1115 Waiver Resources

January 11, 2024

Here’s a link to a Ropes & Gray analysis of the approved NYS 1115 Waiver Amendment.  Former State Medicaid Director Brett Friedman returned to Ropes & Gray after serving as New York’s Medicaid Director.  https://www.ropesgray.com/en/insights/alerts/2024/01/cms-approves-groundbreaking-and-innovative-1115-waiver-amendment-for-new-york-state-medicaid-program

Here’s a link to the Helgerson Solutions Group (HSG) analysis of the 1115 Waiver Amendment.  Jason Helgerson served as New York’s Medicaid Director and is perhaps best known for his leadership implementing the DSRIP Program.https://www.hsg.global/insights/1115-medicaid-waiver-approved-what-you-need-to-know

With the recent approval of New York’s amended 1115 Waiver, NYS has made a commitment to implement several initiatives to address health-related social needs as well as support greater integration between primary care providers, community-based organizations, and behavioral health specialists. This includes the CMS AHEAD model which is a global budgeting initiative for a small portion of the state’s general hospitals.  New York is calling it the Medicaid Hospital Global Budget Initiative (MHGBI).  
According to the Waiver, New York State has agreed to provide incentive payments to eligible private hospitals for collecting and reporting data, meeting milestones for transitioning to alternative payment models, and demonstrating improvement in health care quality and equity.  To access the MHGBI, a hospital must meet all of the below requirements:

·       Private not-for-profit hospital

·       Serves a population that is at least 45% Medicaid covered or uninsured

·       Within Bronx, Kings, Queens, or Westchester County

·       Average annual operating margin from 2019 to 2022 of less than or equal to zero

·       Received state-funded subsidies due to financial distress in state fiscal year 2023 and/or 2024

Here’s more from COPE Health Solutions regarding the CMS AHEAD model, which is the basic framework upon which New York’s Medicaid Hospital Global Budgeting Initiative is based: