What this can mean
Understand the pathway before expecting a service.
Medicaid Fee-for-Service members and Medicaid Managed Care members who do not qualify for Enhanced HRSN services may use 1.1 Navigation for connection to existing federal, state, local, and community programs only. Eligible Medicaid Managed Care members with an identified unmet HRSN who meet Enhanced Population criteria and service-specific clinical or social criteria may proceed through 1.2.
Navigation 1.1 does not provide Enhanced HRSN services. Enhanced HRSN care management under 1.2 is a social-care, non-clinical function; it is not clinical care management.
New York HRSN scope
Services within navigation.
These are program categories, not an approval list. A Social Care Navigator must verify Medicaid and service-specific requirements.
- 1.1
Navigation Services (Eligibility Assessment and Navigation)
Navigation Services is for Medicaid Fee-for-Service members and Medicaid Managed Care members who do not qualify for Enhanced HRSN services. A Navigator may connect them to existing federal, state, local, and community programs only—not Enhanced HRSN services.
- 1.2a
Eligibility Assessment
For eligible Medicaid Managed Care members with an identified unmet HRSN, a Navigator reviews Enhanced Population criteria, service-specific clinical or social requirements, and other program rules before an Enhanced service is arranged.
- 1.2b
Enhanced HRSN Care Management
For eligible Medicaid Managed Care members with an identified unmet HRSN who meet Enhanced Population criteria and service-specific requirements, non-clinical support may include referral management, coordination, education, follow-up, social-care planning, and eligible application costs. This is not clinical care management.