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Amid recent disruptions and growing uncertainty surrounding the Social Care Network program across multiple heimish communities, BoroPark24 sat down with Avi Greenstein of the Boro Park Jewish Community Council to gain clarity on the program, the changes now taking place, and what recipients should expect going forward.

To begin, can you explain the purpose of the SCN program and when it was established? What does an organization need in order to become an SCN provider, and when did BPJCC officially join the program?

A: The Social Care Network program is part of Medicaid’s broader effort to identify the underlying reasons people become sick and to address those issues before they lead to emergency room visits, doctor appointments, or hospitalizations.

The idea is that by identifying and addressing the root causes of poor health, Medicaid can help keep individuals and families healthier while also reducing the government’s healthcare costs.

One of the major needs identified through the program is access to nutritious food. Other areas include housing, transportation, and the ability to prepare food at home, including access to kitchen utensils, refrigerators, microwaves, and other basic equipment.

When people cannot afford healthy food, or do not have the ability to properly prepare it, they and their families can become malnourished and ultimately face greater health problems. The program operates through Medicaid and focuses on what are known as health-related social needs.

The goal is to screen Medicaid members throughout New York State and identify individuals who fall into what the program calls an “enhanced population.” This can include pregnant or postpartum women, children or family members who are frequent Medicaid users, individuals receiving services through OPWDD, people with special needs, and several other eligible groups.

Those who qualify can receive assistance for up to six months. Medicaid believes that providing this support can improve health outcomes across New York State while also reducing long-term healthcare spending.

BPJCC first became aware of the program through the New York State Department of Health in 2022, when we were working with the department during COVID. They approached us, identified the program, and recommended that we become involved.

We joined early in the process and later received a contract through Public Health Solutions, the lead Social Care Network serving our region.

Over the past several months, the types of assistance available through the program appear to have expanded significantly. Was that the result of a new phase in the state’s rollout, a change in the law, or simply providers becoming more familiar with how the program works?

A: The program is currently in the third year of a three-year pilot period, so it began approximately two and a half years ago. When Medicaid began developing the program, it determined that the best way to reach people was through community-based organizations such as BPJCC, UJO, and others.

To operate the program across the entire state, New York was divided into 12 regions. Each region was assigned a lead Social Care Network responsible for partnering and contracting with community-based organizations. For example, Brooklyn, along with parts of Manhattan and Queens, falls under Public Health Solutions. Staten Island is under SIPPS, which stands for Staten Island PPS. Other regions have their own lead networks.

It took time for these Social Care Networks to determine how to operate the program and how to build relationships with local organizations. It also took time for the community-based organizations themselves to complete training and fully understand how the services could be provided.

BPJCC has been working on this for well over a year and was involved relatively early in the process. Throughout that time, we continued receiving new guidance from Medicaid through our Social Care Network, and we repeatedly adjusted and improved our systems.

The reason the program has become much more visible over the past six months is that the lead Social Care Networks were finally able to identify and contract with a large number of community-based organizations. That is when much of the program began springing into action.

The program itself has been around for some time. It simply took a while to develop and become fully operational.

In recent weeks, many residents have noticed uncertainty and disruptions surrounding the program. What exactly happened, and why does the situation appear to be unstable right now?

A: It is important to make clear that there is currently no shortage of funding for the Social Care Network program. This is a very well-funded program because there is strong data, science, and belief behind the idea that it can keep people healthier while saving the government money.

The current concern is not about the availability of funding. The concern is whether the program’s rollout may have led to waste, fraud, or abuse. As a result, Medicaid is conducting an extensive review of agencies and individual cases to ensure that every organization is fully compliant with the program’s requirements.

There is expected to be a continuation of the program, but every organization is now undergoing a detailed review. This is why BPJCC has consistently urged the community to be extremely cautious and to remember that these are Medicaid funds. The program must be handled very carefully.

BPJCC, along with other responsible organizations serving the community, has encouraged residents to work with organizations that have been around, have established accountability, and are guided by serious and responsible professionals. I am hopeful that the program will continue following the review period. These reviews are expected to take place across the Social Care Networks for at least the next 30 days.

Because of concerns over possible waste, fraud, or abuse in certain areas, parts of the program have been paused while internal reviews are conducted. However, we have been assured that there is no lack of funding. There will likely be changes intended to give Medicaid confidence that the program is operating according to its original purpose.

What should residents realistically expect going forward? Will benefits continue as they have until now, or should people prepare for changes?

A: There are several major changes now taking effect that residents need to understand.

Until now, food services or voucher benefits could be provided to an entire household through one family member who qualified as an enhanced member. Some families may have more than one enhanced member. For example, a household may include a pregnant or postpartum mother while one or two children also qualify for separate reasons after completing the screening process.

That system is now changing.

SIPPS issued a notice effective August 1 stating that only the individual who is screened and found to be an enhanced member will be eligible to receive food services. Other members of the household will no longer qualify through that individual.

Public Health Solutions issued similar guidance effective August 5, also stating that only the enhanced member will be eligible for services.

However, there are several important details that residents must understand.

Anyone who is currently receiving food services through BPJCC, whether medically tailored meals, vouchers, or another approved form of assistance, will continue receiving those services under the existing arrangement until the person’s reauthorization date.

Reauthorization can take place at any point within six months of when the person originally applied. This means that someone whose reauthorization does not come up until November, December, or January should continue receiving the current household-level benefit until then. 

However, if someone falls off the program for any reason and must be screened again, the new rules will apply. At that point, benefits will only be provided for the enhanced member or members. A family of seven or eight people could therefore see its benefit reduced to one or two individuals, depending on how many family members qualify as enhanced.

It is also critical for residents to understand what can happen if they change their health insurance. If someone changes insurance and there is any interruption in coverage, the person may fall off the current program. Once rescreened, the household would only receive food assistance for the enhanced member. We strongly encourage people to keep this in mind before making any decisions about changing insurance plans. The same issue can arise when someone changes the type of benefit being received.

For example, a person currently receiving medically tailored meal boxes through SIPS who wants to switch to vouchers may be required to go through the eligibility process again. The person may be able to make that change, but the household could lose the broader family benefit and only receive assistance for the enhanced member.

This is extremely important information for residents to know before contacting their agencies or providers to request changes.

SIPS has also announced that it is eliminating nearly all voucher providers and will continue working with only a very limited number.

BPJCC is one of four providers across the entire SIPS network that has been approved to continue providing vouchers. That approval came because of the strong compliance systems, trackable data, and reputation we established with the assistance of our attorneys and dedicated staff.

Under the current guidelines, SIPS has indicated that no additional voucher providers will be added.

How long is the SCN program expected to remain in place under its current funding and structure?

A: Our current contract with the Social Care Networks runs through the end of March 2027.

As part of the reviews now taking place, the networks may decide whether or not to continue with certain providers based on what those reviews find. However, the existing contract runs through March 2027.

There has been communication indicating that the Social Care Networks intend to continue the program for an additional year, although nothing has yet been provided in writing. They have also made clear that providers will need to apply for a new contract. It will not simply be an automatic continuation for the organizations currently participating. Those decisions will be based on performance and reviews of each provider.

The Social Care Networks are expected to significantly reduce the number of providers they work with and continue with only a small portion of the organizations currently in the program. That is another reason providers must maintain the highest possible level of compliance and oversight. This protects the program, the families who benefit from it, and the community-based organizations providing the services.

There is an intention for the program to continue for another five years. Based on the current outlook, there would first be an additional year extending through the end of March 2028. After that, there is expected to be an application process covering another four years. There will likely be changes in how the program operates based on the data collected during the pilot period.

As new information becomes available, we will continue sharing guidance with BoroPark24 to ensure that important updates reach the community.

Finally, is there anything BPJCC would like the community to better understand about the program, whether regarding expectations or common misconceptions?

A: The Social Care Network program is a game changer that can significantly affect our community and New York State in many ways. At the same time, everyone involved must understand the level of achrayus that comes with participating in the program.

The purpose of the program is to improve the health of families, reduce unnecessary doctor visits and hospitalizations, and provide help to those who genuinely need it. It is not something that should be taken advantage of. People must remember that this is Medicaid funding. If anything is not handled properly, it can fall into the category of Medicaid fraud, which is an extremely serious matter.

BPJCC has approached the program with that level of seriousness. We have retained highly qualified attorneys to review our systems, and when we issue guidance or establish procedures, it is being done with the community’s protection in mind.

It is also important to remember that this is a new program undergoing frequent changes.

Understandably, people want to call and ask questions. BPJCC has been inundated with thousands of phone calls a day, which has created significant challenges. This is not unique to us. Agencies across the program are dealing with the same situation.

First, residents should always prioritize safety and work only with organizations that have strong reputations and that they trust.

Second, people should be patient and watch for guidance as it becomes available.

The program is currently undergoing substantial review. That is not the fault of BPJCC or any particular responsible provider. It is the reality of a heavily funded program that can also be vulnerable to abuse if it is not carefully monitored. We all have an achrayus to treat the program with the level of caution it requires. Hopefully, the program will continue, improve, and keep changing lives for the better.

The main message is to proceed carefully, work only with trusted companies and organizations, and remain patient if there are delays in communication. The volume of calls is extremely high.

Speaking on behalf of BPJCC, we are constantly improving our processes, implementing new technology, hiring additional staff, and expanding training to ensure that everyone who is eligible can receive the services available to them.

As the program undergoes its current review and new guidelines take effect, residents are urged to carefully consider any changes to their insurance or benefits and to continue following updates from trusted providers.