Initiatives

New York State Medicaid Social Care Initiatives: The enacted SFY 2020-21 budget included authorization for the department to create three social determinants of health initiatives to improved health outcomes and generate Medicaid savings. The three initiatives include:

  1. Medically Tailored Meals (MTM) - initiative focuses on providing home delivered medically tailored meals to individuals diagnosed with cancer, diabetes, heart failure, and/or HIV/AIDS and who have had one or more hospitalization within a year. DOH has designated medically tailored meals (MTM) as a State Initiated In Lieu of Service (ILS). Medicaid Managed Care Organizations (MMCOs) may apply for authorization to provide MTM as an ILS to qualified member.
    1. State Identified ILS-MTM Presentation - (PDF)
    2. State Identified Request Form for In Lieu of Services for Medically Tailored Meals (MTM) - (PDF)
    3. State Identified ILS MTM Reporting Template - (XLSX)
    4. MTM Member Notice Template - (DOCX)
    5. Member Handbook Insert Template - (DOCX)
    6. Authorized MTM ILS providers (MMCO) - State Approved Plans
  2. Street Medicine - initiative will allow Diagnostics and Treatment Centers licensed under Article 28 of the Public Health Law to bill for certain services provided at offsite locations to serve the chronically street homeless population.
    • MMCO Guidance on Street Medicine (PDF) - coming soon
    • Provider Guidance on Street Medicine (PDF) - coming soon
  3. Community Health Worker Expansion - Effective January 1, 2024, for New York State (NYS) Medicaid fee-for-service (FFS) and for NYS Medicaid Managed Care (MMC) Plans [inclusive of Mainstream MMC Plans, Human Immunodeficiency Virus-Special Needs Plans (HIV-SNPs), as well as Health and Recovery Plans (HARPs)], NYS Medicaid will expand the populations eligible for Community Health Worker (CHW) services beyond pregnant and postpartum populations, to include:

    1. Children under 21 years of age;
    2. Pregnant and postpartum individuals during pregnancy, and up to 12 months after pregnancy ends, regardless of the pregnancy outcome;
    3. Adults with chronic conditions;
    4. Individuals with justice system involvement within the past 12 months;
    5. Those with an unmet health-related social need in the domains of housing, nutrition, transportation, or interpersonal safety, which have been identified through screening using the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool; and;
    6. Those who have been exposed to community violence or have a personal history of injury sustained as a result of an act of community violence, or who are at an elevated risk of violent injury or retaliation resulting from another act of community violence.

Additional information can be found in the Community Health Worker Policy Manual

Social Care Interventions Under Value Based Payment (VBP)

Effective January 1, 2018, all new and existing VBP Level 2 and 3 arrangements must include at least one SCN intervention and at least one contract with a Community Based Organization (CBO). This requirement applies to Managed Care Organizations (MCO), Managed Long Term Care (MLTC), and PACE plans, entering into a Level 2 or 3 VBP arrangement. Health plans and VBP contractors have the flexibility to decide on the type of intervention that they implement. The guideline recommends the SCN selection be based on information including but not limited to, SCN screening of individual members, member health goals, the impact of SCN on their health outcomes, as well as an assessment of community needs and resources.

  • This document is the SCN interventions that have been approved by the Department of Health. - 10.30.2023

Medical Loss Ratio for Social Care Interventions

Effective January 1, 2018, Value Base Payment (VBP) arrangements Level 2 or higher are required to implement at least one social care need (SCN) intervention. MCOs must provide a “funding advance” (seed money) to the provider that is investing in the intervention. The expenses for SDH services being implemented within the VBP contract, for which the MCO is making the investment, should be included in “Other Medical”. MCOs and providers in Level 1 VBP arrangements may also implement SCN interventions. Expenditures made to support DOH approved VBP SCN interventions should be included in “Other Medical” on MMCOR and MLTCOR.

Medicaid Redesign Team Supportive Housing:

The Medicaid Redesign Team Supportive Housing Initiative is an innovative approach to addressing social determinants of health by investing State only Medicaid dollars into rental subsidy, tenancy services and capital for high-utilizers of Medicaid. The programs work with health systems to create better health outcomes and reduce Medicaid costs.

Medicaid Redesign Team Supportive Housing

The Medicaid Redesign Team Supportive Housing is an innovative approach to addressing social determinants of health by investing State only Medicaid dollars into rental subsidy, tenancy services and capital for high-utilizers of Medicaid. The programs work with health systems to create better health outcomes and reduce Medicaid costs.