After years of state planning, the money is starting to flow. Nine networks tasked with administering the pilot program are set to receive $500 million in contracts from the state in August, marking the official start of the revamp, said Amir Bassiri, New York state’s Medicaid director, in a presentation at the United Hospital Fund’s annual Medicaid conference on Wednesday.
Those networks, called social care networks, will consist of community-based organizations and medical providers that coordinate care – and payments – for the newly covered Medicaid services. The networks are spread across several regions, with multiple locations in New York City, Bassiri said.
“It will take an entire village to see this through,” Bassiri said.
The goal of the pilot program is vast: it is expected to screen the state’s 7 million Medicaid members for social determinants of health and provide services to address their housing, nutrition and transportation needs. The state is racing against the clock to get the program off the ground, as the waiver only extends through March of 2027.
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The pilot program targets groups of individuals with high health risks, including pregnant individuals, people involved in the criminal justice system and those with severe mental illness or substance use. Those high-risk individuals make up 30% of all Medicaid enrollees, yet account for between 50% and 60% of spending, Bassiri said.
The pilot program stems from efforts to expand public health dollars by the U.S. Centers for Medicare and Medicaid Services. New York asked the federal government to approve a $13.5 billion, five-year program to test out new ways to use Medicaid dollars. The state negotiated with the federal government for 15 months, ultimately scoring a $7.5 billion, three-year waiver in early January.
While addressing social needs is a cornerstone of New York’s pilot program, it also will deliver funds to financially distressed providers and allocate resources to training the healthcare workforce.
Many have expressed concerns about whether the state will be able to pull off the pilot program in an expedited timeline – concerns that Bassiri has acknowledged.
“We are a little behind our schedule,” Bassiri said at the conference Wednesday. “A lot of things are going to happen in August.”
This story first appeared in Crain's New York Business.
