New York’s Medicaid 1115 Waiver: Tangible opportunities for scaling Medicaid-funded healthy housing services

By Kevin Chan and Wynn Tucker, GHHI Directors of Policy & Innovation

For a decade, the Green & Healthy Homes Initiative (GHHI) has been a leading voice advocating for Medicaid policy innovation that sustainably supports healthy housing and other health-related social needs (HRSN) services. GHHI has engaged with federal and state Medicaid offices through the years to address barriers that have long inhibited scaled investment for these important services so the announcement in January that the Centers for Medicare and Medicaid Services (CMS) had approved New York State’s amendment to its Medicaid 1115 demonstration waiver was an exciting development.

The amendment establishes a model of Social Care Networks (SCNs) which will act as hubs for the contracting, funding, data sharing, screening, and delivery of services that address the HRSN of Medicaid members.

SCNs will create and maintain a network of contracted community-based organizations (CBOs) that can screen all Medicaid members for HRSN and coordinate and deliver HRSN services for eligible Medicaid members. $3.173 billion has been budgeted for HRSN services between 2025 and 2028.  New York has established a list of HRSN services that can be paid for under this waiver, which includes the following home repair and modification services:

• Home remediation: Repairs or remediation for issues such as mold or pest infestation if repair or remediation provides a cost-effective method of addressing occupant’s health condition, as documented by a health care professional, and remediation is not covered under any other provision such as tenancy law.
• Home accessibility and safety modifications: Medically necessary air conditioners, humidifiers, air filtration devices, and refrigeration units as needed for medical treatment and prevention. Minor medically necessary home accessibility modifications.

Opportunities for Community Based Organizations in New York

The amendment presents meaningful opportunities for CBOs to deliver services to eligible Medicaid members because the SCN facilitates referrals, contracting, data sharing, and payments between Medicaid managed care organizations and many CBOs that do not have the capacity to manage these processes themselves. CBOs that implement healthy housing services which align with the HRSN services described above will need to identify which SCN(s) will be operating in their service delivery footprints once organizations are awarded by the state.

In January 2024, New York issued a Request for Applications (RFA) for organizations to operate as SCN lead entities. The State will award 13 entities by region. The RFA closes in March 2024 and awards are expected later this summer. We recommend CBOs to stay engaged with the SCN application and award process, as applicant entities may be assessing CBO capacity in their region. CBOs should watch for SCN award announcements to know which organizations to engage as SCN infrastructure is built out with CBO partners.

GHHI will monitor developments to SCN procurement, design, and implementation and will share relevant updates with CBO partners as they become available.

Policy Innovation and National Implications

The waiver presents tangible opportunities for scaling Medicaid-funded healthy housing services statewide. For example, the amendment establishes a structure where HRSN investments can be counted in the medical loss ratio and included in capitation rate setting for managed care organizations (MCOs). These considerations make it feasible for MCOs to scale and sustain funding for these services and programs. This amendment is another promising policy innovation that opens Medicaid funding for healthy housing. Other recent policy developments include California’s model of Community Supports under its own 1115 waiver, and CMS’s guidance on how states can use In Lieu Of Services to advance HRSN.

GHHI has also designed and implemented programs that showcase the health benefits of remediating hazards in the home, including the New York Healthy Homes Collaborative (NYHHC). NYHHC is a “pay for success” program for asthma home visiting, assessment, and remediation services in the greater New York City area in partnership with Affinity by Molina, AIRnyc, Association for Energy Affordability, Northern Trust, and Primary Care Development Corporation.  Launched in 2022, the operating model of this program features an MCO (Affinity by Molina) referring eligible Medicaid members to CBOs for home asthma services, which resembles the SCN model to be implemented statewide and across HRSN areas in the coming years.

We are hopeful that New York’s leadership in Medicaid policy innovation will serve as models for other states to follow in the future.

If you have any questions about how your organization can engage with New York’s waiver or advance innovative federal and state policies elsewhere, please reach out to us at mmcknight@ghhi.org.