NY1115 Overview
This waiver program was created to address the social drivers of health while improving health outcomes and reducing costs.
What is the NY1115 Waiver Program?
These members are eligible to receive a screening.
Who are all active Medicaid members?
This is the purpose of a screening.
What is determining whether a member has unmet HRSNs and wants assistance?
This triggers an Eligibility Assessment.
What is identifying an unmet HRSN during the screening?
These team members transfer members to Care Managers.
Who are Navigators?
Name two of the four primary HRSN service categories supported under the waiver.
What is Housing, Nutrition, Transportation, or Social Care Management/Navigation?
These are the only services a Fee-for-Service member can receive.
What are Screening, Navigation, and Level 1 (Standard) Services?
This is how often a routine screening can be completed.
What is every 12 months?
This should never be deleted during an EA unless a pregnant/postpartum member tells you the status is incorrect.
What is the Enhanced Population designation?
This should be reviewed before making referrals.
What is the member's Social Care Plan and priorities?
This is the primary goal of the NY1115 Waiver beyond treating illness.
What is addressing health-related social needs (HRSNs)?
A member with MMC, an Enhanced Population designation, and an unmet HRSN may qualify for these.
What are Enhanced (Level 2) Services?
These events allow a member to be screened before 12 months have passed.
What are qualifying major life events?
This happens if the Enhanced Population designation is accidentally removed from the EA.
What is the member receiving a Level 1 result?
This should happen after referrals have been made.
What is following up and closing the referral loop?
This platform is where member's profile and service care plans are housed.
What is Unite Us?
This Medicaid plan type is not eligible for Enhanced Nutrition Services.
What are MLTC/MAP plans?
This person must answer screening questions for children under age 10.
Who are parents, guardians, or legally authorized representatives?
This is why selecting every needed food assistance option matters.
What is members can only be referred to services selected on the Eligibility Assessment?
This should continue throughout the relationship—not just during intake.
What is assessing for food insecurity and other member needs?
This is the first person a member typically interacts with after agreeing to complete an HRSN screening.
Who is a Navigator (or Screener/Navigator)?
These three things must all be true before a member qualifies for Enhanced Services.
What are an eligible Medicaid plan, Enhanced Population status, and an unmet HRSN?
This is more important than simply reading questions word-for-word during a screening.
What is building rapport and having a conversation with the member?
This response should be selected to the meal preparation questions if a member needs home-delivered meals.
What is "No"?
This should happen if a member's priorities change after referrals have already been made.
What is updating the care plan and referrals?