Medicaid Waiver Update at PHHPC meeting

March 2, 2022

The NYS Council sent all members information about a recent Public Health & Health Planning Council (PHHPC) meeting on Monday, February 28, to include a link to the play back of the meeting with instructions on how to access the portion of the meeting in which Brett Friedman updated the members of PHHPC on the state’s efforts to secure a new 1115 waiver.

Denise Soffel (a colleague and fellow member of Medicaid Matters NY) watched the broadcast of the meeting and crafted a brief summary (directly below).  Denise also includes excerpts from a recent Politico article as well (bottom)

For your convenience, here are a few acronyms used below:
OHIP – NYS Dept of Health Office of Health Insurance Programs (where Medicaid lives)
CBO – community-based organizations
VBP – value based payment
DSRIP – Delivery System Reform Incentive Payment program
PPS – performing provider system (the health care systems/networks that came together as a result of the Delivery System Reform Incentive Payment program)

(From Denise) As I mentioned, Brett Friedman gave a presentation about the status of the 1115 waiver amendment at yesterday’s Public Health and Health Planning Council meeting.  He talked mostly about the Health Equity Regional Organizations (HEROs) that would be established to coordinate health planning activities across the state.

  • CMS has told the state explicitly that they must own up to the mistakes made in DSRIP and talk about what didn’t work with the PPSs, and how that will change under a new waiver.
  • HEROs will not duplicate activities of local departments of health, they are meant to interface with localities and better coordinate alignment with Medicaid.
  • HEROs will not be a funding intermediary as PPSs were.  Their role is solely advisory; it will be managed care plans that will distribute money, largely through VBP arrangements.
  • HEROs will inventory already-existing programs and initiatives and help prepare them for VBP arrangements, and facilitate collaborations across providers and CBOs.
  • HEROs will be a “single source of truth” for a region as to its health care needs.
  • Local Departments of Health could become HEROs, they already have data collection in place and collaborative relationships with providers and CBOs. Regardless of what the actual HERO entity is, the local health department will play an important role in the governance of the HEROs.
  • While they intend to utilize Medicaid rate-setting regions as the regions for HEROs, those regions could be subdivided.  Specifically, it is unlikely that NYC will be a single region given its size and geographic disparities.

Again and for your convenience, here is a link to the PHHPC session; Brett’s remarks are under the OHIP Waiver Proposal tab.  Also included (below) is a brief write-up on the Waiver Proposal presentation Brett gave that appeared in yesterday’s Politico Playbook. 

Link to the meeting archive:

(From Politico)
HEALTH CARE: State Medicaid Director Brett Friedman briefed Public Health and Health Planning Council panels today on the state’s pending 1115 waiver submission , including proposed planning through “Health Equity Regional Organizations” — which seek to build local public health activities “into the fabric of the Medicaid program.”

Friedman told PHHPC’s Committees on Public Health and Health Planning that the Department of Health is converting its August 2021 “concept paper” into a formal application to submit to the federal government in order to make a new investment of up to $17 billion in Medicaid over five years. He noted that the Centers for Medicare and Medicaid Services has provided “extremely positive” but also targeted feedback on the August proposal — namely, “that they think $17 billion is too much money to ask them for.” Despite that, Friedman said, New York is “going to make sure the request is quite substantial given the need.”

Friedman said state Medicaid officials have spent the last three to four months transforming that paper into a “formal and expanded application.” Before the waiver can be formally submitted to CMS — likely in August — it must first go through an extensive transparency process, which includes publication in the State Register, two public hearings and a 120-day public comment period, he said.

He added that “under a best-case scenario” the new waiver program will be in place by January of next year, and can serve as “an appropriate successor to [the Delivery System Reform Incentive Payment Program] and [will] fund aspects of the delivery system that have been revealed as underfunded over the course of the Covid-19 pandemic,” he told council members. — Shannon Young