New York Health Equity Reform

1115 Waiver Amendment

What's the Deal

On January 9, 2024, the Centers for Medicare & Medicaid Services (CMS) approved the 1115 Waiver Amendment, dedicating $7.5 billion through March 2027 to “advance health equity, reduce health disparities, and support the delivery of social care” in the state of New York.

Within this amendment is a call for up to 13 Social Care Network (SCN) lead entities across 9 regions to spearhead the work of collaborating with Community-Based Organizations (CBOs) to more effectively screen for and deliver Health-Related Social Need (HRSN) services to those who qualify for Medicaid.

TogetherNow intends to answer that call in a collaborative application for the Finger Lakes region.

Our Alignment

Building a network of service providers dedicated to the many non-medical contributors to health has been a core mission of TogetherNow since our inception as the Systems Integration Project in 2017.

Seeing the realities of disjointed systems spurred a diverse and passionate team to innovate beyond networking—in collaboration with community members and IBM we developed a new platform to empower that network. We now look towards the vital work of this waiver amendment with the same belief we’ve always had: that real change is possible when we share our strengths and work together.

Applying in Partnership

FLPPS as Lead Entity

The Finger Lakes Performing Provider System (FLPPS) is guiding us towards innovation and excellence in social care, unifying our efforts to create an integrated healthcare ecosystem that reaches every part of our region. As lead, FLPPS will oversee funding for the capacity-building efforts crucial to the network’s success.

TogetherNow as Social Care Network

TogetherNow, in partnership with FLPPS, will focus on health equity and social care within the SCN. Our combined efforts are directed at bolstering the network, ensuring it delivers comprehensive and accessible social care solutions. As part of TogetherNow’s SCN, organizations that provide services eligible under this waiver will directly benefit from capacity-building initiatives.

The 360 Collaborative Network (360 CN) have joined the collective application as well, adding their current network to the pool of connected social care providers in this coordinated strategy. FLPPS, TogetherNow, 360 CN—united in purpose and equipped with experience, our collaboration is critical in advancing health equity for this region’s diverse population.

Centering Equity with MyWayfinder

We believe in the autonomy of community members over their own care, and that communities are experts in their own needs. MyWayfinder is a custom technology solution that can be used both anonymously and with data-secure accounts, with built-in self assessment tools and the ability to check eligibility for multiple programs by inputting information once.

0 +
Contracted Providers
Connected Services
0 +
Unique MyWayfinder Visiters
0 +
Trained CBO Staff
0 +
Community Member Accounts

Interested in taking part?

Several people in a small audience raise their hands

Organizations wishing to join TogetherNow’s Social Care Network and contribute to enhancing support for Medicaid beneficiaries in the Finger Lakes region are invited to submit a completed Letter of Intent (LOI) to by Tuesday 4/9/24.

If your organization is already a part of our network or has already submitted an LOI, no further action!

Our Experience

As long-time students and practitioners of human-centered design, we believe in staying agile and ready to iterate ideas based on feedback from real people. Because “solutions” don’t solve anything if they don’t work how real people work.

Each CBO with connected services in MyWayfinder receive free training and assistance with workflow development. Meeting people where they’re at doesn’t just apply to community members—we work hard to flex with the needs of each CBO, recognizing that they are subject-matter experts with distinct needs to best implement the shared system.

MyWayfinder features an optional check-in system that, when done anonymously, provides the user with results tailored to their needs and location. When done while creating an account, check-ins mark the user’s well-being status, and with each consecutive check-in that status is tracked over time to show the outcomes of service delivery interventions.

Work continues to design and test high level workflows that can be universally applied to each social care domain in MyWayfinder. Starting last year with food, housing, and transportation, and recently expanded to employment, financial management, and income, this pilot will result in baseline standards to help care team managers navigate their clients’ journeys towards true well-being across each HRSN.

We’ve developed definitions across each social care domain and across states of well-being, from “not okay,” to “okay,” to “good,” to “great,” and all the way to “excellent.” These definitions are essential to measuring outcomes and to demonstrate true change in people’s lives—the ultimate goal of this work.

MyWayfinder’s service directory is powered by 211/LIFE LINE’s community resource database, meaning users can access up-to-date information on local CBOs and send requests even if the service is not connected in MyWayfinder.

In response to community requests for local, in-person spaces to get help with navigation care, we contracted with 7 organizations to train them on MyWayfinder and support the staffing at locations across Monroe County.

A core tenant of TogetherNow’s work is the idea of “no wrong front doors,” that individuals should be introduced to holistic, person-centered care no matter where they go in search of assistance. Last year we began training staff at Community-Based Front Doors, places that may not offer direct service, or which may not have current capacity to come on as connected providers, but are places people already naturally go while in need. To date over 200 volunteers have been trained to use MyWayfinder and help people begin their journeys to better health and well-being.

Through surveys, workgroups, and attending events, our team centers the voices of community. We know that systems change cannot happen without adoption, and this must be earned, especially when so many are wary of new community initiatives. Our goal is person-centered care, so real people and their input will always be our guiding light.


Specified in the waiver

Featured in MyWayfinder






Financial Management




Social Connections

Joining Our Network

Fill out the form below and we’ll reach out with more information!

For more direct questions on the waiver or to collaborate with us in our application, email