CHP: CMS Poised to Approve $7.4b Adapted NYS Medicaid Waiver

NYAPRS Note: The below article highlights the news that came from yesterday’s MRT Waiver Amendment Stakeholder Update meeting, presented by Medicaid Director Jason Helgerson. Mr. Helgerson clarified that NY has been in negotiations with CMS about pieces of the $10b 1115 waiver submission that the Federal government won’t pay for in the requested way. The negotiation process, however, has yielded different funding streams in order to achieve the desired outcomes expressed in the 1115 amendment submission from 2012.


The main mechanism in which NYS will receive waiver funds is through a federal performance improvement program called DSRIP (Delivery System Reform Incentive Payment). DSRIP has been described as “a federally-sponsored pay-for-performance initiative with the “Triple Aims” of better care for individuals (including access to care, quality of care, health outcomes), better health for the population and lower cost through improvement and innovation.” While NY is looking for $7.4b to achieve improvement milestones through performance-based awards, they are also seeking over $2b to use through Managed Care contracts for 1915i services over a five year period, which will help to fund the implementation of HARPs.


As more information is released about these various initiatives, NYAPRS will continue to provide you with timely news and discussion that effects providers and consumers around the state. Members will be provided additional information on DSRIP in a memo provided this morning.


To Move Forward, $10 Billion Waiver Gets Overhaul

Crain’s Health Pulse December 5, 2013


New York’s $10 billion Medicaid waiver request is being dramatically altered to meet the demands of the federal government, Medicaid director Jason Helgerson disclosed yesterday. New York state will preserve many of the goals of the original waiver application, filed in August 2012, but was told by CMS that some projects in five specific areas are unfundable.


The revamping of the waiver amendment may let the state’s waiver application move forward. The state had hoped for approval during the summer, but negotiations stalled, despite pleas from Gov. Andrew Cuomo to CMS.


“Lately we’ve been making a lot of progress,” Mr. Helgerson said yesterday. He added the state had to modify its request to move forward. “We can’t continue to fight.”


The unfundable areas are capital projects, rental subsidies to house people so they have better access to health care, regional planning, health information technology, and evaluation of waiver projects. The state will have to look to its own budget to give the Department of Health money to implement and administer the waiver.


Delivery System Reform Incentive Payment projects for safety-net providers (Pulse, Dec. 4) will be the bulk of the waiver, accounting for $7.375 billion in federal funding over five years. Only projects from a CMS-approved list are eligible, and Mr. Helgerson warned that they have a far higher level of accountability to CMS than the state’s previous waivers, such as F-SHRP and HEAL.


“This is not just ‘Here’s money, do nice things,’ it is money to achieve specific outcomes,” he said.

State Plan Amendment projects represent another $525 million over five years, while funding channeled through managed care plans would give the state another $2.1 billion.


An archived webcast of Mr. Helgerson’s presentation is online here.