The Centers for Medicare & Medicaid Services (CMS) has approved New York state’s amendment of its ongoing Medicaid transformation efforts to allow the state to advance health equity, support the delivery of health-related social needs (HRSN) services, and promote workforce development.
The state said the waiver would enable New York to invest nearly $6 billion of federal funding into its healthcare system over the next three years.
In a Jan. 9 letter to New York State Medicaid Director Amir Bassiri, CMS explained that the state is aiming to reduce health disparities across the state through the combination of a Medicaid Hospital Global Budget Initiative, HRSN services and activities, workforce initiatives, and the establishment of a Health Equity Regional Organization (HERO).
Other states, including Vermont, Arkansas, Massachusetts and Oregon, have had their 1115 demonstration amendment approved. The New York approval period will expire March 31, 2027. The amendment also provides the state with Substance Use Disorder (SUD) demonstration authority.
“After many months of negotiations, we have secured an agreement that is critical to the state’s healthcare system,” said Bassiri in a statement. “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.”
The New York 1115 demonstration amendment supports the state’s interest and preparation in pursuing two Center for Medicare and Medicaid Innovation (CMMI) models: the Making Care Primary model and the States Advancing All-Payer Health Equity Approaches and Development (AHEAD). By the end of this section 1115(a) demonstration, the state’s goal is to have made significant movement towards value-based payment strategies, multi-payer alignment, and population health accountability.
The overall goals of this approval include:
• Investments in HRSN via greater integration between primary care providers and community-based organizations (CBOs) with a goal of improved quality and health outcomes;
• Improving quality and outcomes of enrollees in geographic areas that have a longstanding history of health disparities and disengagement from the health system, including through an incentive program for safety net providers with exceptional exposure to enrollees with historically worse health outcomes and HRSN challenges;
• Focus on integrated primary care, behavioral health (BH), and HRSN with a goal to improve population health and health equity outcomes for high-risk enrollees including kids/youth, pregnant and postpartum individuals, the chronically homeless, and individuals with SUD;
• Workforce investments with a goal of equitable and sustainable access to care in Medicaid; and
• Developing regionally focused approaches, including new VBP programs, with a goal of statewide accountability for improving health, outcomes, and equity.
The demonstration amendment provides New York under the HRSN infrastructure authority the opportunity to create social care networks (SCNs), which are contracted entities in each of the state’s regions. The SCNs will provide HRSN screening and referral services to otherwise eligible Medicaid beneficiaries that are targeted populations for HRSN services. CMS’s authorization of limited infrastructure spending up to the amount of $500 million to support HRSN services, is expected to improve the availability and quality of the services delivered.
CMS is authorizing up to $3.173 billion for the provision of increased coverage of certain services that address HRSNs.
CMS is authorizing up to $125 million in expenditure authority for the Health Equity Regional Organization (HERO) over the course of the remaining demonstration period. The HERO is a contracted statewide entity designed to develop regionally focused approaches to reduce health disparities, advance quality and health equity for overall populations, and support the delivery of HRSN services.
The HERO will conduct the following five activities: (1) data aggregation, analytics, and reporting; (2) conduct a regional needs assessment and planning; (3) convene regional stakeholder engagement sessions; (4) make recommendations to support advanced value-based arrangements and develop options for incorporating HRSN into VBP methodologies; and (5) conduct program analysis, such as publishing initial health equity plans and health factor baseline data on Medicaid populations.
The HERO will assist New York in developing and designing VBP goals to address HRSN and the most impactful health equity priorities.
CMS is authorizing up to $2.2 billion over approximately three and a half years or $550 million annually for the Medicaid Hospital Global Budget Initiative. This initiative will provide funding to certain private not-for-profit hospitals that are financially distressed; located in the Bronx, Kings, Queens, and Westchester counties due to their significantly adverse health risk factors and health outcomes and Medicaid and Uninsured Payor Mix of at least 45 percent.
Finally, CMS is authorizing up to $694 million over three years to support workforce recruitment and retention to promote the increased availability of certain health care practitioners who serve Medicaid and demonstration beneficiaries.
