CMS and NYS Reach Tentative Agreement on Medicaid Waiver

Governor Andrew Cuomo announced last night that the Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) have agreed “in principle” to an $8 billion Medicaid adjustment that will allow New York to reinvest this savings to transform the State’s health care system. In response to the agreement, Cuomo said, “Securing this waiver will address those needs, allowing us to increase access and improve the quality of care for New Yorkers, while making New York’s health care system a model for the entire nation.” This agreement, worth a total of $8 billion over five years, is somewhat lower than NYS’ $10 billion request. However, much of this difference will be made up for by the State Department of Health’s (DOH) decision to move some of the reinvestment programs to the State Plan Amendment (SPA) and/or contracts with Managed Care plans. 

On Wednesday, February 12th, NYS DOH advised providers that some NYS reinvestment programs will not be implemented through the Delivery System Reform Incentive Payment (DSRIP) plan and will instead be implemented through SPA or contracts with managed care plans. One area critical to behavioral health providers is the Health Home Development Fund, which will be implemented through a SPA. This fund includes $525 million over 5 years, to be distributed via a grant application process that will target organizations that have not benefitted from HEAL and other technology investments (e.g., behavioral health, smaller community based providers, non-hospital clinics). Funded programs in this track will support:

  • Member Engagement and Health Home Promotion;
  • Workforce Training and Retraining;
  • Clinical Connectivity – Health Information Technology (HIT) Implementation; and
  • Joint Governance Technical Assistance and Implementation Funds for technical assistance and start-up costs related to the formulation of joint governance models and the development of regional collaboration models for Health Homes. 

Several Medicaid Redesign Team (MRT) priorities will be addressed through contracts with managed care companies, including Primary Care Technical and Operational Assistance ($305 million over 5 years); Health Workforce Needs, including Retraining, Recruitment and Retention ($245 million over 5 years); and 1915i Services ($1.375 billion over 5 years). The costs associated with implementing these programs would be provided through managed care capitation payments to plans. The programs will be benchmark-driven, and New York will hold managed care plans accountable for achieving specific quality and performance outcomes.

For more information about the pending Waiver agreement between NYS and CMS announced yesterday, see the NY Times article, “Federal Agency and New York State Are in Accord Over $8 Billion Medicaid Waiver,” located here

For more information about the DSRIP and its proposed program areas, see SAE’s DSRIP page here, which contains a link to the full planning document and a summary of the plan.