community members, and the beautiful part is that it allows us to support people in a way that most programs don't let us support them. So, we refer people to our Department of Social Services for assistance with rental assistance and if someone else is in the household that makes the whole household, household ineligible, and this program is one of the few that doesn't look for reasons to remove services from people and supports. For an anecdotal story, we had a community member, he was unhoused homeless for two years in Broome County. He was originally from Syracuse, Onondaga County. So, when we talked about the 1115 waiver with him and all the ways that it could help him, his insurance was still listed in Onondaga County. It took about six months of him still being homeless outside in Broome County to get his insurance updated to our correct region. He does have some financial assistance through Social Security, and they were basing his Medicaid out of the county where his rep payee is located. So even though our community member is here, it was quite the struggle to actually get him in the region that he belongs but due to him having the support of his Social Security payment, he was able to find an apartment. He found an apartment that he can afford regardless of the Social Care Network. And, at this point he's six months out from his last rental assistance payment. He still maintained that same apartment. The apartment is a studio apartment, and he hasn't had new furniture, ever, and I've never seen the pure look of joy on a 49-

year-old man's eyes to pick out a futon that he was gonna have in his own apartment. So those things that like are very bare minimum but if you don't have that any little thing is a reason to have joy. So, like not only did we, were we able to secure transportation we were able to secure housing, and we were able to secure food for him, because also he gets social security, so he doesn't get a lot in food stamps each month, and so this community member who struggled with substance use for a long time has now been in recovery for about nine months. So, it's amazing that if you can support the human and give them access to like the basic necessities that people need to be able to be people and be functional in society, they can evaluate other things going on in their lives and he's not the only community member, but he's one of my favorite, because the turnaround of this human from who they were to who they are now it's a wild, wild ride. Thank you so much.

Thank you for your comment. Our next speaker is Lori Andrade. Can you hear me?

Yes, we can.

Okay. Thank you. Good afternoon, we are grateful for the opportunity to comment in support of New York State's section 1115 demonstration extension request. My name is Lori Andrade, as the Executive Vice President, I offer these comments on behalf of HEALI's Social Care Network for Long Island. HEALI's network of providers includes 6 health systems, 3 federally qualified health centers, 4 independent practice associations, dozens of independent practices, more than 20 for-profit providers, and more than 60 nonprofit organizations, all working together to ensure that Long Island Medicaid members receive targeted social care interventions. Supported by the funding of the 1115 waiver, our integrated care network has accomplished the following. Trained and deployed over 800 Community Health Workers or Navigators in healthcare and community-based settings, screened approximately 100,000 Medicaid beneficiaries to identify unmet social needs including food insecurity, housing instability, and transportation barriers, which are upstream drivers of chronic disease. Connected more than 30,000 high-need beneficiaries to more than 56,000 evidence-based preventive services, embedded Community Health Workers in primary care sites to screen for unmet social needs directly within the healthcare service delivery system. Developed, implemented, and enforced a standard of nutrition services service delivery by a network of 20 nonprofit and for-profit providers to ensure consistent and high-quality impactful services. Together, our nutrition providers have served thousands of members with 36,000 nutrition services, bringing more than 5.8 million to providers and the local economy.

Developed, implemented, and enforced standards for delivery of housing services, including rental assistance and navigation, medical respite, asthma education and remediation and home modifications. Together, our housing providers have delivered more than 1,700 services, bringing more than 1.2 million dollars, to providers and the local economy. We've launched a food as medicine nutrition project for beneficiaries with diabetes across four health systems and three nutrition providers with six managed care organizations, including the transition to value-based payment arrangements. On behalf of HEALI, I support the State's proposal, including the following. The waiver extension for five years with one year of non-risk funding for HRSN services. In the first two years of the waiver, Social Care Networks have built the infrastructure to deliver evidence-based services to enhance populations across the state. A five-year extension enables SCNs to complete the work of the demonstration by allowing data to mature and measuring the effect of targeted services on chronic disease, progression, and avoidable care utilization, and generating the outcomes evidence required to build sustainability. I support the transition to risk-based payment arrangements by continuing non-risk payments for an additional year. The State's proposal ensures the success of that transition, which is already underway on Long Island. An additional year provides time for these relationships to expand and for HEALI's encounter data to mature into a reliable basis for rate setting.

Second, recommend following that we're in support of is designated the health, designated state health program funding rollover and continuation of HRSN services, along with the other S, SCNs, HEALI is demonstrating that we could successfully bridge the gap between healthcare and social care. Of the Medicaid beneficiaries we have screened and identified with an unmet HRSN, we completed eligibility assessments for

more than two thirds. Among those assessed, more than half are eligible for enhanced services and nearly all those referred had a service initiated. We are closing the loop, converting unmet needs identified into enhanced services delivery. By equipping us to continue our work, we, with the rollover funds ensure continuity of care for New Yorkers and give us the opportunity to evaluate our targeted social care interventions and their impact on health outcomes and health care utilization costs. We thank the New York State Department of Health for providing us this incredible opportunity for public comment, and for this important program, as we move forward, we support the State's proposal to integrate health and social care systems and address health-related social needs by implementing meaningful and strategic initiatives. Thank you.

Thank you for your comment. Our next speaker is David Greenfield.

Good afternoon. Hopefully you can hear me. Yes? Wonderful. Thank you very much. Thanks for the opportunity to testify, my name is David Greenfield and I'm privileged to serve as the CEO of Met Council, America's largest Jewish charity dedicated to fighting poverty. We serve more than 350,000 New Yorkers annually across every denomination and demographic. Before I share why we're here today, I want to say thank you. I wanna thank Governor Hochul for championing this waiver and for a vision of Medicaid that recognizes food, housing, and safety as the healthcare they truly are. Thank you to Commissioner McDonald and the entire Department of Health team for the extraordinary work of building this program from the ground up. And thank you to State Medicaid Director, Amir Bassiri, whose leadership and genuine partnership with CBOs have made social care what it is today. New York is fortunate to have this leadership team. As a contracted partner in all three Social Care Networks serving New York City, Met Council reaches every borough from seniors aging in place to young families. Community-based organizations like ours have earned New Yorker's trust over five decades, and that trust is what brings people into this program. You will hear plenty of data today proving that SCN is a success. I want to share some stories behind the numbers. Last summer in the middle of school break, when grocery costs pressed hardest on families, a young mother broke down in tears during a screening call. Someone had skimmed her SNAP benefits off of her EBT card. She did not know how she would feed her children through the end of the month. Then she learned she was eligible for enhanced SCN services. We enrolled her on the spot and a food box tailored to match her family's needs arrived within days. No other publicly funded program matches that speed and compassion. Another story shows why CBOs are the ideal home for this work. Earlier this spring a client came into our Brooklyn hub, one of our 50 locations. This particular location serves more than 13,000 people in southern Brooklyn last year, for a routine appointment. Before she left, the staff member paused to ask a simple question. Might she be eligible for the Social Care Network? That question opened a door. We enrolled her son and in the same conversation she quietly shared what she had been carrying alone, her elderly mother was struggling to make rent and showed signs of elder abuse. Because our SCN staff sit along colleagues in benefits, housing, and senior services, help for her mother was one conversation away. She walked in for a routine appointment, and she walked out knowing that three generations of her family would be cared for. That is what it means to house these services inside a community-based organization. The trust is already in the building and so is the help. Which brings me to why I'm here today. We join our colleagues in urging the State and federal government to protect what we have built together with three asks. First, advance the five-year extension including the one year no cost bridge, so this network does not lose a single day of continuity. Second, keep community-based organizations at the center of delivery, especially as the State moves towards capitated risk adjustment payments. Third, sustain infrastructure and capacity funding for CBO partners throughout this transition. The outreach arm that reached tens of thousands of New Yorkers this year did not exist before this program. Met Council built it along with many other organizations. We invested over a million of our own dollars because we believe in what this program does. That investment only pays off if the network stays standing. I also want to recognize Public Health Solutions, our Lead Entity for Manhattan, Brooklyn and Queens. PHS has been an exceptional partner and instrumental at helping us build the infrastructure to deliver at scale. Continued investment in that partnership between SCN and CBOs will extend this program's reach even further. One sobering fact fewer than one in five CBO partners in the system can cover their cost through fee schedule payments alone. Met Council has the scale to absorb the gap, but most CBOs do not. We built something that works executing the vision of the Governor, the Commissioner, Director Bassiri, and the Department have led for years. Now we ask you to protect this partnership among the CBOs, the Social Care Networks, the Department of Health, and every partner who made that possible. Thank you for your leadership.

Thank you for your comment. At this time, we will go through the list of registered speakers for anybody who we may have missed or who joined late. If anybody that we call is a call-in number and not associated with their name, please raise your hand since we have to manually unmute. We just may not know that you're on the line. Or, if you are attending and your name on Webex is different from the name you registered under, you may also raise your hand, so we know that it's you. After we conclude with the pre-registered speakers, and going back through to see if we missed anyone, I will then open it up. So, please bear with us to finish the pre-registered speakers, and then everybody will get a chance to comment. So, I will go back through is Rasheed Ford on the line?

Okay, we will go to Shana McCormick then. Hi, Shana? Okay. Next is Ann Selfridge? Ann, can you hear us now?

Yes, before when you called, I was unable to unmute. Can you guys hear me? We can now. Thank you so much for your patience.

Yes, thank you for the communication. Good afternoon, everybody. My name is Ann Marie Selfridge. I'm the Founder and Administrator of the ACT Care Foundation. Together with Steven Kim, the Lead Supervisor we both serve as a contracted partner with the New York State Social Care Network, SCN. The ACT Care Foundation, we are contracted with two

Lead Entities, Staten Island PPS system and also Public Health Solutions. We strongly support the extension of the waiver, the continuation of health-related social needs services, and the continued investment in New York State's Social Care Network model. The SCN has been a way to enhance life for many people, mainly people who do not have resources or money to maintain a safe and healthy environment. Working with the SCN has really allowed the ACT team to see firsthand some challenges people face when they don't have access to support, connections, and/or funding to help facilitate service delivery. We've seen, and we all know on the call, health is not only maintained and cared for in hospitals or clinics it is also having safe access to homes, kitchens, bathrooms, bedrooms, and your neighborhoods. Some of the cases that ACT has helped to maintain, have been remarkable, definitely eye opening. It's very powerful from our point of view to be able to provide and connect families to resources that help increase physical and mental health. The number of people living in New York, especially in the city, they have many difficult realities, and seeing the perspective from, you know, where we're positioned of how New York State has taken a truly powerful initiative, to help the families, is really innovative, it's very inspiring. I've been in this space for many, many years, and it's the true essence of helping people to age in place in their communities. As the SCN partner we have been responsible for helping to deliver home modifications, nutrition services, mobility supports, and of course case management. We've been in the homes, boots on the ground, with the families, connecting the contractors, providing the service, you know, very hands on. Through diligent case management, establishing trust from our navigators with our partners and the families, we've worked with families who had no heat all winter, including households with young children sleeping in freezing temperatures, living without functioning HVAC systems for months, we've coordinated both heating and cooling system replacements, huge jobs. Families receive space heaters, humidifiers, dehumidifiers to stabilize unsafe conditions, families who are living in mold infested houses, mold spreading into children's bedrooms, three different types of mold growing in an elderly family's basement- all remediated through the SCN funded services. Major roof leaks that cause water to pour into kitchens and bathrooms, water dripping into pots in the kitchen, cracks in the ceiling, showers that leak every rainfall, dangerous unsanitary conditions, internal ducts that don't work, leaving families without cooling in extreme heat. It's been very hot this summer. Ducts are replaced to restore airflow. I've seen and the team has seen, I have a great team that, a child needs to sleep in a warm room instead of shivering through the winter. A stroke survivor can safely enter a shower without fear of falling, with the bathroom modifications we've helped to install. Family has food in the fridge instead of going hungry. Families experiencing domestic violence, they receive pressure alleviation with the resources that help to keep them safe. We partner with extremely compassionate, experienced contractors who treat families with dignity. Our case managers collaborate with other SCN partners. One of the most notable cases we were working just yesterday, a family with four children under twelve, a six-month-old baby sleeping in a car carrier because the family had to throw out every mattress due to bed bugs, sleeping on wooden boards. With the SCN and ACT we've gotten exterminator services, we've paid for seventeen bags of their laundry services, cleaning supplies, disinfectants. We helped to schedule mobility jobs for non-subtraction bathroom modifications, grab bars, we do help with nutritional services, groceries, food voucher credits, people with chronic illness are getting deliveries to their homes, they have access to food, being able to feed their families, there are starving families out there, like truly.

The case managers, they're true all-stars providing emotional support, navigation through these really complex systems working with us, working together, really coordinating the care. The case management is really the only support systems the families have. We speak their languages, we understand their cultures, the CBOs are very important. We ask for the demonstration to continue, include CBOs, keep funding in the community and I'll submit the written testimony. Thank you.

Thank you for your comment. Alright, our last registered speaker we'll circle back to is Shannon Willis. Do we have Shannon on the line? Okay. It looks like that concludes our list of pre-registered speakers, I will now open the floor if there is anyone else who wishes to provide comment today, please raise your hand and we will unmute you.

Hello, can you hear me? Yes, we can.

Awesome. Thank you for the opportunity to speak. My name is Alex Mikowski. I'm a person with disabilities, a social worker by training, an Executive Director for Access to Independence, which is a small, independent living center in rural Cortland, New York.

Today I am testifying from two perspectives, as a daughter who has seen this support help a loved one, and as Executive Director for a small Independent Living Center who sees similar needs across our community every day. As a daughter I can see the difference this program can make. My biological mom recently lost much of her vision and was beginning a pattern of multiple day hospital stays. Because she lives in a rural area she had extremely limited access to healthy foods. Through Seven Valleys Health Coalition within the Care Compass area, she was able to be screened and connected with food boxes that have helped her get on her feet and now she's getting more connected to services and moving into better housing which is on the bus line. As an agency, we see amazing stories every day. One of the services allowed is helping people get cooking supplies so they can live healthier and eat healthier. We had one case where someone was in the early stages of heart failure and eating food from the corner store. His doctor wanted him to eat a lower salt diet; we were able to get him a microwave. As I like to say, it is much cheaper to buy a microwave than to get a new heart transplant. We have helped community members get bus passes so they can get healthy food, go to pharmacies, and also, so much housing. We've also seen brief enhanced care management help people navigate systems and it frees up our other staff to serve more people because we know the 1115 waiver staff can be reimbursed to help them. Capacity building funding has been critical to us, to our success, and getting the service up to sustainability is taking longer than expected. Our agency is in the Healthy Alliance region, they have been very helpful in navigating the program and ensuring that we are effectively utilizing and following all, all the rules of the program. It's an amazing program. So, it's both as a family member, a community member and Executive Director, I strongly encourage this program to continue to help all the people in our lovely state and just as a side note for accessibility, it seems like the captions aren't working in the CC captions or in the other caption panel. So, just wanted to let you know in case other people are having that access need. Thank you.

Thank you. And thank you for your comment. Okay, we will unmute the next speaker with their hand raised.

Hi, my name is Jamaica Tyler. I am the Founder and CEO of IRIC, Incorporated. That stands for Inspiring Responsibility In Spite of Crisis. I do apologize for any background noise. I am currently outside on the ground, dealing with members and trying to get some screening done. I'm speaking for, and advocating for, Onondaga County. I believe in the vision of the whole-person care, I believe that health-related social needs must be addressed if we expect people to experience better health outcomes. This waiver is exactly what is needed in the times that we're facing but I do have a concern. In Onondaga County, there's still a significant unmet need and at the same time since April, Healthy Alliance has stated there's a pause in bringing additional community-based providers into the network with no active date suggested. That need has not paused. The people in Onondaga County who need help have not paused. The housing instability has not been paused, the food insecurity has not paused, the mental and health substance use challenges have not paused, the need for transportation has not paused, and the navigation has not paused either. I'm asking for the State to look at Onondaga County and ask whether the current community-based capacity matches the levels of the need. I'm asking the State to reconsider what a pause means when the community itself is still in need because if there's qualified organizations ready to do the work, doing the work outside, having people express, the wait, not the whole person-centered care, or just having people who are at the most vulnerable who are not being touched at all what is that doing? You know the waiver's awesome, the money is there, the intention is there. The success stories that I hear are so awesome, they give me and my team the inspiration to keep going but right now Onondaga County is in need to unpause it and so regardless of what, we're gonna stay on the ground we're gonna still continue to do what we have to do in order to help people as much as we can, we can only get so far. The five-year extension is going to be a tremendous impact on our county we still need some help though. And so that's the goal is to reach out to have the State hear that there are people who are outside with the most vulnerable population and that is what the waiver states it was created for. To get that high utilization out. We need your help to see what's going on with Onondaga County, get them to talk to us so we can have as many success stories as we've heard, whether it's here or the in person, just period. So, I appreciate the fact that, you know, I didn't register and you guys still allowed me to speak. But, IRIC Incorporated is here, I'm inspired and hopefully we can get more, we can get Healthy Alliance to give us help out here. We need some help out here. I appreciate it.

Thank you for your comment. Alright, we will unmute the next speaker.

Hi, can you hear me?

Yes, Melissa, we can hear you.

Thank you. Yeah well, hello everyone, my name is Melissa Isavoran Vice President for Policy with Foodsmart. Foodsmart's a registered dietician provider organization. We currently have over 100 safety net trained RDs, registered dieticians, providing services to thousands of New York Medicaid members where we align medical nutrition therapy with food as medicine benefits. In providing these types of services, we see net savings in total cost of care equating to $60 per member per month, and over $200 per member per month for members with specific chronic diseases. We do all know at this time that higher costs and higher utilization, combined with continuous regulatory shifts, are putting an immense amount of strain on Medicaid. So, I do want to state that I appreciate the State Department of Health and other key leaders for your continued focus on critical HRSN services particularly, of course, in relation to nutrition benefits, and your intended continuation of the Social Care Networks that we really rely on for community support and food services. Today I'm focusing my public comment on policy avenues that can ensure the continuation of vital nutrition-related benefits. Because while the transition to new budget neutrality provisions doesn't really technically start until January, there's likely pressure on CMS's waiver team to start reviewing requests with the higher level of scrutiny. In recent months, I've been privy to conversations with Dan Brillman CMS Medicaid Administrator through a Duke Margolis Policy Institute Rapid Learning Collaborative where Dan Brillman has explicitly advised state leaders to leverage 1115 waiver authorities strictly for special populations and service designs that are not allowable under other medical Medicaid authorities such as State Plan options. Given this, I'm providing the following public comments on Foodsmart's behalf for your consideration and in effort to protect these benefits, nutrition benefits and others that are truly positioned to reduce the burdens of chronic disease. So overall, Foodsmart recommends that the State shift nutrition benefits to its State Plan, to the extent possible to ensure the long-term sustainability of nutrition services. The State can either prepare to do this now through the SPA process or indicate the transition in its waiver renewal, which could provide ample time to do appropriate planning prior to the DSHP funding discontinuing. So, for instance, nutrition counseling and medical nutrition therapy are considered Medicaid optional benefits under 1905(a) authority. These benefits are also automatically covered under EPSDT provisions for children and adolescents where the State has to cover any service required to correct or ameliorate a condition. That's an important point of note for some of the previous comments as well. Food benefits and related supports on the other hand, can be moved under HCBS, home and community-based services, 1915(i) State Plan Authority with food insecurity documented as the functional limitation. State Plan Authority permanently embeds benefit into the Medicaid program whereas waivers are temporary and come with arduous certain standard terms and conditions and costly actuarial validation. Also, per the additional guidance from Dan Brillman, integrating food benefits management will go a long way in obtaining continued approval for food benefits. Foodsmart's been able to leverage registered dieticians to oversee food benefits management programming, which essentially leverages targeted nutrition care planning to ensure the right food for the right duration which results in greater intervention efficacy, improved health outcomes, and food security. The last thing I would say is that I appreciate the intention to move toward a risk-based payment for these services and urge you to consider how these payment models work within the integration of nutrition education and medical nutrition therapy with food benefits management. I'll note I'll be submitting these written public comments with additional details for your consideration, and I truly appreciate the opportunity to provide comment today.

Thank you for your comment. We will go ahead and unmute the next speaker. Lara, your line has been unmuted.

Hi. Thank you. This is Lara Kassel, I'm the Coordinator of Medicaid Matters New York. Medicaid Matters is the statewide Medicaid Consumer Advocacy Coalition representing the interests of people who are served by Medicaid. And my comments are really central to the mission and the goals of the coalition and they are really, if you've been paying attention to our work over the last many years, not different than a lot of the work that we've been doing, a lot of the comments and a lot of the participation and the feedback that we've provided over the last many years. Central to our agenda is calling for, which we've done for many years, greater transparency and accountability in the ways that Medicaid dollars are spent. We believe that one way to improve on this would be to build greater transparency into Medicaid managed care and allow for greater data and information about the inner workings of Medicaid managed care; how the program operates to shed light on how the program works or doesn't work for accessing services and this same theme of transparency we believe is also important in the context of the NYHER waiver amendment. The Social Care Networks have been doing tremendous work around the State, which we've heard about for the last many weeks, and one of the things that we believe really could be improved in the area of transparency is to provide greater levels of data, deeper data availability into how the Social Care Networks are operating, we think perhaps this could be built into the HERO functionality. The HERO is of course responsible for data collection, and perhaps, you know, one idea that could be employed is dashboards, which is not a new concept in the area of Medicaid. There were DSRIP dashboards that showed a lot of information publicly about what was happening with the Performing Provider Systems within DSRIP so that's just one big example. We think that could be an opportunity within the context of the HERO and the funding for the HERO to provide that level of transparency publicly. Also, related to data with respect to NYHER, and the operations of the Social Care Networks, we believe it's extraordinarily important to expand into qualitative data and in particular, asking Medicaid beneficiaries for their experiences. Not just like the mechanics of how many people were assessed, and how many people were provided services, etc., which is all very important, but asking what their experiences have been, and how the consumer experience could be improved in the way that all of these services are provided. Moving on now to a few different areas that are also included in the extension application. It is very unfortunate and really heart breaking to many of us in the Medicaid consumer advocacy community to see in print, the request that continuous eligibility from birth to age six be eliminated. And we fully understand that this is due to federal guidance and that the State is being required to remove that functionality in continuous eligibility, but it's really sad and you know, it's important to be on record to say we hope that would come back under different federal circumstances.

And then lastly there is the provision to what's being referred to as delinking, which is removing the TANF eligibility, being linked to Medicaid or vice versa, so when a person comes in to apply for TANF, they can also apply for Medicaid at the same time. That is being eliminated and we think that it's really important that you know, we understand the mechanics of why this is being proposed. We have had a number of conversations about why this is happening, and what needs to be done to continue to enhance Medicaid eligibility even though that functionality is going away. And we think that it's important to put in writing some of the things that would allow people to have greater, you know, access through applying for cash assistance at the district. Thanks very much.

Thank you for your comment. We will go ahead and unmute the next speaker.

Hello, my name is Alex. I am a Registered Dietician with Nutrition Education for All, and we provide nutrition education and counseling services, as well as partner with companies to provide food boxes, medically tailored meals, as well as cooking supplies, kitchenware, fridges, microwaves, so we do all the nutrition-related services. We have three dieticians on staff, actually, I'm sorry, four dieticians on staff and then a manager and executive director. We work in a couple different Social Care Networks and we've really seen the growth from when we started back about a year ago to now helping serve Medicaid members not only with nutrition education and counseling, but really being able to provide them the access to the healthy nutritious foods to make those changes in their day-to-day lives, and we really hope that the waiver is able to get extended so we can continue to provide these great services to members. And thank you guys for giving me the opportunity to share about our organization.

Thank you for your comment. And we will unmute our next speaker. Hi, can you guys hear me?

Yes, we can.

Awesome. Thank you. Hi everyone. My name is Faven Araya I serve as the Director of Community Engagement and Health Equity Research. I'm speaking on behalf of Communities Together for Health Equity or CTHE, a coalition of community-based organizations and stakeholders committed to advancing health equity across New York City. For more than a decade, CTHE has worked to ensure that community-based organizations have a meaningful role in transforming the healthcare system. We know firsthand that CBOs are not simply service providers. We're trusted partners, community advocates, navigators, and essential bridges between healthcare systems and the communities that we serve. I want to first say that CTHE strongly supports the continuation of the 1115 Medicaid waiver and the continued integration of health-related social needs into Medicaid. We believe the waiver represents an important opportunity to move beyond a traditional medical model and recognize the conditions that shape people's health, including housing, food security, transportation and other social needs. The 1115 waiver and Social Care Networks represent an important opportunity to recognize the role of social care and improving health. As New York considers the next phase of the waiver, we urge the State to protect and strengthen the role of CBOs, ensure sustainable funding, and provide sufficient time to demonstrate the value and effectiveness of this new model. We offer four key recommendations. First, protect CBO participation and funding, the administrative technology contracting and billing requirements for Medicaid can disproportionately disadvantage smaller grassroot organizations. The State should provide sustainable funding and capacity building support that allows CBOs of different sizes and levels of Medicaid experience to participate. SCN implementation should not result in the consolidation of social care among larger institutions at the expense of organizations with deep community trust. Second, provide sufficient time to demonstrate proof of concept. The accelerated timeline for implementing the waiver and the SCNs has created significant challenges for CBOs. Many grassroot organizations did not have the infrastructure, workforce technology, or financial reserves necessary to rapidly scale new Medicaid-funded services while simultaneously maintaining their existing community responsibilities. Building a sustainable social care delivery system takes time. CBOs need time to develop partnerships, establish workflows, train staff, build referral capacity, implement technology, and understand the financial realities of Medicaid reimbursement. We cannot fairly evaluate a model before the organizations responsible for delivering it have had a reasonable opportunity to provide, to build the capacity necessary for success. We therefore urge New York State and CMS provide an extended implementation evaluation period that allows CBOs and SCNs to demonstrate proof of concept, identify and correct implementation barriers, and generate meaningful evidence about what works. The goal should not be simply to rapidly scale, it should be sustainable scale that improves outcomes and advances health equity. Third, reimburse the full value of community-based care, successful social care requires much more than a billable service. Outreach, education, relationship building, navigation, follow-up, prevention, and culturally responsive engagement are essential to reaching and retaining members. Reimbursement must reflect the true cost of this work, including workforce technology, administrative and coordination costs. CBOs should not have to subsidize Medicaid transformation with already limited resources. Fourth, make community voice and accountability central to the waiver. CBOs and the community members should have a meaningful role, not only in service delivery but also in governance, evaluation, and decision making. We recommend an independent community-informed evaluation of the SCNs that examines access, equity, member experience, referral outcomes, CBO participation, and financial sustainability, not simply the number of screenings or referrals completed. These recommendations are particularly important in today's social and political environment. Communities are facing growing needs, organizations are experiencing financial and workforce pressures, and trust in public health systems cannot be assumed. CBOs are often the trusted bridge that makes it possible for people to engage with healthcare and social services. As New York moves toward, moves forward with the 1115 waiver, we urge the State and CMS to invest in that bridge rather than weaken it. Protect the role of CBOs, fund their participation sustainably, give communities and CBOs the time needed to demonstrate what works and ensure that community voices have a meaningful seat at the table in shaping the future of social care. Thank you.

Thank you for your comment. Okay, is there anybody else who would like to provide comment today? If so, please raise your hand and we will unmute your line. Okay. I don't see anybody on my end. It looks like somebody did just raise their hand. Marta, we will go ahead and unmute your line.

Yes. Hi, my name is Marta Reeger. I'm representing United Hands Organization, who is a CBO with partners on several of the SCNs in lower downstate. I just wanted to just absolutely ditto everything that the previous speaker, Faven Araya, just said about the very small organizations and particularly I see you have sign language interpreters here but across all of the SCNs it's not unified on how big the access is across the different SCNs. So, I have a fear that the deaf population has not been properly captured in the data that's going to be used to demonstrate the future of managed care and all these Medicaid changes going forward. So, thank you very much for the opportunity to speak. Appreciate you.

Thank you. Is there anybody else who would like to provide comment today, before we wrap up? Okay. If not, I will go ahead and turn it back to my colleague Simone Milos to provide closing remarks. Thank you guys so much.

Thank you, Brianna. Thank you everyone for joining us for today's public hearing and annual public forum. We really appreciate the thoughtful comments shared today. As a reminder, we're accepting written comments through August 21st, and again, thank you so much for the time today. Take care everyone.