Partnering with Social Care Networks under New York's 1115 waiver

 SCNs and the value-based care mandate in New York state

New York’s 1115 Medicaid waiver represents a pivotal opportunity for providers to engage in value-based care models that improve outcomes and reduce costs. At the heart of this transformation are Social Care Networks (SCNs) — a state initiative designed to address health-related social needs (HRSN) such as food insecurity, housing instability and transportation barriers for Medicaid recipients. 

SCNs are central to New York’s long-term strategy for integrating clinical and non-clinical care. For primary care providers (PCPs), engaging with SCNs offers not only a chance to better serve vulnerable populations but also to receive enhanced reimbursement through the waiver, particularly when paired with the National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) recognition. 

What are Social Care Networks (SCNs)? 

SCNs are regional networks of community-based organizations (CBOs) and providers that deliver non-clinical, yet essential, services to Medicaid patients. These services target HRSN pain points and help unburden overstretched clinical staff by providing a clear referral and reimbursement infrastructure for social needs. 

What are enhanced HRSN services? 

Per DOH’s Social Care Networks (SCN): Introduction for HRSN service providers guide, “New York State Medicaid is expanding coverage of certain services that address HRSN, as evidence indicates that these benefits are critical drivers of an individual’s access to health services that keep them well and may improve health outcomes.” To fulfill this mission, New York state will be reimbursing HRSN services under four categories.  

Enhanced HRSN service categories reimbursable under New York’s 1115 waiver demonstration include: 

• Nutrition: Counseling, home-delivered meals, pantry and cooking supplies, etc. 

• Housing: Rent assistance, temporary housing, utility setup, etc. 

• Social care management: Outreach, referrals and navigation to education, childcare and more. 

• Transportation: Public or private transportation to HRSN-related services. 
  
  

Two main engagement paths with SCNs 

Option 1: Referral-only participation (limited reimbursement) 

Primary care practices can participate in SCNs by referring patients only to the network. This includes: 

• sharing information about SCN services with eligible Medicaid patients; 

• distributing SCN-provided educational materials; and 

• referring patients as one would refer them to a specialist or local CBO. 

Note: This model does not qualify the provider for direct reimbursement outside of enhanced PCMH payments. It is, however, an effective low-resource method of participation. 

Option 2: Contractual participation (full reimbursement potential) 

For practices seeking reimbursement for activities like screening, navigation and service delivery, entering a formal contract with an SCN is essential. Key steps include: 

1. Screening using the Accountable Health Communities (AHC) HRSN screening tool. 

2. Signing a data-sharing agreement and participation contract with the SCN. 

3. Establishing one of the approved data-sharing methods for secure integration. 

Data sharing: A prerequisite for reimbursement 

To receive enhanced payments under the state’s 1115 Medicaid waiver, practices must securely share data with their associated SCN. Options include: 

1. Using the SCN IT platform 

• Without Electronic Health Record Application Programming Interface (EHR API): Direct platform usage (screening + navigation reimbursement). 

• With EHR API: Integrated workflow (screening + navigation reimbursement). 

2. Using an EHR connected to a SHIN-NY qualified entity 

• Existing or new Health Information Exchange (HIE) connection: Screening reimbursement only. 

• Embedded Fast Healthcare Interoperability Resources (FHIR) app: Screening reimbursement only. 

The most complete reimbursement model requires a direct connection (with or without EHR API) to the SCN IT platform. 

Best practices for working with SCNs 

1. Engage your SCN early 

Contact your local SCN to: 

• understand specific onboarding requirements, such as training on HRSN screening tool; 

• request promotional materials; and 

• explore available reimbursement models. 
  
  

2. Determine your level of participation 

Balance your practice’s: 

• staffing and technology capabilities; 

• financial goals (enhanced payments vs. PCMH-only); and 

• patient population’s needs. 
  
  

3. Prioritize PCMH recognition 

Providers with PCMH recognition are positioned for additional payment streams when combined with SCN engagement. DataGen helps streamline NCQA PCMH sustainability through medical practice consulting services that include: 

• automated reporting and attestation support; 

• strategic alignment with SCN workflows; and 

• simplified EHR-to-platform integration guidance. 
  
  

4. Leverage the AHC HRSN tool 

Standardized screening is critical to both clinical integration and billing accuracy. Train staff to use the HRSN tool and ensure data flows securely to your SCN partner. The SCN can train the staff on how to use the tool as well. 

Make the connection, maximize the value 

SCNs aren’t just a requirement, they’re essential allies in the success of New York state’s Medicaid redesign. Whether your practice is starting small with referrals or aiming to fully contract and integrate, your decisions today will determine your value-based care revenue streams tomorrow. 

Next steps: Contact DataGen for New York 1115 Medicaid waiver success 

Connect with your regional SCN and schedule a consultation with a value-based care advisor at DataGen to learn how we can help your practice sustain PCMH recognition while optimizing reimbursement through the 1115 waiver. Download our free guide to navigating enhanced incentives under New York state’s 1115 Medicaid waiver. 

Through DataGen’s Medical Practice Consulting solution, we partner with providers, health systems and managed care organizations across New York state to deliver actionable insights, sustainable compliance and strategic guidance for value-based care. We specialize in simplifying PCMH workflows, aligning practices with SCNs and preparing organizations to succeed under Medicaid 1115 waiver reforms.