MHW: N.Y. Stakeholders Laud Medicaid Waiver's Major Boost to Community Supports

N.Y. Stakeholders See Medicaid Proposal as Major Boost to CommunitySupports

Mental Health Weekly August 17, 2012

Members of New York state's behavioral health community say they are pleased with Gov. Andrew Cuomo's request for a federal waiver that would allow the state to reinvest $10 billion in anticipated savings from its Medicaid Redesign Team (MRT) reforms to transform the state's health care system and provide community supports such as supported housing,

peer services, and workforce training.

Cuomo on Aug. 6 submitted the state's Medicaid 1115 waiver amendment to the Centers for Medicare & Medicaid Services (CMS) to fully implement the MRT action plan, anticipated to lower health care costs over the long term. The waiver application requests that the federal government allow the state to reinvest over a five-year period up to $10 billion of the $17.1 billion in federal savings generated by MRT reforms.

In general, Section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years, according to CMS. Demonstrations must be "budget neutral" to the federal government, which means that during the course of the project fed-eral Medicaid expenditures will not be more than federal spending without the waiver.

New York's Medicaid program, considered the largest in the country, spends nearly $53 billion to serve 5 million people - twice the national average when compared on a per recipient basis, according to a previous report issued following

the release of the MRT's action plan, "A Plan to Transform the Empire State's Medicaid Program."

Through an executive order, Cuomo established the MRT and charged its members with conducting regional public hearings across the state to solicit ideas from the public on how the Medicaid system could be changed to be more fiscally responsible (see MHW, Feb. 7, 2011, March 14, 2011).

The MRT included advocates, community-based mental health organizations, consumers and other stakeholders who made recommendations to redesign and restructure the Medicaid program. "The reforms put in place by the Medicaid Redesign Team have already resulted in major savings for taxpayers and better quality of care for New Yorkers," Cuomo said in a statement. "This waiver amendment will allow New York State to fully implement the groundbreaking MRT action plan to permanently restructure our health care system and continue to make New York a national model."

Proposal highlights

Key strategies highlighted in the waiver amendment include positioning and preparing health care providers and consumers for longterm care integration into managed care, and grants to establish health homes to improve the quality of care for the state's highest-need/highest-cost patients. The waiver plan also includes the establishment

of interim behavioral health organizations to manage carved-out behavioral health services.

Other Medicaid waiver plan highlights:

* The dedication of $525 million over the next five years toward health home implementation, in such areas as

workforce development, locating members identified as eligible for enrollment, and addressing gaps in health information technology (HIT) systems.

* The funding would support a Health Workforce Retraining Initiative, including $500 million over five years to support

workforce development for patient-centered medical homes and health homes; long-term care, and training in culturally competent, patient-centered care.

* $150 million annually, totally $750 million over five years, to expand access to supportive housing services.

* Funding of $839.1 million over five years toward long-term transformation and integration to managed care.

The creation of a statewide ombudsperson program would help to reduce grievances and appeals and ensure that members have an independent voice to help them.

Mental health input

The governor provided for an inclusionary process to receive input from the field for the waiver proposal, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS) "Advocates

are really pleased with the proposal and the way [our] input was received through local forums, regional meetings,

webinars, e-mails, and webbased surveys," Rosenthal told MHW. "We were very concerned that reinvestment would go purely toward medical services."

Rosenthal said that the state's waiver amendment is consistent with the triple aims of health care reform outcomes,

improved service quality, and lower costs. "We have to look beyond the hospitals to the social determinants of health: housing, peer support, and addressing economic instability, cultural barriers and [avoid] social isolations," he said.

The key aim is to move from a fee-for-service model into a Medicaid managed care system and to have a service coordinator at the plan level and the health home level, said Rosenthal. One of the state's predominant strategies is to save billions by providing alternatives to the overuse of emergency room and hospital admissions, he said. "New

York ranks 50th in the country of [having the] most avoidable readmissions," Rosenthal said.

The state's message to the federal government is to give the state an advance payment of $10 billion "and let us reinvest to build up community care," he said. The state is putting its commitment and money toward resources

that the advocacy community believes are critical, said Rosenthal.

"It's not enough to put funding into a good health care system if people do not [avail themselves of those services]," Rosenthal added. "They're too busy battling crucial everyday issues about where to live, how they're going to eat, how

to find transportation and someone to explain to me why I need to see a doctor and take these pills," Rosenthal said.

Funding would support peer crisis services, supportive housing, cultural competency, recovery-oriented workforce training - services "we long believed are critical and are the front and center of the behavioral health care system," he said.

Lara Kassel is coordinator of Medicaid Matters New York, a statewide consumer-oriented coalition that advocates on behalf of the state's Medicaid program and its beneficiaries. Kassel said she is pleased that the state's proposal includes

a Medicaid managed care ombudsman program that will help protect consumers' rights and assist individuals with disabilities and chronic illnesses in accessing services in managed care.

Medicaid Matters, a member of MRT, advocated for the ombudsman program, said Kassel, who added that the organization hopes to change the name of the program. "We're very pleased with the initiatives borne out of Medicaid Matters, including peer support services," she told MHW.

Phillip Saperia, CEO of the Coalition of Behavioral Health Agencies, Inc., in New York, said he thinks CMS will respond to the waiver request by early fall. "We're excited about this whole reinvestment issue," Saperia told MHW. The Coalition,

also a member of the MRT, also had a hand in developing some of the overall recommendations that are included in the waiver, he said.

Of key importance, said Saperia, is funding for the continued development of health homes in the state. Some of the state's health home providers have started to hire staff and are receiving clients, he said. "It's incredibly expensive and labor-intensive," said Saperia. "The reinvestment plans would defray some of the costs that have been


The state's proposal is "allowing the community to come up with creative solutions" and funding support in the area of peer supports and wellness coaches, and crisis services, said Saperia. "I don't know [of any state waiver] as comprehensive as this one," he said. *