January 9, 2024

We are analyzing the content of the newly approved NYS 1115 waiver but it will take some time.  Below is a first blush general breakdown of use of waiver dollars.Note:  The CMS approval letter is attached, fyi.  In addition, two press releases are below – one from CMS, other from Governor’s Office:

PRESS RELEASE 

CMS Approves New York’s Groundbreaking Section 1115 Demonstration Amendment to Improve Primary Care, Behavioral Health, and Health Equity

New, innovative efforts will establish base rates for safety net providers, address critical social needs for millions of Medicaid recipients, and grow the health care workforce across the state

Today, as part of the Biden-Harris Administration’s efforts to build a health care system that benefits all Americans, the Centers for Medicare & Medicaid Services (CMS) approved an amendment to New York’s Medicaid section 1115 demonstration that bundles a series of actions to advance health equity and strengthen access to primary and behavioral health care across the state. CMS’ approval allows New York to make large investments in wide-ranging Medicaid initiatives, including establishing sustainable base rates for safety net hospitals that serve the state’s most underserved communities; connecting people to critical housing and nutritional support services; enhancing access to coordinated and comprehensive treatment for substance use disorders (SUDs); and making long-term, sustainable investments in the state’s health care workforce.

“As the nation’s largest insurer, CMS is proud to approve this critical demonstration amendment, which gets to the heart of Medicaid’s role as an innovator,” said CMS Administrator Chiquita Brooks-LaSure. “The demonstration’s initiatives will provide a broad swath of health and social supports to underserved communities, improving their health and quality of life. We encourage other states to follow New York’s efforts to address health disparities.”

Medicaid section 1115 demonstrations allow CMS to approve innovative projects that promote the objectives of Medicaid, which provides health coverage to millions of low-income adults, children, pregnant people, and people with disabilities.

In New York’s demonstration, CMS is approving 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 complements other Biden-Harris Administration efforts to strengthen the primary care infrastructure in this country, including the recently announced CMS Innovation Center’s Making Care Primary (MCP) and States Advancing All-Payer Health Equity Approaches and Development (AHEAD) models.

Additionally, in November 2023, the White House released the first ever Social Determinants of Health Playbook, which lays out an initial set of structural actions federal agencies are undertaking to break down silos that provide both health care and critical services and support equitable health outcomes. CMS also recently issued an informational bulletin on health-related social needs, as well as a Call to Action to Address Health-Related Social Needs, and a Medicaid and CHIP Health-Related Social Needs Framework. These resources build on the Biden-Harris Administration’s work to advance health equity by acknowledging that peoples’ social and economic conditions play an important role in their health and wellbeing.

The demonstration amendment also aims to support hospitals that help serve the most vulnerable populations and have significantly more adverse health risk factors and poorer health outcomes compared to other parts of the state. It includes funding to support a Medicaid Hospital Global Budget Initiative for a subset of financially distressed safety net hospitals looking to transition payment to rewarding value rather than volume of care provided. The demonstration will also help with establishing sustainable base reimbursement rates for safety net hospitals and addressing significant health care workforce shortages in safety net settings. The workforce initiatives include a loan repayment program for clinicians who commit to working in community-based practices in underserved areas, and enhanced training for under- and unemployed individuals who assist doctors and nurses as part of broader health provider teams. Additionally, New York will increase and sustain provider payment rates and Medicaid managed care payment rates for obstetrics, primary care, and behavioral health.

Across these and other efforts, CMS and the state will monitor progress through rigorous independent evaluations to determine outcomes and impacts.

Under the Biden-Harris Administration, more people than ever before have health care coverage. Demonstrations like New York’s — as well as similar efforts in Arkansas, Arizona, California, Massachusetts, New Jersey, Oregon, and Washington — make that coverage even more impactful by improving access and affordability.

For additional information on New York’s approval, visit Medicaid.gov.

GOVERNOR HOCHUL ANNOUNCES GROUNDBREAKING MEDICAID 1115 WAIVER AMENDMENT TO ENHANCE NEW YORK STATE’S HEALTH CARE SYSTEM

$7.5 Billion Waiver Will Enable New York to Invest Nearly $6 Billion of Federal Funding into State’s Health Care System Over the Next Three Years

Waiver Amendment to Improve Health Equity and Address Health Disparities Throughout State

Waiver Will Deliver Critical Support to Address Health-Related Social Needs, Support Safety Net Hospitals, and Address Workforce Shortages

New York Plans to Submit an Amendment to its Demonstration in Early 2024 to Provide Continuous Medicaid Eligibility for Children Up to Age Six

Governor Kathy Hochul today announced the Centers for Medicare and Medicaid Services approved a groundbreaking amendment to New York’s Medicaid Section 1115 Demonstration that will be catalytic in New York’s continuing efforts to build a health care system that benefits all New Yorkers. The demonstration bundles a comprehensive series of actions to advance health equity, reduce health disparities, and strengthen access to primary and behavioral health care across the state, and will be supported through $7.5 billion in funding over the next three years.

“This amendment allows New York to make investments in critical Medicaid initiatives that will enhance health equity in this state,” Governor Hochul said. “CMS’ approval of the amendment will help us to continue to support underserved communities, provide New Yorkers with critical services such as nutrition and housing support, and improve access for individuals and families affected by substance use.”

New York State Health Commissioner Dr. James McDonald said, “This Medicaid 1115 waiver amendment will help the Department continue to invest in the health and well-being of New Yorkers. I thank CMS for giving us the opportunity to continue to invest in high quality health services and programs, expand the health care workforce, and strive towards true health equity.”

State Medicaid Director Amir Bassiri said, “After many months of negotiations, we have secured an agreement that is critical to the state’s health care system. Approval of this demonstration amendment will allow the state to advance health equity, reduce health disparities, support the delivery of health-related social needs, sustain critical safety net hospitals, and establish career pathways training programs for front-line health and social care professionals that will target workforce shortages throughout the state.”

Senate Majority Leader Chuck Schumer said, “Medicaid is the bedrock of healthcare for thousands of New Yorkers, and this federal approval of New York’s Medicaid waiver will create a stronger foundation for care in the Empire State. I applaud Governor Hochul’s effort to invest upwards of $6 billion in federal funding to deliver better health care to the neediest, help our safety net hospitals provide top-notch care and address the serious challenge of health worker shortages.”

Democratic Leader Hakeem Jeffries said, “Many Americans rely on Medicaid to live with grace and dignity, and our healthcare heroes count on its crucial funding to keep our hospital system operational. I thank Governor Hochul, the Biden administration and the New York congressional delegation for their work to protect and strengthen Medicaid in New York, expand our healthcare workforce and strive towards health equity across the state.”

Representative Jerrold Nadler said, “I applaud today’s announcement which will deliver urgently needed funding to support New York’s safety net hospitals and advance health equity across the state. The approval of this demonstration project will allow New York to continue to invest in health services and programs that support our most underserved communities.”

Representative Brian Higgins said, “This action gives New York State the flexibility to dedicate federal resources to address the root causes of disparities and ultimately better serve the health needs of people and communities. Governor Hochul’s bold leadership and initiative to think beyond the band-aid and look at the big picture will create meaningful, lasting improvements to the health and lives of New Yorkers.”

Representative Joe Morelle said, “The environment you live in is directly related to your healthcare risks, and underserved communities are experiencing a higher rate of negative outcomes due to health inequities. This federal waiver will allow our state flexibility in planning programs to increase workforce initiatives designed to ensure the continued availability of care in distressed neighborhoods. I’m grateful to Governor Hochul for recognizing the need for this waiver and look forward to our work together addressing the many social determinants to healthcare.”

Representative Paul Tonko said, “I’ve long championed efforts to bolster our health care system and, in particular, to bring compassionate, quality care to individuals struggling with addiction and mental illness. I’m thankful that this comprehensive care will be delivered to New Yorkers and will continue to do all I can to secure federal funding that supports our communities and provides hope to those who need it most.”

Representative Dan Goldman said, “Our society has an obligation to provide health care to those among us who need it most, and we must attack this problem with a whole-of-government approach. This historic $6 billion investment is critical to providing access to high-quality, affordable care to New Yorkers across the state. I was proud to support this initiative back in May, and I applaud Governor Hochul in securing this critical funding and bolstering Medicaid for the millions of New Yorkers who rely on it.”

CMS’ approval allows New York to make large investments across a series of wide-ranging Medicaid initiatives, including establishing Social Care Networks to integrate health, behavioral, and social care services that connect high-need members to critical nutritional and housing support services; enhancing access to coordinated and comprehensive treatment for substance use disorders; investing in primary care and making long-term, sustainable investments in the state’s health care workforce.

The demonstration amendment also includes funding to support a Medicaid Hospital Global Budget Initiative for a subset of financially distressed safety net hospitals looking to transition to payments that reward value rather than volume of care provided. This initiative will support essential safety net hospitals that help serve the most vulnerable populations and have significantly more adverse health risk factors and poorer health outcomes. 

The demonstration will address significant health care workforce shortages in safety net settings through innovative career pathways training programs for front-line health and social care professionals that will increase access to culturally appropriate services. These career pathways training programs will train and educate for the purpose of creating a reliable healthcare workforce pipeline to address workforce shortages, as well as increasing opportunities for employment and career advancement.

The workforce initiatives also include a loan repayment program for certain healthcare workforce professionals who commit to working in community-based practices in underserved areas, including dentists, psychiatrists, and clinical nurse specialists.

By the end of the demonstration, the state’s goal is to have made significant progress in its Value-Based Payment (VBP) strategies and alignment across Medicare and Medicaid to advance primary care and population health outcomes.