Unite Us Celebrates the Approval of the New York State 1115 Medicaid Waiver: Improving Access to Care and Advancing Health Equity Together
This week’s approval of the New York State 1115 Medicaid Waiver is a major step forward in advancing a stronger, healthier state for all New Yorkers. At Unite Us, we strongly support the waiver’s ambitious goals of building a resilient, flexible, and integrated delivery system that will improve access to health and social care, advance health equity, reduce disparities, and support health-related social needs (HRSNs).
With our proven track record of successfully facilitating secure closed-loop referrals and social care payments in New York and other Medicaid waiver states, Unite Us stands ready to support this important initiative.
Key Insights on Social Care Components
Social Care Networks (SCNs):
SCNs, or contracted entities in each of the State’s nine regions, will be charged with establishing a network of social services and community providers to deliver eligible Medicaid beneficiaries with HRSN screenings and referral services. The State will reimburse selected HRSN services related to housing, food, and transportation.
Managed Care Plans:
Managed care plans will contract with SCNs to deliver the selected HRSN services through two tiers of benefits. Level 1 services will be available to all Medicaid beneficiaries and will include referrals to existing public programs that are separate from the newly authorized HRSN services; Level 2 services will be provided to targeted beneficiaries who meet certain criteria. Subsequently, MCOs will be required to report data in order to evaluate the utilization and effectiveness of the HRSN services on health outcomes and equity of care.
Hospitals:
Safety net hospitals located in Brooklyn, Bronx, Queens, and Westchester Counties can apply to participate in a Medicaid Hospital Global Budget Initiative that aims to help safety net hospitals transition to a global budget system. This initiative is designed to empower selected hospitals to prioritize population health and enhance quality of care in order to stabilize their financial situations and advance accountability and health equity.
Together, Driving Impact in New York
Building upon our ongoing collaborations with valued partners and community networks in New York, we are ready to deliver the solutions needed to successfully achieve the goals of the waiver while establishing a sustainable infrastructure for the continuous delivery of social care.
Leveraging Our Experience with State Medicaid Programs
We are proud to have established a reputation as the leading software solution for Medicaid programs addressing HRSNs across the country. Our cross-sector collaboration tools support a no-wrong-door system of social care, produce comprehensive insights to measure social need and community capacity at scale, and enable government leaders to strategically shift investments upstream to community-based partners, maximizing health benefits and better managing government spending. Like many Medicaid leaders, we know that social care coordination will improve outcomes, so we built our tools to collect structured social care data using a longitudinal care record. This allows states to measure real-time network performance and conduct integrated or longitudinal program evaluations over time, which will be critical in New York.
With networks in 44 states and partners leading the way in Medicaid transformation across the country, we’ve learned a lot about how we can support this critical work. Here are just a few examples:
North Carolina
In North Carolina, Unite Us has partnered with the North Carolina Department of Health and Human Services to act as the technology backbone connecting health plans, network leads, providers, and public entities engaged in The Healthy Opportunities Pilot. The pilot directs $650M in Medicaid funds to social care through NCCARE360, its statewide care coordination network that is powered by Unite Us.
Since the program launched in March 2022, the partnership has seen an incredible impact, with invoice metrics citing a 2-3% payer rejection rate – compared to the national denials rate of 18% – and over 236,354 services delivered to Medicaid members to date.
Oregon
To implement SDoH initiatives from Oregon’s previous Medicaid 1115 demonstration, Unite Us partnered with Oregon’s Coordinated Care Organizations (CCOs) to establish screening and referral workflows.
The Unite Us longitudinal care record enables care teams across providers, plans, government, and social services to collaborate securely across sectors and care for the whole person.
Unite Us and Connect Oregon network partner CCOs are working to implement workflows and functionality to reimburse for Medicaid members’ health-related social needs, as approved by Oregon’s 1115 new Medicaid waiver.
As of January 2024:
- The Connect Oregon network offers partners access to over 2,400 accountable, in-network programs.
- 15 of the 16 Oregon CCOs have contracted with Unite Us to provide social care infrastructure to any healthcare provider or community-based organization serving Medicaid members in Oregon.
Rhode Island
In Rhode Island, the Executive Office of Health and Human Services offers SDoH screening through our collaborative software, allowing the State and health plans to understand gaps, target resources, and drive plan performance toward equity.
As of January 2024:
- The Unite Rhode Island network offers partners access to nearly 1,000 accountable, in-network programs.
- More than 28,000 managed cases have been seen to completion since 2021, meaning that social or healthcare services have actually been delivered to the client in need.
- Nearly 83% of all referrals are accepted within four days.
Missouri
Unite Us is supporting an innovative rural healthcare delivery model serving Medicaid members in Missouri. The Transformation of Rural Community Health (ToRCH) project led by the Missouri HealthNet Division of the Missouri Department of Social Services is a new model of care to direct resources to rural communities committed to addressing the ‘upstream’ causes of poor health through integrating social care supports into clinical care.
The ToRCH project establishes community-based hubs that serve as regional leads to direct strategy and coordinate the efforts of healthcare providers, community-based organizations, and social service agencies within a designated rural community. These hubs will holistically address social determinants of health (SDoH) by screening for health-related social needs (HRSN) and connecting Medicaid recipients with select CBOs funded to provide social services. By addressing social needs of Medicaid recipients, ToRCH aims to improve population health outcomes and achieve cost savings. Through Unite Us’ Social Care Payments product, partners will be able to manage eligibility and authorization, send referrals to contracted providers (i.e., close the loop), securely track outcomes and document services, generate invoices, and efficiently manage reimbursement of social care services.
We’re proud to support partners across the country in leveraging our solutions to support Medicaid waiver initiatives and advancing whole-person care. Interested in learning more about Unite Us solutions?
About Unite Us
Unite Us is the nation’s leading software company bringing sectors together to improve the health and well-being of communities. We drive the collaboration to identify, deliver, and pay for services that impact whole-person health. Through Unite Us’ national network and software, community-based organizations, government agencies, and healthcare organizations are all connected to better collaborate to meet the needs of the individuals in their communities.
