TU Coverage, Medicaid Matters Response to NYS Medicaid Waiver Proposal

NYAPRS Note: Here’s more coverage on yesterday's release by the Cuomo Administration of their proposal to reinvest $10 billion in anticipated savings from Medicaid reforms into a broad array of system improvements. See below too for a release by Medicaid Matters which helped develop and successfully advocate for the inclusion of a $23 million Medicaid managed care ombuds program that will go a long way to protecting beneficiary rights and choices. Special thanks to the proposal’s authors, Shelly Nortz and Leah Farrell.


Health Officials: Invest Savings

$10B Saved Through Changes to Medicaid Program Would Be Used for Other State Services

By Jimmy Vielkind  Albany Times Union August 6, 2012


ALBANY — State officials formally submitted a request to keep $10 billion that recent changes to the Medicaid program have saved the federal government, saying that investing the money over the next five years will further "bend the Medicaid cost curve."


Health Commissioner Nirav Shah and James Introne, director of health care redesign, unveiled the state's 127-page proposal at an event Monday. Changes to the ballooning Medicaid system - which is jointly funded by the federal, state and county governments - were implemented in the past two state budgets and are expected to trim $34 billion in spending over the next five years. Growth in Medicaid spending was capped at 4 percent, and to cut costs, officials are directing more dollars to primary care, a cheaper alternative to hospitalization.


The federal share of that savings is $17 billion, and the waiver - which officials have been talking about for months - would keep a majority of those dollars flowing to the state.


"This targeted reinvestment will improve health care alternatives and lower health care costs, but is budget-neutral," Introne said.


The state proposes to spread the money across a range of health care and related services, generally focused on treating patients before they require costly hospital care. Among the spending outlined in the waiver proposal:

  • $525 million for "medical home" (actually health home) programs that coordinate care among facilities for patients with chronic conditions. There are 34 such programs already operating in the state, but Shah said the money will help "build to scale."
  • Just over $1.7 billion would go to hospitals in poor communities, some of which are fiscally under water. These facilities service a high rate of Medicaid patients. Just over $1 billion of this money will be used for "balance sheet restructuring," which will help hospitals pay off debt and invest in emerging areas of care.
  • $750 million over five years for supportive housing services. According to Harvey Rosenthal of the New York Association of Psychiatric Rehabilitation Services, a statewide coalition of mental health consumers and providers, this funding will help prevent some Medicaid patients from turning to hospitals for housing. "New York's Medicaid waiver proposal recognizes what many of our stakeholders have told us and the administration ... that recovery and wellness is not just about doctors and pills but about expanding critical supports like housing," he said.
  • $20 million for water fluoridation.
  • Starting in 2014, the state hopes to spend $125 million a year for recruitment, retention and retraining of staff — a total of $500 million over the life of the proposed waiver.


Introne and Shah said they hoped the federal government would evaluate and approve the waiver before the state's fiscal year ends in March.



Interests Of Medicaid Consumers Reflected In The Super Waiver,

Says Statewide Coalition; Implementation And Way Funding Is Allocated Is Key

(Albany, NY – August 6, 2012) The State’s interest in continuing to reform the Medicaid program in New York was reaffirmed today through an 1115 Medicaid waiver amendment application submitted to the Centers for Medicare and Medicaid Services (CMS), referred to as the Super Waiver. Medicaid Matters New York (MMNY), a statewide coalition representing the interests of the over five million people served by the Medicaid program, applauds the inclusion of new initiatives and funding to protect and enhance the interests of Medicaid consumers and the providers that serve them.

The application includes initiatives that will make a positive difference in access to needed care and services, such as expanded capacity for community-based primary care and investment in peer supports. The waiver application mentions improved consumer education and communications, and includes a groundbreaking new initiative to provide funding for advocacy assistance for people with disabilities and chronic illnesses newly-enrolled in Medicaid Managed Care, which was proposed by MMNY.

"Navigating Medicaid Redesign has been a mixed bag for consumers and their advocates," said Lara Kassel, MMNY Coordinator. "We remain concerned about low-income, medically underserved communities and how they will fare in this waiver - about whether health disparities are sufficiently addressed, and whether there is enough attention to ensuring that services are available directly in these communities. But the waiver application submitted to CMS today clearly demonstrates the State’s commitment to improving access to information, advice and assistance for people with long-term needs who are trying to navigate their way through the system."

MMNY was pleased the Department of Health (DOH) process for developing the Super Waiver application included the engagement of stakeholders in what it should look like, including consumers and community-based organizations and advocates. MMNY submitted proposals to DOH and will look for inclusion of these recommendations in the document. "We urge DOH to invest time and attention to continuing to hear the concerns and interests of Medicaid beneficiaries, including directly from people in the program themselves," added Kassel. The Medicaid Member Focus Groups, which brought Medicaid consumers directly to the discussion were an important piece of the process and should continue going forward.

"There is much work still left to do, and it is incumbent on the State to ensure the interests of consumers are represented and met," added Kassel. "MMNY stands ready to provide input and feedback as these new initiatives are implemented and the new funding is allocated, and urges the Department to reach out to consumers and people in communities around the state as this process continues."


Will NY Succeed Where Other States Have Failed?

Crain’s Health Pulse August 7, 2012


Convincing the federal government it needs to spend money to save money does not always work. The feds have recently rejected parts of Medicaid waiver requests from Utah, Illinois, Colorado and California that were similar to the $10 billion proposal announced yesterday by the Cuomo administration.

But advocates from various sectors of New York's health care world yesterday said they are confident that the state's proposal to save CMS $17 billion over the next five years would not only be approved, but that its innovations would become a model for the nation.

CMS rejected other states' proposed changes, such as upping co-pays, because they would shift costs to Medicaid recipients rather than reduce those costs.

"What's different here is that the Cuomo administration is showing it is taking control of spending by taking some short-term gains and turning them into long-term improvements," said Jim Tallon, president of the United Hospital Fund.

New York plans to save money by putting patients who need long-term medical services into managed care plans and doing away with underused and outmoded "big box" hospitals, and focusing on outpatient care.

A centerpiece of the proposed waiver calls for spending $75 million to create supportive housing-places to live where health care is available on site. That investment could save New York's Medicaid program more than $650 million over five years by avoiding unnecessary emergency room visits and hospital stays, according to the proposal. The idea is that many people with chronic health problems, including mental illness, become hospital patients because they have no managed care team. Supported housing costs less than $50 a day, while a psychiatric hospital stay costs more than $400 a day and inpatient hospital care costs about $750.

Funding would go to a variety of state entities, and proposals are still coming in from others. Click here for the details in the waiver request submitted by Mr. Cuomo's Medicaid Redesign Team. In announcing the official filing of the request yesterday, Health Commissioner Dr. Nirav Shah said the state proposed a workable plan that would improve care and save money. "We don't have time for pilots anymore," Dr. Shah said.

HANYS was among those endorsing the plan. "We believe the request is very strong," a HANYS spokesman said.


Governor Cuomo Announces That New York Submits Federal Waiver To Invest $10 Billion In Medicaid Redesign Team Savings To Transform The State's Health Care System
Federal Waiver Will Allow New York To Fully Implement the MRT Action Plan

Governor Andrew M. Cuomo today announced that New York has submitted an application for a waiver from the federal government that will allow the state to invest up to $10 billion in savings  generated by the Medicaid Redesign Team (MRT) reforms to implement an action plan to transform the state's health care system.

The Medicaid 1115 waiver amendment will enable New York to fully implement the MRT action plan, facilitate innovation, and lower health care costs over the long term. The waiver application submitted today by New York State 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. 

"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," Governor Cuomo said. "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."

The initiatives proposed by the MRT - and adopted by the Legislature last year - have led to major savings for state and federal taxpayers. MRT initiatives are projected to save $34.3 billion over the next five years - divided between the State and federal government. If not for these MRT initiatives, state spending would have grown by $2.3 billion in the 2011-12 fiscal year alone. 

The waiver amendment’s broad objectives are consistent with the Centers for Medicare and Medicaid Services’ (CMS ) Triple Aim: better health, better care, and lower costs. New York will use federal dollars generated through MRT savings to reinvest in the state’s health care system. 

Key strategies outlined in the waiver amendment document include:

· Major investments to expand access to high quality primary care

· Grants to establish Health Homes to improve the quality of care for the state’s highest need/highest costs patients

· Expanding resources available to transform and protect safety net providers

· Positioning and preparing health care providers and consumers for long term care integration to managed care

· Innovations in public health strategies that will generate significant, long-term Medicaid savings

· Training and support to ensure that New York has the workforce it needs to thrive as national health care reform is implemented

· Thorough and rigorous evaluation of both new and ongoing MRT initiatives to ensure the wise investment of taxpayers’ contributions and to enhance patient outcomes

· Strategies that will reduce hospital readmissions and help protect patients from getting sick during their hospital stay

As part of the waiver amendment application process and in accordance with requirements outlined by the CMS, New York initiated an extensive public engagement effort. Citizens and stakeholders participated in public forums, topic-specific webinars, and Medicaid member focus groups. The process also included a survey tool, which enabled the public and stakeholders to submit ideas and comments which informed the waiver amendment application. 

More information and a copy of the Medicaid waiver amendment application and is available at: http://www.health.ny.gov/health_care/medicaid/redesign/.  

U.S. Representative Brian Higgins said, "Health Care infrastructure investment in Western New York benefits both patient care and the region’s economy. This waiver will allow for continued progress to improve our health care delivery system, creating a better health care network for our region and beyond."

U.S. Representative Peter King said, "The waiver amendment provides a critical opportunity for New York to modernize and strengthen its health system. I am proud to work with Governor Cuomo and to take the lead on the federal level to ensure that the application is approved quickly."

U.S. Representative Eliot Engel, said, "Reinvesting our state’s savings to improve the Medicaid program can only help New Yorkers. Instead of Medicaid costing another $2.3 billion, in the 2011-12 fiscal year, savings initiatives are projected to save approximately $34 billion over the next five years, to be divided between the state and federal governments. Putting these funds back to work here in New York helps to keep New Yorkers healthier."