top of page

NYS FAM Research Resource Guide

CMS - Opportunities in Medicaid and CHIP to address Social Determinants of Health (SDOH)

This State Health Official (SHO) letter advises states on how states can choose to provide flexible coverage through Medicaid and CHIP to address social determinants of health (SDOH). States flexibility to choose to provide optional benefits under state plan authority is outlined here. Through waiver authority under section 1915 of the Act, states can offer non-mandatory benefits under demonstration project waiver, or expenditure authorities under section 1115 of the Act. Other opportunities for states to address SDOH in their Medicaid and/or CHIP programs, and in some instances receive federal financial participation for the services and benefits, is provided assuming states meet the requirements of the coverage authority.

Department of Health and Human Services (DHHS). (2021, Jan 7). Opportunities in Medicaid and CHIP to address Social Determinants of Health (SDOH). CMS. https://www.medicaid.gov/federal-policy-guidance/downloads/sho21001.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Meeting Health-Related Social Needs through Medicaid - Center for Health Care Strategies

This website is a resource center for how state's can leverage federal flexibilities to tailor individual Medicaid coverage to meet health-related social needs (HRSN). Topics include designing Medicaid benefits, supporting health care and community-based organization (CBO) partnerships, and developing accountability mechanisms.
Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2023

Small Running Title

Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care | Health Policy | JAMA Network Open | JAMA Network

This cross-sectional study of payment model development and performance was conducted between February 2022 and November 2024. Participants included all 2019 Massachusetts Medicaid managed-care eligible members who were enrolled for 183 days or longer, and describes MassHealth’s initiative and a complexity-adjusted payment model.

Ash, A.S., Alcusky, M.J., Ellis, R.P., Sabatino, M.J., Eanet, F.E., Mick, E.O. (2025). Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care. JAMA Netw Open. 8(2):e2458170. doi:10.1001/jamanetworkopen.2024.58170

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Texas bill could save billions by treating food as medicine via Medicaid

This new article highlights a bill that has been filed in the state looking at food as a medication. Republican Texas representative Tom Oliverson from east Texas has introduced house bill 2946.

Sterling, P. (2025, February 26). Texas bill could save billions by treating food as medicine via Medicaid. MSN. https://www.msn.com/en-us/politics/government/texas-bill-could-save-billions-by-treating-food-as-medicine-via-medicaid/ar-AA1zSlDq?ocid=BingNewsVerp

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Applying Evidence to Address Social Needs in Health Care: Insights from Complex Care Experts | Playbook

This article discusses how the design of interventions that address social needs would be more effective in its outcomes if critical thinking methods were used and data was collected through meaningful community engagements that go beyond limited peer-reviewed, observational studies, and randomized control trials; to include an experience-based approach that builds trust within communities and it's partners.

Lisch, M. (2025, January 14). Applying Evidence to Apply Social Needs in Health Care: Insights from Complex Care Experts. Center for Health Care Strategies. https://bettercareplaybook.org/applying-evidence-to-address-social-needs-in-health-care-insights-from-complex-care-experts/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

How Medicaid Delivery System Reform Can Support Care Integration for Populations with Complex Needs | Playbook

This article discusses how Medicaid accountable care organizations (ACOs) can support better care integration among those with complex needs, providing coordinated, continuous, and inclusive care, addressing behavior and social service needs. Suggesting policy strategy to break barriers of fragmented care and reach a goal of delivery system reform, advancing health equity.

Brykman, K. (2025, March 11). How Medicaid Delivery System Reform Can Support Care Integration for Populations with Complex Needs. Center for Health Care Strategies. https://bettercareplaybook.org/how-medicaid-delivery-system-reform-can-support-care-integration-for-populations-with-complex-needs/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Medicaid Spending and Health-Related Social Needs in the North Carolina Healthy Opportunities Pilots Program | Health Care Economics, Insurance, Payment | JAMA | JAMA Network

This investigation evaluates how health-related social needs are drivers of worse health and high health care spending, and the effectiveness of the North Carolina Medicaid's 1115 Waiver pilot program in addressing these needs.

Berkowitz, S.A., Archibald, J., Yu, Z., et al. (2025). Medicaid Spending and Health-Related Social Needs in the North Carolina Healthy Opportunities Pilots Program. JAMA. 333(12):1041–1050. doi:10.1001/jama.2025.1042

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Medicaid is the New Tool to Expand Healthy Food Access

This article discusses the use of pilot programs in various states that expand healthy food and housing access through the state's Medicaid 1115 Waiver, and how it can connect patients to longer-term options if their coverage is disrupted.

Held, L. (2022, December 15). Medicaid Is a New Tool to Expand Healthy Food Access. Civil Eats. https://civileats.com/2022/12/15/medicaid-is-a-new-tool-to-expand-healthy-food-access/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

Addressing Health-Related Social Needs in Section 1115 Demonstrations (CMS)

This document addressing how Medicaid and the flexible use of the 1115 Waiver will allow for better coverage to meet the unmet health needs of individuals. This expands coverage in certain states that addressing health-related social needs (HSRN) that are resultant of a persons social determinants of health (SDOH) and account for approximately 50% of health outcomes.

Centers for Medicare & Medicaid Services. (2022, December 6). Addressing Health-Related Social Needs in Section 1115 Demonstrations. https://www.medicaid.gov/medicaid/downloads/addrss-hlth-soc-needs-1115-demo-all-st-call-12062022.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

About Section 1115 Demonstrations

This page of the government site explains how current state 1115 demonstrations may be handled when up for renewal, as well as the anticipated handling of future proposals by the authority of the Secretary of Health and Human Services.

Medicaid.gov. (n.d.). About Section 1115 Demonstrations. Centers for Medicare &Medicaid Services. https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations/index.html

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

CHLPI Letter to CMS - Implementation Survey and Recommendations

This letter is asking the CMS administrator of Maryland to consider support post-PHE Medicaid changes through guidance on 1115 demonstrations to include medically-tailored meals, and produce prescriptions in addressing food insecurity after SNAP benefits have been canceled for recipients.

Center for Health Law and Policy Innovation. (2023, April 24).
Food is Medicine Section 1115 Demonstrations – Implementation Survey and
Recommendations. Harvard Law School, Food is Medicine Coalition. https://www.healthlawlab.org/wp-content/uploads/2023/04/Letter-to-CMS-re-1115-Waiver-Survey-2023.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2023

Small Running Title

Section 1115 Waiver Watch: Approvals to Address Health-Related Social Needs 

This issue brief identifies states with approved and pending Medicaid 1115 waivers with SDOH-related provisions and summarizes approvals under the new Biden administration HRSN 1115 framework, highlighting approved services, target populations, and key requirements related to financing HRSN services.

Hinton, E. & Diana, A. (2024, March 4). Section 1115 Medicaid Waiver Watch: A Closer Look at Recent Approvals to Address Health-Related Social Needs (HRSN). KFF. https://www.kff.org/medicaid/section-1115-medicaid-waiver-watch-a-closer-look-at-recent-approvals-to-address-health-related-social-needs-hrsn/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2024

Small Running Title

$2.3M in Grant Funding Available for Faith-Based and Not-for-Profit Organizations to Improve Public Access to Essential Technologies | NYS Department of State

This article by the New York State Department of State announces a 2.3 million dollar grant available to faith-based and nonprofit organizations meant to improve public access to essential technologies. "Interested organizations can apply for this grant funding to turn available spaces into community resource rooms where community members can use computers, Wi-Fi, audio/video equipment and other technologies for a variety of health, education, career and social services. The grants will allow these organizations to further break down barriers for people in need of technology services including telehealth appointments, career advance services, remote educational opportunities, social services applications and other computer service needs."

New York State. (2024, November 22). NYS Office of Faith and Nonprofit Development Services Announces $2.3M in Grant Funding Available for Faith-Based and Not-for-Profit Organizations to Improve Public Access to Essential Technologies. Department of State. https://dos.ny.gov/news/nys-office-faith-and-nonprofit-development-services-announces-23m-grant-funding-available

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2024

Small Running Title

Approval of Colorado's Request to Include Nutrition Services in 1115 Waiver

This document outlines the authority given by The Centers for Medicare & Medicaid Services (CMS) to the state of Colorado in expanding targeted services, within the limitations of the 1115 Waiver, to certain incarcerated individuals for up to 90 days immediately prior to the individual’s expected date of release. This amendment will introduce new initiatives that increase and improve health access and equity.

Department of Health and Human Services. (2025, January 13). Letter addressed to: Medicaid Director Adela Flores-Brennan. CMS. https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/co-continuum-care-appvl-01132025.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Contracting Strategies: Community Based Organizations Value Based Payment (VBP) Guidance Document

This document covers potential contracting strategies CBOs may consider, and provides details on how CBOs are uniquely positioned to address social determinants of health (SDH).

New York State Department of Health (NYS DOH). (2017, September). Contracting Strategies: Community Based Organizations -Value Based Payment (VBP) Guidance Document. https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_u/docs/contracting_strategies-cbo.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2017

Small Running Title

General Instructions for CBOs enrolling in the NYS Medicaid program 

Provider enrollment and maintenance, information on applying for INITIAL ENROLLMENT or ALREADY ENROLLED and enrolling another NPI, or responding to a letter instructing you to REVALIDATE your enrollment, or Seeking REINSTATEMENT or REACTIVATION of your previous enrollment, or Reporting an OWNERSHIP CHANGE

eMedNY. (2025). Provider Enrollment, Community Based Organizations (CBOs). NYS DOH. https://itf.www.emedny.org/info/ProviderEnrollment/cbo/index.aspx

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Value Based Payment and Community Based Organizations - Training for Contracting Scenarios

This presentation gives guidelines on SDH intervention selection. VBP contractors in a Level 2 or 3 arrangement must implement at least one social determinant of health intervention. Language fulfilling this standard must be included in the MCO contract submission to count as an “on-menu” VBP arrangement. SDH interventions must align with five key areas: Education, Social, family, and community context, Health and healthcare, Neighborhood and environment, and Economic stability.

Engel, E. & Ahadzi, M. (2018, July). Value Based Payment and Community Based Organizations. New York State Department of Health, Office of Health Insurance Programs. [PowerPoint slides]. https://www.health.ny.gov/health_care/medicaid/redesign/sdh/docs/2018-07-11_vbp_cbo.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2018

Small Running Title

Standard Clauses for Managed Care Provider/IPA/ACO Contracts  

This document provides definitions and outlines standard clauses pertaining to the agreement for Managed Care Providers/IPA/ACO contracts.

New York State Department of Health. (Revised: 2017, April 1). New York State Department of Health: Standard Clauses for Managed Care Provider/IPA/ACO Contracts. https://www.health.ny.gov/health_care/managed_care/hmoipa/docs/standard_clauses_revisions.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2017

Small Running Title

Improving Health And Well-Being Through Community Care Hubs

This article discusses the issues around a continuity of care and how Hubs can be used to deliver a sustainable operating infrastructure, providing better aligned health and social care systems. Hubs support a network of CBOs and are considered the backbone organizations that allow multistakeholder collaborations to address SDOH and provide equitable social care.

Chappel, A., Cronin, K., Kulinski, K. et al. (2022, November 29). Improving Health And Well-Being Through Community Care Hubs. Health Affairs. DOI: 10.1377/forefront.20221123.577877

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

New York’s 1115 amendment proposal - Regional Social Determinant of Health Networks (SDHNs) (p. 9)

In this document New York State (NYS or the State) requests $13.52 billion over five (5) years to fund a new amendment to its 1115 Waiver Demonstration that addresses the inextricably linked health disparities and systemic health care delivery issues that have been both highlighted and intensified by the COVID-19 pandemic. This1115 Waiver amendment proposes to utilize an array of multi-faceted and linked initiatives to change the way the Medicaid program integrates and pays for social care and health care in NYS. It also lays the groundwork for reducing long standing racial, disability-related, and socioeconomic health disparities; increase health equity through measurable improvement of clinical quality and outcomes; and keep overall Medicaid program expenditures budget neutral to the federal government.

New York State Department of Health. (2022). New York State Medicaid Redesign Team (MRT) Waiver, Strategic Health Equity Reform Payment Arrangements: Making Targeted, Evidence-Based Investments to Address the Health Disparities Exacerbated by the COVID-19 Pandemic. NYS DOH, Office of Health Insurance Programs. https://www.health.ny.gov/health_care/medicaid/redesign/2022/docs/2022-04_1115_waiver_draft_amendment.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

Healthy Opportunities Pilots   

This website gives details about how the Pilots will allow for the establishment and evaluation of a systematic approach to integrating and financing evidence-based, non-medical services into the delivery of healthcare. If shown to be effective in improving health outcomes and reducing healthcare costs after rigorous evaluation, the NC Department of Health and Human Services will look to systematically integrate high-value Pilot services statewide through NC Medicaid Managed Care.
Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Lessons Learned Thus Far From North Carolina’s Healthy Opportunities Pilots

This news article from NCIOM shares valuable insights from research conducted by the Margolis Center, Will Bleser, PhD, MSPH, that evaluates and assesses the impact of the Pilot program on health outcomes.

North Carolina Institute of Medicine. (2022, August 15). Lessons Learned Thus Far From North Carolina's Healthy Opportunities Pilots. https://nciom.org/lessons-learned-thus-far-from-north-carolinas-healthy-opportunities-pilots/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

Practical, Timely Lessons for Advancing and Aligning North Carolina's Health Care Transformation Leadership to Address Social Needs

North Carolina's Pilot service delivery was paused on July 1, 2025. This article aims to bring awareness to the challenges that exist for integrated health and social services. Highlighting a need for practical guidance on improved implementation of the Pilots, North Carolina’s broader Medicaid transformation. In doing so, looking at similar initiatives in other states and project deliverables.

Whitaker, R., Huber, K., Van Stekelenburg, B., et al. (2018). Practical, Timely Lessons for Advancing and Aligning North Carolina's Healthcare Transformation Leadership to Address Social Needs. Duke - Margolis Institute for Health Policy. https://healthpolicy.duke.edu/projects/practical-timely-lessons-advancing-and-aligning-north-carolinas-health-care-transformation

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2018-2025

Small Running Title

How North Carolina Is Using Medicaid To Address Social Determinants of Health 

This article addresses the fact that although Medicaid coverage is associated with better health outcomes and lower mortality rates; clinical interventions are not sufficient in tackling health inequities that negatively impact low-income populations in achieving improved health and well-being. North Carolina's Healthy Opportunities Pilot program allows state governments to use Medicaid dollars to address social determinants of health.

Rapfogel, N. Rosenthal, J. (2022, February 3). How North Carolina Is Using Medicaid To Address Social Determinants of Health. Center for American Progress. https://www.americanprogress.org/article/how-north-carolina-is-using-medicaid-to-address-social-determinants-of-health/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

Healthy Opportunities Pilot: Network Lead-HSO Model Contract 

This contract defines the role of the Network Lead and provides information regarding the rights and responsibilities of a network lead of a Healthy Opportunities Pilot program and the agreement between the network lead and the Human Services Organization (HSO). It outlines the terms and conditions, privacy, security, and records access, and lists all contracted Pilot services and descriptions.

NCDHHS. (2021, October). Network Lead-HSO Contract: Healthy Opportunities Pilot-Network Lead-HSO Model Contract. https://www.ncdhhs.gov/network-lead-hso-model-contract/open

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Healthy Opportunities Pilot: PHP-Network Lead Model Contract  

This contract defines the role of the PHP-Network Lead and provides information regarding the rights and responsibilities of a PHP-Network Lead of a Healthy Opportunities Pilot program and the agreement between the network lead and the Human Services Organization (HSO). It outlines the terms and conditions, privacy, security, and records access, and lists all contracted Pilot services and descriptions.

NCDHHS. (2021, October). PHP-Network Lead Contract: Healthy Opportunities Pilot: PHP-Network Lead-HSO Lead Model Contract. https://www.ncdhhs.gov/php-network-lead-model-contract/open

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Healthy Opportunities Pilot Fee Schedule and Service Definitions

Updated fee schedule approved by CMS as of July, 2024. This schedule will continue to be updated in the future based on DHHS experience implementing the Pilots and any feedback from CMS.

NCDHHS. (2021, July1). Updated Healthy Opportunities Pilots Fee Schedule. https://www.ncdhhs.gov/healthy-opportunities-pilot-fee-schedule-and-service-definitions/open

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2024

Small Running Title

NCCARE360-third party statewide referral platform

North Carolina's Care360 (NCCARE360) is the first statewide coordinated community care network that electronically connects those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. This solution ensures accountability around services delivered, provides a “no wrong door” approach and closes the loop on every referral made. As of June 2020, NCCARE360 is available in every county in North Carolina.
Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Waiver Approval - Reporting Requirements

This letter , addressed to the Deputy Secretary for Medical Assistance, describes and informs the reader of the limitations, scope, extent of demonstrations, and award details that were approved by CMS, in the form of the 1115 Medicaid demonstration project entitled, North Carolina Medicaid Reform Demonstration, during the timeframe of January, 2019, through October, 2024.

​

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2018

Small Running Title

Evaluation  

This article outlines the Healthy Opportunities Pilots (HOP) program and how, through an extension granted, NC Medicaid is authorized to implement HOP via an 1115 waiver. It provides information on background, pilot regions, pilot services, eligibility criteria, including key pilot entities and evaluation.
Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

​

Small Running Title

Evaluation Design Approval 

This document outlines the CMS approved NC evaluation design and the sections and tables provided in this letter detail the quantitative measures to be used to test each hypothesis, the source or custodian of each measure, the sample or population to which the measure is relevant, and the proposed data sources. This document also reiterates that it is well known that medical care is only responsible for a fraction of a person's health and that factors like social determinants of health and the environment are also considerable drivers. An increased emphasis on a whole person orientation will improve beneficiary outcomes.

Centers for Medicare and Medicaid Services (CMS). (2020, January 14). State Demonstrations Group letter to Mr. Dave Richard of the North Carolina Department of Health and Human Services. DHHS. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/nc/Medicaid-Reform/nc-medicaid-reform-demo-eval-des-appvl-01152020.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2020

Small Running Title

A Landscape Analysis of Medically Supportive Food and Nutrition Interventions in California

This report looks at the existing assets of California related to Medically Supportive Food and Nutrition (MSF&N) programs and next steps needed to secure the benefits of expanding MSF&N with funding and capacity-building support through CalAIM. To support the transition of MSF&N interventions from pilot to permanent in California the UCSF Center for Vulnerable Populations, Harvard Law School’s Center for Health Law and Policy Innovation, the Food as Medicine Collaborative, and SPUR, worked together to survey 145 organizations in California. These efforts brought forward the need to identify all currently operating MSF&N programs and understand the most common barriers to scaling.

Ettman, K., Tong, J. , et al. (2021, October). Integrating Food into Health Care: A Landscape Analysis of Medically Supportive Food and Nutrition Intervention in California. SPUR, Food as Medicine Collaborative, Center for Vulnerable Populations: Zuckerberg San Francisco General Hospital. https://www.spur.org/sites/default/files/2021-11/SPUR_Integrating_Food_Into_Healthcare.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Building Partnerships to Advance Nutrition in California’s CalAIM Waiver

This article highlights a newly released case study series illuminating efforts in California to expand access to and coverage of nutrition interventions and other social services for Medicaid enrollees. California calls the services provided by its five-year Medicaid waiver, California Advancing and Innovating Medi-Cal (CalAIM), launched in 2022, Community Supports.

Center for Health Law and Policy Innovation. (2023, January 31). Harvard Health Law Lab Case Studies Pinpoint Early Successes, Challenges of California's Innovative Medicaid Program. Harvard Law School - Health Law & Policy, News. https://chlpi.org/news-and-events/news-and-commentary/news/harvard-health-law-lab-case-studies-pinpoint-early-successes-challenges-of-californias-innovative-medicaid-program/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2023

Small Running Title

Equity in CalAIM: How to Identify the Patients Who Will Benefit Most   

This report offers insights into California's CalAIM initiative and the efforts made to transform the state’s Medi-Cal program with a focus on equity and whole-person care. Enrollees with complex needs are receiving care management and supportive services through the Department of Health Care Services (DHCS) enlisted managed care plans. The links provided in this report address the unintended consequences of using utilization data to identify patients who would benefit from comprehensive services.

Davis, R., Kelly, L., Hamblin, A. (2023, May 10). Equity in CalAIM: How to Identify Patients Who Will Benefit Most. California Health Care Foundation. https://www.chcf.org/resource/equity-calaim-how-identify-who-will-benefit-most/#related-links-and-downloads

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2023

Small Running Title

Community Supports: Select Service Definition Updates (2025)

California's Department of Health Care Services has released an Action Plan committed to improvements to standardization and access among Members to ECM and Community Supports services. In this document, DHCS provides for each service definition a summary of the rationale for each set of refinements and the finalized, updated service definition. This document does not contain updates to the service definitions for the Housing Trio.

California Department of Health Care Services (DHCS). (2025, February). Community Supports: Select Service Definitions Updates. https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-February-2025-Service-Definition-Updates.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Medi-Cal Community Supports, or In Lieu of Services (ILOS), Policy Guide

This Community Supports Policy Guide Volume 1 is intended to serve as a resource for Medi-Cal Managed Care health plans, or Managed Care Plans (MCPs), in the implementation of Community Supports. A key feature of CalAIM was the statewide introduction, in January 2022, of the Enhanced Care Management (ECM) benefit and a menu of 14 Community Supports.

California Department of Health Care Services (DHCS). (Updated: 2025, April). Community Supports Policy Guide, Volume I. https://www.dhcs.ca.gov/Documents/MCQMD/DHCS-Community-Supports-Policy-Guide.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

National Provider Identifier (NPI) Application A Step-by-Step Guide for Providers Participating in the ECM and Community Supports Programs 

This document provides step by step guidance to providers participating in the Enhanced Care Management (ECM) and Community Supports, or In Lieu of Services (ILOS), programs on how to obtain a National Provider Identifier (NPI). An NPI is a 10-digit numeric identifier assigned by the Centers for Medicare and Medicaid Services (CMS) to be used on electronic claim transactions for health care billing and reimbursement. As part of participation in the ECM or Community Supports programs, it is necessary for providers to apply for and obtain an NPI.

California Department of Health Care Services (DHCS). (n.d.). National Provider Identifier (NPI) Application. https://www.dhcs.ca.gov/Documents/MCQMD/NPI-Application-Guidance-for-MCPs-ECM-and-Community-Services-Providers.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Enhanced Care Management and Community Supports (formerly “In Lieu of Services”) Provider Standard Terms and Conditions

This document is an outline for Enhanced Care Management (ECM) that contains pertinent definitions and provider requirements. It also provides an overview checklist, delivery and payment methods, data sharing to support Community Supports, and information on quality and oversight.

Baass, M., Newsom, G. (n.d.). Enhanced Care Management and Community Supports (formerly "In Lieu of Services") Provider Standard Terms and Conditions. State of California - Health and Human Services Agency, Department of Health Care Services. https://www.dhcs.ca.gov/services/Documents/MCQMD/ECM-and-Community-Supports-Standard-Provider-Terms-and-Conditions.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Contract Template Provisions  

This document provides Enhanced Care Management (ECM) definitions, a breakdown of Scope of Services, Community Support definitions, and details of Community Supports.

Baass, M., Newsom, G. (n.d.). CalAIM Enhanced Care Management (ECM) and Community Supports (ILOS)
Contract Template Provisions. State of California - Health and Human Services Agency, Department of Health Care Services. https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Enhanced Care Management and Community Supports

This article explains what the Medi-Cal transformation means for Californians. ECM is available to eligible members with complex needs as well as Community Supports that will address health-related needs such as, housing transition and navigation services, medically tailored meals and medically supportive foods, and asthma remediation.

DHCS. (2025). Enhanced Care Management and Community Supports. State of California. https://www.dhcs.ca.gov/CalAIM/ECM/Pages/Home.aspx

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

bottom of page