CurrentFidelis CarePolicy N/A

Fidelis Care 1115 Waiver and Social Care Network (SCN) FAQ

Explains New York's NYHER 1115 Waiver effective 1/1/25 and the Social Care Network program that enables reimbursement for specified Health-Related Social Needs (HRSN) services for eligible Fidelis Care Medicaid members across New York State.

Policy Summary

PayerFidelis Care

PolicyFidelis Care 1115 Waiver and Social Care Network (SCN) FAQ

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionScreen and assess members for SCN eligibility through their regional SCN; members must be enrolled in Medicaid managed care and should not contact SCNs before 1/1/25.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

9regional SCNs

Jan 1, 2025program effective

Mar 31, 2027waiver end

Multipleservice categories

Enhanced HRSN Coverage & Operations

Enhanced HRSN Coverage Criteria and Operations

Enhanced HRSN Services may be reimbursable to eligible enrolled Medicaid managed care members through the regional SCN after assessment and screening.

Member is an enrolled Medicaid Managed Care member.

Eligible plan types include Mainstream MMS, HIV-SNP, HARP; MLTCP and MAP members may be eligible for some services but not others and will be reviewed during SCN eligibility assessment.

Member has been screened and assessed for SCN eligibility by their regional Social Care Network (SCN).

Eligibility assessments are conducted by the member's regional SCN; members should be screened and assessed by the SCN before services are provided.

Services delivered are within the scope of Enhanced HRSN Services as defined by the waiver (examples include housing and utilities support, nutrition support, transportation services, and care management services).

Specific Enhanced HRSN Service categories include home modifications and repairs; up to 6 months of home-delivered meals/groceries and nutrition guidance; transportation to approved essential destinations; and care management supports such as job placement and connections to childcare.

Policy Summary

PayerFidelis Care

PolicyFidelis Care 1115 Waiver and Social Care Network (SCN) FAQ

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionScreen and assess members for SCN eligibility through their regional SCN; members must be enrolled in Medicaid managed care and should not contact SCNs before 1/1/25.

SourceLink

On This Page

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ALL of the following

Members must not contact their SCN prior to program launch on 1/1/25.
Members should refrain from contacting their SCN until the program goes live on 1/1/25; website guidance will be available then.
Existing Fidelis Care benefits and care management continue and may operate in parallel with SCN referrals.
Benefits provided by Fidelis Care remain the same; members who receive care management through Fidelis Care will continue to partner with their care manager while being referred to an SCN as appropriate.
Referrals to local Departments of Social Services (LDSS) for urgent services may occur in parallel with SCN referrals.
Enrolled Medicaid members may still be referred to LDSS for urgent services in parallel to a referral to the SCN; more information about urgent referrals will be provided by 1/1/25.

Enhanced HRSN Service Categories & Plan Types

Enhanced HRSN Service Categoriesmixed

Housing and Utilities Support	Home modifications for safety and accessibility, such as ramps, handrails, and grab bars; repairs to prevent mold and pest issues, including sealing cracks and fixing leaks; access to essential appliances like air conditioners, heaters, and dehumidifiers; assistance in finding and applying for stable housing within the community.
Nutrition Support	One-on-one guidance from a nutrition expert; up to six months of home-delivered meals, fresh produce, and groceries tailored to health requirements; essential cooking supplies (pots, pans, microwave, refrigerator, utensils) to support meal preparation at home.
Transportation Services	Reliable transportation to essential destinations approved by the SCN, including job interviews, parenting classes, housing court, local farmers' markets, and government offices.
Care Management Services	Comprehensive support with job placement, training, financial management, applications for public benefits; connection to childcare, counseling, crisis intervention, health home programs, and other critical services.

Eligible plan types

Covered plan typesMainstream Medicaid Managed Care (MMS), HIV-SNP, HARP, MLTCP, MAP

MLTCP/MAP exclusionsSome MLTCP and MAP members are not eligible for certain Enhanced HRSN services; exclusions are determined during SCN eligibility assessment.

Enrollment requirementMember must be an enrolled Medicaid Managed Care member to be eligible for Enhanced HRSN Services.

SCN Enrollment, Screening, and Contact Guidance

Prior Authorization

SCN Eligibility and Contact Guidance

Providers must screen eligible Medicaid members for Social Care Network (SCN) enrollment and refer or connect members to their regional SCN when indicated. Only enrolled Medicaid managed care members (Mainstream MMS, HIV‑SNP, HARP, and certain MLTCP and MAP members where eligible) may receive Enhanced HRSN services; eligibility is confirmed by the member's regional SCN. Do not direct members to contact an SCN before the program launch date of 2025‑01‑01. For urgent social service needs, continue parallel referrals to LDSS while initiating SCN referral.

Screen all Medicaid members for HRSNs and consider referral to the SCN for navigation to enhanced HRSN services.
Confirm member enrollment in Medicaid managed care product (Mainstream MMS, HIV‑SNP, HARP; note: MLTCP and MAP members may have limited eligibility — verify during SCN assessment).
Determine member's regional SCN by residential county; members must be referred to the SCN that serves their county.
Do not instruct members to contact an SCN prior to 2025‑01‑01; SCN contact and enrollment details will be available at https://www.fideliscare.org/scn starting 2025‑01‑01.
If a member has urgent needs, continue to refer to LDSS in parallel with initiating SCN referral; SCN eligibility assessment will clarify service scope and any exclusions.

Key Terms

Health-Related Social Need (HRSN)

DefinitionA non-medical factor in a person's life that significantly impacts health and well-being, including housing stability, food security, transportation, safety, employment, and more.

Role under the waiverUnder the NYHER 1115 Waiver, a specific list of HRSNs becomes reimbursable to eligible Medicaid members as 'Enhanced HRSN Services'.

ExamplesExamples include housing instability, food insecurity, lack of transportation, and other basic social and environmental determinants.

Social Care Network (SCN)

DefinitionA regional Medicaid social care services provider that contracts with Community Based Organizations and other partners to deliver HRSN screening, navigation, and HRSN services across a defined set of counties.

Geography and coverageThere are nine regional SCNs covering all 62 New York State counties; a member's residential county determines their regional SCN.

Operational responsibilitySCNs ensure an end-to-end process in their region for HRSN screening, eligibility assessment, navigation, and delivery of Enhanced HRSN Services.