CBOs and the 1115 Waiver Concept Paper

What this summer's 1115 waiver concept paper means for community-based organizations, non-profits, and other healthcare adjacent groups

by Emilija Postolovska

Emilija Postolovska

In a previous post, we discussed some key highlights from a new concept paper that outlines New York State’s proposed 1115 waiver demonstration program based on previous work from the first iteration of DSRIP. Most notable are the overarching commitments to addressing social determinants of health through multi-sector collaboration and the explicit goal of achieving health equity for all New Yorkers—particularly our most vulnerable and disenfranchised communities. To support these efforts, NYS is proposing a $17 billion investment over five years that will be used to convene, coordinate, and integrate multiple systems and organizations who serve shared populations. The COVID-19 pandemic blew the door wide open on deeply rooted inequities, where a combination of rising unemployment rates, illness, and other factors exacerbated the need for resources and supports in areas like access to safe, stable and affordable housing and adequate care management and coordination for medically and socially complex individuals. These issues converge in especially vulnerable populations, like those who are justice-involved and often have several co-morbidities to address during and after incarceration. Care for these populations requires strong cross-sector collaboration among organizations who have a shared mission to advance equity and address multiple social determinants of health. The proposed framework provides an avenue for disconnected organizations and systems to actively come together and work toward these goals.

Today we’re going to take a look at two key domains where this concept paper intends to make an impact.


New York State’s recent NYS 1115 waiver concept paper identifies additional investment opportunities for supportive housing alongside new resources aimed at discovering gaps, strengthening infrastructure, and providing alternatives to housing displacement. The paper highlights a key opportunity for housing and housing-adjacent stakeholders to coalesce around comprehensive and collaborative care so that funding – should it become available through the waiver – can have maximum impact. The waiver also indicates shifts in New York State’s approach to health and health care as it encourages a more integrative and coordinated approach. Two newly proposed convening bodies, the Health Equity Regional Organizations (HEROs) and Social Determinants of Health Networks (SDHNs), represent an evolution of the state’s approach during DSRIP with their revised focus on engendering cross-sector collaboration between health systems and community housing stakeholders. Practically, this means that in the world of the NYS concept paper, health systems will work more closely with housing organizations to implement initiatives like medical respite models for post-hospitalization discharge planning, behavioral health and substance use disorder services partnering with workforce organizations, and any other combination of agencies and systems whose focus is on housing related concerns.

The waiver funds aimed at housing services will also leverage other emerging opportunities at the local, state, and federal levels to alleviate some of the financial and capacity burdens many service providers face. Traditionally, health systems benefit most through Medicaid reimbursement mechanisms; however, the structure outlined in this concept paper focuses on more comprehensive, upstream service interventions, opening the door to partners from outside the conventional healthcare field to receive Medicaid funds for their efforts.

Care Management and Care Coordination and/or Justice-Involved Populations

The concept paper also signals additional investments in case management and care coordination across all sectors related to health and their social determinants, along with opportunities for Medicaid enrollment and reimbursement. These investments are likely to play a key role in achieving the state’s overriding interest in health equity, especially with respect to New York’s stated goals to improve health outcomes among the criminal justice-involved population where higher rates of behavioral health issues and substance use disorders present unique challenges for treatment, housing, and other supportive services. The waiver seeks to alleviate barriers to care for these populations by reinstating Medicaid enrollment for people 30 days prior to release from correctional facilities. These efforts are also connected to reduced recidivism, lower healthcare costs, lower burden on the carceral and healthcare systems, decreased adverse health outcomes, and improved reintegration. The justice system is intrinsically tied to public health and healthcare, and this concept paper offers clear avenues for pursuing closer collaboration among these interwoven systems and their adjacent service providers.

Next Up…

Check back in soon when we take a look at a final key aspect of the concept paper: workforce.