In New York, Medicaid provides healthcare for nearly 8 million people and half of all births. With the COVID-19 pandemic highlighting existing health disparities and disrupting the health care system, there is a significant need and opportunity to innovate Medicaid care delivery. On the latest episode of Policy Outsider, we examine how New York is using a Section 1115 waiver to address health equity issues. The State’s Acting Medicaid Director, Amir Bassiri, and Rockefeller Institute Senior Fellow for Health Policy Courtney Burke join the show to discuss how the waiver works, the goals the waiver seeks to accomplish, strategies for achieving those goals, and a vision for the future of Medicaid.

Guests:

Courtney  Burke, senior fellow for health policy, Rockefeller Institute of Government
Amir Bassiri, New York acting Medicaid director & deputy commissioner, Office of Heath Insurance Programs

Terms:

CBO—Community-based Organization
CMS—Centers for Medicare & Medicaid Services
DSRIP—Delivery System Reform Incentive Payment
MRT—Medicaid Redesign Team
HERO—Health Equity Regional Organization
SDHN—Social Determinant Health Network
VBP—Value-based Payment

 

  • Transcript

    Transcript was generated using AI software and may contain errors. 

    Alexander Morse  00:02

    Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Alex Morse. Medicaid is a critical component of the nation’s and New York’s health care systems. In New York, Medicaid covers nearly 8 million people, half of all births, and approximately two thirds of people receiving nursing home care, and services and supports for people with mental health or disability needs. In all, New York’s Medicaid budget is over $90 billion. Given the importance, size and scope of Medicaid, how can New York improve its health care delivery and achieve better health outcomes. The state aims to achieve better health outcomes through a new Medicaid waiver request that will allow the state to research, implement, and demonstrate innovative and cost effective delivery methods to improve health outcomes. New York currently operates under what’s known as an 1115 waiver, a waiver type that has broad authority to allow states to test new methods of health care delivery. New York is now seeking to amend that waiver so that it can focus more specifically on health equity issues. Joining us to dive into New York’s new Medicaid waiver request are two health policy professionals with a combined decades of health research and administration experience. Courtney Burke, senior fellow for health policy at the Rockefeller Institute, and Amir Bassiri, Acting Director of New York’s Medicaid program and Deputy Commissioner for the Office of Health Insurance Programs. Courtney and Amir will touch on the importance of Medicaid waivers for research and demonstration, as well as what health equity issues and health outcomes New York hopes to achieve through this new waiver request. Coming up next. Hi, and good morning, I’m joined by Courtney Burke, senior fellow for health policy at the Rockefeller Institute, and acting Medicaid Director and Deputy Commissioner for the Office of Health Insurance Programs, Amir Bassiri. Good morning both. Thank you for joining me.

    Courtney Burke  02:15

    Good morning. Thank you as well. Amir, thank you for joining us this morning.

    Amir Bassiri  02:19

    Thank you for having me.

    Courtney Burke  02:20

    Yeah. Well, it’s great to have you here today to talk about the state’s new pending Medicaid waiver. Amir, I know you began your career working at various nonprofits in the area of social determinants of health, which is also a big focus of this waiver, and then worked as an empire fellow, the governor’s office, a senior policy advisor for health before transitioning to chief of staff to the Medicaid director than deputy director and now the acting Medicaid director. So this waiver is a big deal, Amir. Why don’t we start by having you give us a high level overview of what you hope to see this waiver achieve and perhaps the dollar figure ask as well.

    Amir Bassiri  02:59

    Absolutely. And thank you for the introduction. As Courtney mentioned, the 1115 waiver amendment, which we are calling the New York Health Equity reform waiver, or NYHE for short, is essentially the Medicaid programs strategic plan to address health equity in New York. The waiver seeks approximately $13.52 billion over a five year demonstration period to systematically redesign the delivery system under a health equity lens that seeks to change the way care is delivered and paid for here in New York Medicaid. The central goal of the waiver is to reduce health disparities, advance health equity, and support the delivery of social care. Specifically building upon the lessons learned under our prior waiver, the DSRIP waiver to address some of the unprecedented and extraordinary impacts that the COVID 19 pandemic has had on vulnerable populations and exacerbating health disparities. That’s the central goal and we aim to achieve that goal through various strategies which are outlined in our amendment to the federal government. There are sub strategies but the first of those strategies is to build a more resilient and flexible integrated delivery system that achieves the goal of reducing health disparities, advancing health equity, and the delivery of social care. The second strategy is to strengthen and enrich our transitional housing, supportive services and alternatives to homelessness and institutional settings of care. The third strategy is to redesign the system specifically around workforce development to improve quality, advanced health equity and address existing shortages which we’re feeling an insane pressure on currently, though, the waiver will be very timely to address a lot of the workforce challenges that are existing in the market. And the last strategy is to create a statewide digital health and telehealth infrastructure. At the highest level, that’s sort of the underlying goal and the four strategies in which we expect to achieve that goal of reducing health disparities advancing health equity in the Medicaid program. But underneath each one of these strategies, there’s a lot of sub components and programmatic changes that we hope will help get us to, to that end state at the end of the five years.

    Courtney Burke  05:36

    That’s great. So why don’t we dig into those four areas a little bit more based on what you said, and we’ll start with the first one around building a more resilient and integrated delivery system to promote health equity. How exactly will that work?

    Amir Bassiri  05:51

    Great question, Courtney. This strategy is the most funding under the waiver is allocated for this strategy. And the reason for that is that we are establishing new entities and the delivery systems. And I’ll go through those. And we’re allocating a lot of funding in this area for advanced value based payment, specifically for health related social needs investments.

    Courtney Burke  06:16

    Let me just pause there and say, advanced value based payment. I’m sure we have some listeners who are familiar with the term value based payment, if you could just explain what it means. And then what is the difference between value based payment and advanced value based payment?

    Amir Bassiri  06:32

    Yes, absolutely. So value based payment. So traditionally in healthcare we pay in a fee for service environment in which a provider is paid for the delivery of a service to a member. And what we’ve learned over the last decade or so, is that that doesn’t always lead to better outcomes and may lead to unnecessary healthcare utilization. And it is not really innovative, in the sense that a provider can only be paid so long as they see an individual. So what value based payment aims to do is change those incentives to say that we will pay you regardless of whether you see the member on a volume basis, and more so as to whether you’re improving the health or the outcomes of that member or reducing the total cost of care necessary to deliver services to the member while keeping costs as efficient as possible. So what is advanced value based payment, or what are we calling advanced value based payment is really create the incentives or managed care organizations, community based organizations, healthcare providers to come together to meaningfully address harder to reach populations and meaningful VBP. We think the opportunities are there to create innovation and reduce the total cost of care of caring for those members while improving outcomes and bringing in new providers, social care providers or community based organizations who may not be traditional Medicaid billing providers through the 1115 authorities. That’s really the innovation we’re hoping to seek. If you aren’t participating in the Medicaid program, it’s very difficult to pay you. However, if we use value based payment as the source of innovation, we can encourage managed care organizations and our new social determinant of health networks to not only pay community based organizations, but to treat people with more services that they’re not currently available under the traditional Medicaid benefit. Things like housing supports, nutritional services, innovative transportation services, those things are not traditionally in the state plan amendment, which is our authorizing document with the federal government as to what is covered and not covered. So this waiver really presents a unique and extraordinary opportunity to really advance the way care is delivered and incorporate social care into how we deliver care to our members. So how are we going to do that? The waiver really starts with the establishment of health equity regional organizations. And these are intended to be regional planning entities to incentivize regional collaboration amongst various stakeholders across the delivery system and incorporate their voices and perspectives into the planning effort for a particular region. They’re going to lay the groundwork and develop annual health equity regional needs assessment. Think about a needs assessment on steroids, for lack of a better phrase that really brings together all the providers health and non health in a room to establish a plan, and a needs assessment for a region to identify the gaps in terms of where are the health equity gaps, where are the resources, whether it be housing inventory, or strong supportive community based organizations, and where are the gaps in terms of the populations or parts of a region that are not receiving services for whatever reason, whether it’s a rural area, and there’s no access to health care, or there are strong measures of ongoing disparities for certain populations, like the chronically homeless, or the criminally injustice involved populations. So these HEROs, as we call them, will establish a plan and a needs assessment that will really lay the groundwork for everything that comes after it. They’re also intended to provide, you know, reasonable collaboration amongst stakeholders. They are not intended to result in any duplication of efforts. Really rather to augment existing planning efforts, and bring it to scale under the context of the waiver. So once those HEROs are established, and the plans are laid out, we then have the second new entity in the delivery system, one that will play a pivotal pivotal role in measuring success and and helping achieve the goals of the waiver. And those are the social determinant health networks, or SDHNs as we call them, we’re allocating almost a billion dollars for these entities. And what they are, is a network of community based organizations and social care providers that serve as a coordinated referral network to provide health related social needs interventions to our members. And this is really a lesson learned from the prior amendment DSRIP, we were able to achieve a lot of value based payment. But we were not able to successfully and meaningfully pay CBOs for their efforts and taking care of Medicaid members. And so what these networks will do is they will bring a range of community based organizations together with one lead entity who will serve as the primary contracting vehicle with a managed care plan, and also serve as the vehicle to gather more health equity related information and demographics information on our members to identify what the needs are and how to serve them. And then furthermore, when we identify those needs, are they being referred for services and what is happening after those services are referred. And that’s really the role the SDHNs play. There are hoping that these are not temporary entities like the HEROs which may be but these SDHNs are intended to be permanent fixtures and the delivery system, as really the vehicle for having CBOs participate in the Medicaid delivery system and payment system. The SDHNs will be responsible for paying community based organizations for the services that they deliver. And they will also be responsible for engaging in that advanced value based payment with managed care plans targeted on sub populations and vulnerable populations and being held to meaningful standards of health improvement. We are thinking currently and in our discussions with CMS that for every HERO in each region, there would be a corresponding Social Determinant Health Network in that region. And we want that for alignment or attribution to make sure that we’re bringing providers together, collaboration together. And we want them to be able to do referral management and fiscal administration in a meaningful way, such that when the waiver is gone, after five years that these entities will have the basis to be able to enter into these arrangements after the waiver funding is no longer allocated. Those feed into another strategy, which is the advanced value based payment and a bulk of the money in the waiver here about $6.8 billion, which is a significant significant investment and really speaks to how the State and the Department is prioritizing VBP as a vehicle for creating an inniskilling better delivery of services that we believe will result in better outcomes and reduced cost of care. The last strategy is a sub component, and it’s really treated separately because of how unique of a population it is and the authorities that are pressing which is to allow and ensure meaningful access for the criminally injustice involved populations. prior to discharge from incarceration, so you may have seen this many other states have also put this proposal forward under their 1115 authority, which is to allow for inreach services or for Medicaid funded services while an individual is incarcerated, leading into their discharge. And this is really to serve as a safety net as people come out of incarceration, so that they don’t end up back in the hospital or fall through the cracks of the system. But rather, they have access to comprehensive care coordination of care, there’s a health plan there to help them with their discharge and make sure they’re receiving services having access to their medications that their routine or chronic need medications, and bringing them into the delivery system such that, you know, a health plan is responsible to care for these individuals, as opposed to them going into fee for service, which is, practically what happens today. So that is about round out our strategy one, which is probably 65% of all the funding we’re asking for is to really redesign the health system to focus on populations this way while bringing in new social care providers to help meet those goals.

    Courtney Burke  16:22

    That’s an incredibly helpful explanation of the first goal and exactly how they would see this playing out and how community based organizations would be more involved, how some of those organizations would be in transportation, nutrition, and housing was one of the ones that you’ve mentioned. So I think that’s a good segue to bring us to the second goal, which is, which is about housing strengthening enriching supportive housing for people. So we’d love to hear a little bit more about that goal.

    Amir Bassiri  16:54

    Absolutely. $1.57 billion, has been allocated for strengthening our and enriching our transitional housing services and creating alternatives to care for the chronically homeless and those who are in long term institutional settings. And this is really building on something we know works and has a return on investment, which was demonstrated in the first MRT, from our supportive housing efforts for higher acuity populations. And this is a significant expansion of that success, with a distinct focus on populations transitioning out of institutional care, like a nursing home, into a community based setting to age in place. And it really starts at the top again, with the HEROs and their work coordinating existing regional partners, and identifying the housing inventory within a particular region region, and helping map high utilizers and institutional settings to those resources. And if there are gaps, putting in the investments and interventions to meet those gaps. A lot of supportive housing addresses the capital need and the operating from various federal city, local funding streams. But the role of integrator and connecting those efforts with other social care and health delivery providers isn’t happening on a statewide basis or at a scale to really support the broader supportive Housing effort. So once the HEROs identify the resources and inventory within a particular region, and where gaps are needed, a social determinants of health network will then begin identifying members matching Medicaid data with almost s or other institutional data populations that could transition to the community. We would provide funding for the value based payment for the infrastructure and enrich housing, transitional housing services, which are in place today, but would be augmented in a very, very significant way things like medical respite programming, street homeless programming and community transitional services, tenancy supports, including first last month of rent and other supportive services outside of paying for room and board. And then lastly, referral and coordination of related services and benefits really the social care providers coming in for for other additional services to wrap around the needs of these members. And this builds on the work as I said, that we have in place today, but we have not really scaled and provided a significant infusion of funding for in this way that we think will have a meaningful impact and really target very vulnerable populations that could live safely in the community but are not living safely in a community for various reasons, including capacity and resources of the providers in a particular geography. So we’re very, very excited about this. We wanted to go further there with this strategy and with the funding, CMS tempered our expectations, but did offer support with with the goal and the funding under the goal and other states are following suit as well. So this is a huge, huge investment that we’re really excited about. And we hope to have a very lasting impact for our very high need populations.

    Courtney Burke  20:24

    Yeah, precisely, you had mentioned that some of the populations that are being targeted for this advance value based payment are exactly those kinds of observations that could be vulnerable, and especially if they don’t have some supportive housing or any type of housing to transition. So.

    Amir Bassiri  20:40

    And to that point, Courtney, I mean, we’re always seeking opportunities to expand, you know, the supportive housing availability, the site units throughout the state, augmenting the existing programs. But this will be I think, one of the more meaningful aspects of the waiver, and one in which we hope will demonstrate ROI across larger populations to make more meaningful investments post waiver in the availability of supportive housing.

    Courtney Burke  21:07

    Right. And I would say another critical thing for the waiver to be successful is what under lies all of this, which is the health and human services workforce. So I know that goal three is about system redesign, but it is also largely focused on the workforce.

    Amir Bassiri  21:25

    Absolutely. I mean this as the biggest problem in healthcare right now for all providers, both for the community based organizations, and obviously for our health infrastructure and facility providers like hospitals and nursing homes, and we are allocating $3 billion to workforce under the waiver. It’s segmented into two distinct buckets, the first of which is really investments in our safety net hospitals and nursing homes who were just decimated during the COVID 19 pandemic and whose businesses were fundamentally changed. And we’re trying to right size for those providers by making very large investments and workforce and quality as they rebuild from the COVID 19 pandemic. So the first strategy under that or the first, you know, investment under that strategy or workforce is $1.5 billion, for a quality incentive pool are distressed, hospitals and nursing homes and it will have a distinct quality focus on workforce and staffing. That would be allocated $300 million each year. We haven’t defined the specifics, but we are we are in the process of working through that with CMS right now. And workforce will be a critical, meaningful measure and how we distribute and measure the impact of that funding. The remaining $1.5 billion is what we more traditionally think of workforce development and training. Really funding to address long standing shortages, including those that were exacerbated by the pandemic, to make the healthcare and social care field more attractive to workers, provide opportunities for advancement, including recruitment and retention, development of career pathways, training and expansion of opportunities and jobs like community health workers, having individuals transition from, you know, being a health home worker to a community health worker to a peer specialist, creating those advancement ladders is very critical as part of this waiver. And we intend to fund you know, the WIOs, or Workforce Investment organizations to help assist with that, as well as create standardized trainings throughout the state, depending on the region to address things that overcome racial and implicit bias. We feel that the HERO plan and needs assessment plan back to the top will help identify needs and gaps in workforce, depending on the region. And we will make those investments based on that established need for each region. Whether it be you know downstate, we have a greater need for community health workers and peer support specialists, upstate, we may have more needs on health care professionals training, whether it be nurses or another field. And we’re working very diligently to make sure that we have the flexibility to make differing investments depending on what providers, subject matter experts, and workforce development organizations identify as the critical and biggest need for each region. So I wish we had more funding for this bucket knowing what we’re dealing with right now. But $3 billion is still meaningful, and we want to make sure we separate the needs of our inpatient and facility based provider with their community based providers. And so we’ve allocated the funding in that way.

    Courtney Burke  25:07

    That’s great. And I think the fourth platform and goal that you mentioned is also critical to all of this. It really underlies the workforce, the housing, the ability of the networks to communicate with each other, and a whole new way of delivering care which people are much more comfortable with now after the pandemic, which is digital care and telehealth delivery. So if you could talk a little bit more about that last platform?

    Amir Bassiri  25:31

    Yes, absolutely. While it’s the least funded platform, which is the statewide digital health and telehealth infrastructure is $300 million over the five years and is still critical. And as opposed to the prior strategies where we’re either funding a Social Determinant Health Network, a managed care organization here of this funding is directly for providers to meaningfully participate in telehealth and provision, you know, the IT necessary to train and support their workforce to provide telehealth. And this is really all about patient access and creating more opportunities for patient access throughout the state. Things like telehealth kiosks and homeless shelters, enabling community health workers to assist members in utilizing telehealth, whether they’re in a community based or institutional setting, and giving access to tablets to members and providers. So that they have various ways to receive the services and care that they need. We are also looking at and allocating grant funds for remote patient monitoring data platforms and interoperability so that the telehealth utilization can be shared and measured across state patient facing tools, virtual care models, and assistive technology. And so while it’s the smallest funding bucket, we think it will have a major, major impact to advance what we’ve seen over the last three or four years, which is a massive increase and widespread adoption of telehealth that’s a modality to deliver care.

    Courtney Burke  27:13

    It’s great, very helpful to hear about the four areas. And it’s a very ambitious plan. So one of my questions is how will you know this is working? How will you measure the progress in some of these areas?

    Amir Bassiri  27:25

    That is a fantastic question. And something we’re in the process of discussing with the federal government. Right now. They are very interested in this. And if we look to what they’ve done in other states, we can see that they’re very interested in the total funding that states are allocating more health related social needs interventions. They are interested in funding for community based organizations from the Medicaid dollar, which we’re thinking of as part of our measurement, and the number of assessments and social care screenings that are followed by referrals and delivery of care by community based and healthcare organizations, which are all things that we’re negotiating with CMS right now, at the end of the waiver period, I think what we’re hoping we can effectively measure is the unmet need pre waiver, and how that need was met with health related social needs, interventions and funding. And ultimately, what that resulted in from health care spending and quality outcomes for our members. Did we improve the physical, mental health or social care needs outcomes for our members with these investments? Can we stratify and measure our own Medicaid member data, or health equity measures that we can’t do today. And some of these are to be defined, but we want to be able to stratify all of our data by race, ethnicity, language, geography, disability status, sexual orientation, and many other ways to really look at everything in a more granular way and measure it differently. So the details are still to be determined. But those are the types of conversations were in the process of having with CMS, and we’re comfortable with many of the things they’ve approved in other states, and really want to keep the focus on the health related social needs interventions, how much funding is going towards them, because we believe those investments are what’s going to lead to the better and higher quality outcomes for our members.

    Courtney Burke  29:37

    That’s great to understand what the endpoint is. And so I’m curious about the shorter term. You mentioned the negotiations with the federal government. I have some experience in a prior life of being part of negotiations with the federal government and I know it gets very detailed and it goes back and forth for quite some time. So I’m guessing our listeners are wondering how is that going? Any predictions on when things may come to a resolution.

    Amir Bassiri  30:03

    It is going very well, from my standpoint, as you said, coordinating these negotiations do take time they get in the weeds, there’s a lot of back and forth with questions as to how we’re going to do this or how we’re going to measure that. And what this funding explore, what that funding is for. We are having conversations with the federal government weekly. I want to thank all the listeners for their advocacy to the federal government as to as to the importance of this waiver, because I think there’s widespread understanding of how important this is for the Medicaid program and the delivery system. And so I think, from a negotiation standpoint, I think we are getting into the meat as we speak, there is an understanding between us and CMS that we are seeking approval as quickly as humanly possible. We are certainly working our way towards a move approval by April 1. And I think that’s the track we’re on. You know, there’s been a lot of questions on the health equity related measures and how we are going to measure success for the waiver. And I think that’s the last sort of hurdle we have to cross and some of that is driven by by CMS and their their feedback to us has been to look towards the other states in ways that they’re being measured for success or what they’re being authorized to do, which gives me a lot of optimism, given that those other states really replicated what New York has been working towards under this waiver for the last several years. So I think we are on track for an April 1 approval date, barring anything unexpected.

    Courtney Burke  31:56

    Well, that’s really good to hear that things are progressing. You mentioned that CMS requested that you look at other states and sort of things that they’re doing. I know that both Massachusetts and Oregon recently had similar waivers approved. Was there any aspects of their waiver applications that you found particularly interesting where you think New York might steal some of their good ideas?

    Amir Bassiri  32:17

    Well, they stole from us, Courtney. So I’m gonna put that plug in. I know would appreciate it. Because our waiver really, while while we are in the process of negotiating, and now the development of it has been underway for the last several years, really, with meaningful stakeholder engagement, which is why there’s so much excitement from various providers with respect to the waiver. But there are many things and the other two waivers that you mentioned, that we like, including in Oregon, you know, the specific provisions to allow for health related social needs benefits, like housing and nutritional services to members is very positive and optimistic, including, because we have replicated some of that in our waiver, we go a little bit further. But that approval really establishes a framework for or what we’re trying to do here in New York. I think Massachusetts, their provider incentive pool, the funding they have, or their distress providers like hospitals is very, very attractive for us in the sense that it lays, it integrates very meaningful and high priority quality measurement, whether it’s maternal health, or health equity related needs assessment, for members in in coordination with supplemental funding. And that is a framework we’re very, very interested in and CMS has pushed us towards or some of our quality incentive programming. And that’s something we’re likely to replicate, given its focus on quality, staffing, workforce development and health equity, in addition to providing critical funding for many of our distressed providers that were turned upside down throughout the pandemic. So those are two major elements, one in Oregon, one in Massachusetts that I think you will see in the final terms and conditions negotiated in our waiver. They went a little bit further than we did with respect to coverage expansion. They included elements of coverage expansion in their waivers, things like coverage, continuous coverage for children, zero to six in in Oregon, and expansion of the Medicaid buy in program for workers with for people working with disabilities. Those are things that are likely not to be in our waiver but are still of interest. You know, maybe down the line once we get this 1115 approved, we’ll we’ll look to another 1115 waiver for those coverage expansion related authorities, where we’re focused really is on redesign of the delivery system and changing the way that we pay for and care for our Medicaid members.

    Courtney Burke  35:13

    So you’ve given us a really wonderful overview today. Amir, thank you for the time. But one more question before we let you go, which is, so many different things you spoke about today really changed the way the delivery system looks, five years from now much more integrated, I think, is your goal and resilient, and really integrating health and human services more so than today. If you could describe what you think, is that ideal vision, or at least a better version of today’s Health and Human Services system? What what would that be?

    Amir Bassiri  35:47

    That’s a fantastic question. I don’t know, our listeners may not be as familiar with this with this chart or visualization. But the way I like to think about it, and something that I think of when measuring success is if you were to look at a visual chart put forward by I believe the Brookings Institute or another research institution that measured the top 20 OECD countries, and what they spend on health care, versus social care as a percentage of GDP. And on that chart, you’ll see that the US by far and away, then is the most on health care as a ratio of health care to social care than these other countries. And unfortunately, we have the worst outcomes as compared to those 20 countries. And so what I would hope is after this waiver is after the five year demonstration period, New York Medicaid would have a higher ratio of social to health spending as compared to what it has today. And we believe that will lead to better outcomes. And that’s really what we’re hoping to achieve under this flavor is to bring social care into the delivery system. And the payments system, which we hope to do the through the strategies under the waiver. I would also hope Courtney, sorry to keep going, but data systems and interoperability is a huge, huge priority for for me and the Medicaid team to really ensure that we have long standing and permanency with respect to social care data exchange, to enrich our existing member data with health equity and demographics information, which will be a critical measure of success, that we can stratify the health equity needs of our members, as well as measure the health equity needs improvement with our existing clinical and claims data to really drive innovation on on outcomes.

    Alexander Morse  37:56

    You mentioned that this waiver is a five year period. What happens at the end of five years. If the program proves to be successful, you have to reapply for funding, you have to get a new waiver, or does it it become statute?

    Amir Bassiri  38:11

    That’s a great question. It really depends. But if the waiver is successful, and we are meeting meaningful goals and meeting the terms and conditions, there’s a number of things that could happen. One is that the state may choose to continue some of these authorities with its own funding post waiver. So right now, what the waiver provides is a lot of incentive farms for innovative interventions are innovation in delivery. And if those are tested, and they’re positive, ideally, you know, managed care plans will want to keep making those investments because the total cost of care for treating people is lower, which means they can save more money, as well as pay more or the social care providers and the delivery system. So ideally, it would continue organically with how we incentivize payments in the delivery system. CMS may say, oh, all these other states have had similar investments and interventions and health related social needs interventions. We’re going to make this a permanent fixture as part of the approvable state plan amendments, which means in our agreement with you, we will recognize these interventions as things we will match in how you pay for Medicaid providers. So there’s a range of ways that can go. From the state’s perspective, in terms of statute, you mentioned statute, there are certain authorities or flexibilities that we would have under the waiver that we could put permanently into state law, whether it’s related to regulation, surveillance, licensing. So those are the types of things that will change but it is intended to be a demonstration and And ideally, if it’s evaluated, and we’re successful and implementation, these are investments providers and health plans will want to make moving forward. Because the evidence will suggest that it’s better for them, and it’s better for people.

    Courtney Burke  40:15

    That’s wonderful, incredibly ambitious agenda. You are very articulate and explaining it. And we really appreciate you taking the time today. We look forward to seeing what happens over the next few months. We won’t hold you to the April 1 deadline, but then maybe we’ll check back in with you in a few months to see how things are going. So thank you again.

    Amir Bassiri  40:34

    Yes, thank you for the opportunity. And I hope to do this again with you in a better in a better format. So I could be telling you about the success of the waiver and what we were able to accomplish.

    Courtney Burke  40:45

    I look forward to that. Thank you again, Amir.

    Alexander Morse  40:51

    Thanks to Courtney Burke, senior fellow of health policy at the Rockefeller Institute, and Amir Bassiri, New York’s acting Medicaid director and Deputy Commissioner for the Office of Health Insurance Programs for taking the time to share insights into the importance of New York’s Medicaid program and how redesigning the healthcare delivery infrastructure aims to address health equity issues and ensure everyone has access to quality health care throughout the state. If you liked this episode, please rate subscribe and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcast. Transcripts are also available on our website. Special thanks to Rockefeller Institute staff Joel Tirado, Heather Trela, and Laura Schultz for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time. Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York state and the nation. Learn more at rockinst.org or by following at Rockefeller inst. That’s Rockefeller i n s t on social media. Have a question comment or idea? Email us at [email protected].


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