Medicaid is the largest public health insurance program in New York State. In September 2022, New York submitted a proposal to modify how it administers the program in order to focus on improving health equity. The mechanism to make this modification was an amendment to the state’s existing federal Medicaid 1115 Research and Demonstration waiver. 1115 Research and Demonstration waivers allow states to modify their Medicaid programs in a wide variety of ways. New York’s existing 1115 waiver, known as the Medicaid Redesign Team Waiver Amendment, is approved through March 31, 2027. The proposed amendment that was submitted in September 2022 is called New York Health Equity Reform (NYHER): Making Targeted, Evidence-Based Investments to Address the Health Disparities Exacerbated by the COVID-19 Pandemic. At the end of 2022 and the start of 2023, the Rockefeller Institute invited New York’s State’s Medicaid director, Amir Bassiri, to discuss the proposal on our Policy Outsider podcast, including the status of its ongoing negotiations with the federal government for the amendment’s approval.
As noted, the proposed amendment to the waiver hoped to achieve greater health equity. The major strategies under this proposal to improve health equity included: 1) building a more resilient, flexible, and integrated delivery systems that reduce disparities, advance health equity, and support the delivery of social care, 2) developing and strengthening transitional housing services and alternatives for the homeless and long-term institutional populations, 3) redesigning and strengthening system capabilities to improve quality and advance health equity and address workforce shortages and, 4) creating statewide digital health and telehealth infrastructure. The proposed amendment also importantly included a dollar request to the federal government for $13.52 billion over 5 years.
Recently, on January 9, 2024, New York State received an official approval letter for its proposed amendment to the existing waiver from the federal Centers for Medicare and Medicaid Services (CMS). Much of the original proposal stayed intact although the amount of the total funding requested was reduced, in part due to a shorter runway of time before the expiration of the current waiver in 2027.
Among other items, what stayed the same is the focus on health equity, the importance of social determinants of health (such as housing, transportation, or nutrition), shoring up safety net providers, investing in primary care, and supporting the health workforce—as well as some investment in infrastructures to support these strategies. The new approval letter provides more details about the investments related to these goals. For example, there is money set aside for health-related social needs (HRSN). Specifically, there is up to $500 million allotted for infrastructure to enhance HRSNs and $3.173 billion for increased coverage of certain services that address social determinants of health. There is also up to $125 million to create a statewide Health Equity Regional Organization to develop regionally focused health equity efforts. And there is a significant and larger emphasis on hospital global budget pilots ($2.2 billion). Those investments are designed to make hospitals serving vulnerable populations more sustainable while improving the health equity and overall outcomes for patients residing in the service area of these hospitals. In addition, there is $694 million targeted at strengthening the overall health workforce through recruitment and retention initiatives for workers that serve vulnerable populations.
In addition to all the above, there are also investments to increase providers’ payment rates and new provisions to allow federal matching funds for services such as health information technology and the prevention of substance-use disorders. Notable among the proposals approved by CMS is the expansion of continuous Medicaid eligibility for children ages 0–6. This will allow better access to things like vaccinations and primary and preventive care for all children in these age categories without risk of losing insurance coverage.
There are many other details encompassed in the 22-page waiver approval letter from the federal government. And an additional 217 pages of correspondence from CMS to New York State outlines the various terms, authorities, and conditions the state must meet going forward. Public input and an evaluation of the waiver are included. The Rockefeller Institute will continue to provide educational podcasts and blogs on topics related to the waiver as the state moves forward with implementation in the coming months and years.
ABOUT THE AUTHOR
Courtney Burke is senior fellow for health policy at the Rockefeller Institute of Government.