NY Medicaid Section 1115 Waiver Amendment Improves Access to Care

CMS has approved an amendment to New York State’s Medicaid section 1115 waiver that will address health disparities and improve access to primary and behavioral healthcare, Governor Kathy Hochul announced.

The waiver amendment will receive $7.5 billion in funding over the next three years, allowing the state to invest $6 billion in federal funding to strengthen the healthcare system.

“This amendment allows New York to make investments in critical Medicaid initiatives that will enhance health equity in this state,” Governor Hochul said in the press release. “CMS’ approval of the amendment will help us to continue to support underserved communities, provide New Yorkers with critical services such as nutrition and housing support, and improve access for individuals and families affected by substance use.”

The approval will help the state establish Social Care Networks in its Medicaid program to integrate health, behavioral, and social care services to connect members to social determinants of health support. The investments will also go toward facilitating access to coordinated and comprehensive treatment for substance use disorders and improving access to primary care.

“As the nation’s largest insurer, CMS is proud to approve this critical demonstration amendment, which gets to the heart of Medicaid’s role as an innovator,” CMS Administrator Chiquita Brooks-LaSure said in a separate press release. “The demonstration’s initiatives will provide a broad swath of health and social supports to underserved communities, improving their health and quality of life. We encourage other states to follow New York’s efforts to address health disparities.”

The waiver amendment will support a Medicaid Hospital Global Budget Initiative for safety-net hospitals looking to shift to value-based care payment models. The initiative will prioritize safety-net hospitals serving vulnerable populations with significant health risk factors and poorer health outcomes.

“After many months of negotiations, we have secured an agreement that is critical to the state’s health care system,” State Medicaid Director Amir Bassiri said.

“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 training programs for healthcare professionals aim to address ongoing staffing shortages and increase access to culturally appropriate care. The programs will also increase opportunities for employment and career advancement, according to the press release.

Healthcare professionals who choose to work in community-based practices in underserved areas, including psychiatrists, clinical nurse specialists, and dentists, may be eligible for a loan repayment program as part of the waiver amendment.

Once the demonstration has ended, the state is expected to have made strides in its value-based payment strategies, improved Medicare-Medicaid alignment, and advanced primary care and population health outcomes.

States can leverage Medicaid section 1115 demonstrations to implement a range of Medicaid initiatives, such as expanding coverage for incarcerated individuals or establishing continuous coverage for children.

Section 1115 demonstrations are typically approved for a five-year period and states can extend the waivers for up to an additional three to five years.