July 21, 2023

On Thursday morning Medicaid Director Amir Bassiri shared several significant updates re:  NY’s 1115 Waiver submission to CMS during his keynote presentation at the United Hospital Fund of New York‘s annual #Medicaid conference.  We previously sent you the PowerPoint slides Amir used during his presentation, and I am watching for the video of the event to be posted on UHF’s site.  I will send it as soon as I see it.

Major takeaways from Amir’s keynote presentation include (Source:  Kalin Scott at Helgerson Solutions Group)
-New York is in the final stages of negotiation, meeting near-daily with CMS and expects to announce approval ‘later in the fall’

-Approval will align with the current 1115 waiver period – meaning the program will run until March 2027, just about 3.5 years from now.

-A streamlined version of what was originally proposed is likely to be the final product – accountable and aligned investments in population health, establishment of and coordination with social care networks, and investments in workforce to support overall efforts.

-Some parts of the original request are very close to agreement, others are still under discussion or on hold.

-NY and CMS are nearing agreement for social care networks (formerly SDHNs) and health-related social needs (HRSN) services – SCNs will be regional Medicaid-enrolled organizations that will bring together community-based organizations, manage social needs screening for all Medicaid members, and coordinate delivery of approved HRSN services for qualifying members. 

-HRSNs will also be new in New York Medicaid, and will likely build on what we’ve seen in other states – housing, food & nutrition, and transportation supports for qualifying Medicaid members tied to individual health needs and outcomes.

-Also close? A primary care delivery system model to be implemented statewide, allowing for multi-payor alignment, enabling advanced value-based payment (VBP), and including a special focus on care for children.

-Workforce investments are also nearly there – investments will flow through programs including loan forgiveness for providers and career pathways trainings programs delivered by a subset of ‘high-performing’ workforce investment organizations (WIOs)

-Still ‘under discussion’: funding intended to ‘stabilize the safety net & advance accountability’ and creation of health equity regional organizations (HEROs). The vision of regional HEROs has evolved into a single statewide entity focused on accountability, data aggregation, regional planning, evaluation, and VBP design & development.

-What’s on hold? Targeted services for criminal justice-involved populations – NY is likely to pursue this in a separate approach. Also on hold – investments in digital health and telehealth infrastructure.

-The waiver update didn’t include any insight on the dollar amount CMS will agree to (though expected to be less than the original $13.52B ask) or how much funding will go to each initiative.

While there’s still uncertainty, the waiver is evolving and CMS is fully engaged. The update reflects the depth of conversations and work the New York team has done to respond to CMS feedback, concerns, and requests.

Additional notes on the Keynote from Lauri are attached to this email.