April 17, 2023

This morning members of the NYS Council met with State Medicaid Director Amir Bassiri, Trisha Schell-Guy and April Hamilton from DoH/Office of Health Insurance Programs.  Here are my notes from the portion of the discussion related to NY’s 1115 Waiver proposal that was submitted to CMS last fall.

Amir Bassiri, State Medicaid Director provided the following information:

CMS will not approve NY’s 1115 proposal for a full 5 year period (as proposed).  NYS is currently in an existing 1115 waiver period that began in 2022.  As such, the new waiver proposal will be approved for as long as the current waiver is in place (2027).  This means NYS would have 3.5 years to implement the elements of the proposed 1115 waiver rather than the proposed 5 years.  CMS has committed to working on an extension in 2027 but there is no guarantee. As such, the scope and extent of the proposal submitted last fall will change.  

CMS wants NYS to align the proposed NYS 1115 waiver with what has already been approved in other states.  That means a focus on health-related social care needs and social care networks.  CMS is not yet ‘bought in’ on NY’s proposal for HEROs, however NY is pushing back.  

Important to recognize that HEROs were never going to be permanent networks.  They were proposed as a temporary vehicle, and will be temporary if at all.  Use of HEROs as a  vehicle for stakeholder engagement and collaboration may be lost if CMS does not approve.  State still fighting for HEROs. 

CMS is saying certain elements of our proposal do not require new waiver authority.  Also saying that our infrastructure request can only be 15% of the total amount sought by the state ($13.52B).  Therefore, capital for infrastructure (to include proposed waiver funds for data and telehealth infrastructure) are unlikely to be approved as originally proposed.

Criminal Justice Inreach part of the 1115 waiver proposal could be moving in a positive direction, from the proposed 30 days prior to release to 90 days, however this will require a separate 1115 proposal be filed by NYS, for CMS approval.  Here’s a link to some information regarding the California Criminal Justice Inreach Program that was just approved (CMS has referenced this as a model they want NYS to carefully study). https://www.dhcs.ca.gov/CalAIM/Pages/Justice.aspx

When asked a question about which social determinants of health have now taken center stage in discussions with CMS, the list has narrowed and now focuses on food, housing and care coordination.  Care Coordination is a bucket that can contain many different social care needs however currently, only includes housing and nutrition.  Level 1 Care Coordination will include assessment, screening and referral, and Level II (for higher need individuals) will add transportation and housing supports to include transitional housing supports for higher need populations including the Health Home eligible population, criminal justice involved/cj prior involved population, foster care and other vulnerable populations.