NYS 1115 Waiver - HRSN Services
In New York’s groundbreaking initiative to address Health-Related Social Needs (HRSN) in the 1115 Waiver Amendment, the services are meticulously structured into two tiers, each designed to cater to the diverse needs of the state’s Medicaid population. These tiers, known as Level 1 and Level 2 services, serve as critical components in the state’s strategy to promote health equity and reduce disparities.

Let’s
delve deeper into each tier to understand their scope and impact:
 

Level 1 Services: Universal Access to Essential Support

Level 1 services represent the foundational layer of HRSN support and are accessible to all Medicaid beneficiaries. These services aim to provide essential support and resources to individuals facing various social challenges. Key components of Level 1 services include:

Case Management and Referrals

Medicaid enrollees will have access to case management services aimed at assessing their social needs and connecting them with existing public programs and resources. This may include referrals to state, federal, and local programs addressing housing, food assistance, employment services, legal aid, and more.

Universal Screening

To ensure comprehensive coverage, all beneficiaries will undergo universal screening for HRSN eligibility. Screening tools will be employed to identify individuals at risk due to social determinants of health, such as housing instability, food insecurity, or lack of access to transportation.

Coordination with Existing Programs

Level 1 services prioritize coordination with existing public programs and community resources. By leveraging these partnerships, Medicaid beneficiaries can access a wide range of support services tailored to their specific needs. 

Level 2 Services: Targeted Support for Complex Care Needs

Level 2 services represent an enhanced level of support targeted towards specific populations with complex care needs. These services are designed to address the unique challenges faced by individuals dealing with significant health and social complexities.

Key features of Level 2 services include:
 
Targeted Eligibility Criteria

Eligibility for Level 2 services is determined based on standardized assessments and targeted populations. Individuals with complex care needs, including those with substance use disorders, serious mental illness, pregnant persons, homeless individuals, and children with chronic conditions, among others, may qualify for Level 2 services.

Expanded Benefit Package
Unlike Level 1 services, which primarily focus on referrals, Level 2 services offer a comprehensive benefit package encompassing a wide array of interventions. These interventions may include: 
  • Housing Supports: Temporary housing assistance, home modifications, security deposits, utility cost coverage, and air conditioners to address housing instability and homelessness.
  • Enhanced Case Management: Intensive case management services aimed at connecting individuals to healthcare and social care programs, legal assistance, education, and employment services.
  • Nutrition and Food Support: Nutritional counseling, prepared meals, medically tailored meals, cooking supplies, and food assistance programs to combat food insecurity and promote healthy lifestyles.
  • Respite Care and Transportation: Respite care services for pre-procedure or post-hospitalization support, as well as transportation assistance for accessing covered HRSN services.

The tiered structure of HRSN services in New York’s Medicaid program reflects a nuanced approach to addressing health disparities and promoting health equity. By offering universal access to essential support through Level 1 services and targeted interventions for individuals with complex care needs through Level 2 services, the state aims to provide comprehensive assistance to its Medicaid population.  

Aigilx Health’s SCN platform is designed to address health disparities and enhance health equity through Social Care Networks (SCNs). Leveraging advanced technology and robust infrastructure, Aigilx Health provides a comprehensive solution for screening, referral, and case management within SCNs. The platform offers efficient closed-loop referral systems, standardized assessment tools, and seamless integration with existing electronic health record systems, ensuring smooth coordination and communication among stakeholders.  

With Aigilx Health’s SCN platform, Medicaid beneficiaries receive timely access to essential HRSN services, while providers and SCNs benefit from streamlined workflows and enhanced data management capabilities. By facilitating the delivery of Level 1 and Level 2 services, Aigilx Health empowers SCNs to effectively address social determinants of health and improve outcomes for vulnerable populations across New York state. To know more about Aigilx Health’s SCN Platform, click here.  

Aigilx health specializes in developing Interoperability solutions to create a healthcare ecosystem and aids in the delivery of efficient, patient-centric and population-focused healthcare.

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