CHP: Helgerson 'Bullish' On Waiver Approval

NYAPRS Note: On the heels of ‘full tilt’ effort to implement federal and state Medicaid reforms and to rebalance our payment systems, the New York State Governor and Medicaid director are urging CMS to approve our Medicaid Design Team’s Waiver proposal that would direct anticipated federal savings into bolstering the infrastructure, facilities and provider readiness necessary to proceed. The waiver provides for vital resources that will infuse our health homes, retrain the workforce to implement new ACA directives, prime the pump to aid the development of new service models and raise our level of cultural competence to address health disparities. Advocates join the state in urging prompt adoption of our MRT Waiver.


Helgerson 'Bullish' On Waiver Approval

Crain’s Health Pulse  May 10, 2013


In quick succession this week, the Cuomo administration released a press release from the state Department of Health that extolled the virtues of the Medicaid Redesign Team, and a letter to HHS making a case for the feds to finally grant the 1115 waiver it requested in August. The message is the same, along the lines of "We saved Washington billions of dollars, and we need help now."


The letter from the governor to HHS makes the case that hospital finances in Brooklyn are most pressing. But for months, hospitals throughout the state have had to scramble for financing because the waiver money never materialized. To press hospitals' case in Washington, GNYHA is in the process of meeting with politicians to get help in securing an "expedited decision on the waiver." Ken Raske met with Sen. Charles Schumer on Wednesday, and urged the trade group's members to contact Sen. Kirsten Gillibrand and local congressional representatives. HANYS did the same, pressing for talks "particularly at the congressional level to strongly advocate for CMS' approval."


"There's a lot of pressure on providers," concedes Medicaid Director Jason Helgerson, coming from both state MRT reforms and the federal ACA law, both of which lower utilization.


With the waiver in limbo, hospitals had hoped for relief from a private equity pilot project that still might be negotiated in Albany this session. "It is a complex issue but something we need to move ahead with discussing," said Mr. Helgerson.


He described himself as "bullish" about HHS approving the waiver this calendar year. "I feel very good about it," he said.


So what's the holdup? Payments to New York for the developmentally disabled had to be resolved first, and that has been done, said Mr. Helgerson. CMS has not expressed concern about specific elements of the waiver. But New York state has loaded CMS with many pleas to approve reforms, with, at one point, some 130 requests pending before the agency.


"They have limited bandwidth," said Mr. Helgerson. New York has asked a lot from Washington, he added, but lately has had "good, positive connections with CMS."



The Honorable Kathleen Sebelius

May 7, 2013

U.S. Department of Health & Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201


Dear Secretary Sebelius:

Last August, the State of New York submitted an application for an 1115 Medicaid waiver

amendment to the Centers for Medicare and Medicaid Services (CMS). This waiver amendment was

intended to provide the funding flexibility necessary to fully implement our state's Medicaid Redesign

Team (MRT) multi-year action plan and continue the transformation of our health care delivery system, with the goals of bending the Medicaid cost curve and assuring access to quality care.


New York has had a strong Medicaid reform track record during my administration. After years

of drift and political discord, an historic consensus was achieved in terms of how best to achieve the

health care three-part aim: better care, better health, and lower costs. The results so far have been

remarkable, with per recipient Medicaid spending down 9 percent, and New York on track to save the

federal government over $17 billion over the next five years.


The National Committee for Quality Assurance recently analyzed New York's Medicaid health care plans against 76 different quality measures and found that when it comes to offering the right type of care for common, costly diseases like diabetes, childhood obesity, smoking cessation, and follow-up care for the mentally ill, New York is a national leader, second only to Massachusetts.


The 1115 waiver amendment would allow New York to reinvest in the state's health care system,

pave the way for implementation for national health care reform and continue to make New York a

national health care reform model. Reinvestment strategies would include primary care expansion, public health innovations, safety net hospital stabilization, workforce flexibility, and long term care

transformation. These initiatives, among others, would benefit New Yorkers in all areas of the state, and would be funded through up to $10 billion of the $17 billion in federal savings generated by MRT



We are grateful for the time and effort your staff at CMS has dedicated to working th rough the

1115 waiver negotiations with us. With dramatic transformations in the health care delivery system now occurring throughout the state, the need for this 1115 waiver has taken on a new urgency.


Without this waiver, areas throughout New York will face serious consequences. Nowhere is the situation more critical than in Brooklyn.


Due to a rapid deterioration in the financial status of essential components of the health care services system in Brooklyn, if nothing is done within the next 12 months, the outcome will be disastrous.


Without the waiver, at least four hospitals- having among them nearly one thousand inpatient beds and supporting hundreds of thousands of emergency room and ambulatory care visits - will be in danger of closing. Access to care will be compromised and the remaining health care providers in the borough will be destabilized. Though just one borough, Brooklyn is home to 2.5 million people. indeed, on its own, it would be the fourth largest city in the United States - an entire city that could be without adequate, quality health care for all of its residents.


The causes of the crisis in Brooklyn are numerous and long-standing. Not the least of them is the

inherent difficulty of the borough's demographics, which encompass extraordinarily diverse cultures and some of the poorest communities in the country. Health care providers are challenged by the unique needs of the people they serve and a payer mix that leans strongly towards public insurance programs.


Medicaid pays for the births of approximately 60% of all babies born in Brooklyn and more than I

million borough residents are enrolled in Medicaid.


Serving the health care needs of Brooklyn's diverse populations are an array of older hospitals.

These facilities continue to provide many services that could be better delivered in ambulatory settings if such new infrastructure could be developed. Our challenge is to find the means to modernize and downsize those hospitals (where it makes sense) and to develop community-based, ambulatory care infrastructure as rapidly as possible. If approved, the waiver will facilitate this kind of system transformation.


No state has been more supportive of President Obama's historic health care reform agenda than

New York. Our program to transform Medicaid is directly aligned with the provisions of the Affordable

Care Act. The New York Health Exchange will be operational in October and we will welcome over one

million newly insured individuals.


Combined with Affordable Care Act (ACA) changes, Medicaid reform has the potential to lead to broader health system reform in New York. Implementation of the MRT multi-year action plan and ACA changes will lead to sweeping changes in health care delivery that will benefit the state's 19 million residents. The waiver amendment will a low the state to reinvest in its health care infrastructure that will both lower Medicaid costs and ensure that New Yorkers will have access to cost-effective health care services. We continue to work towards better and more cost effective

health care services and broader, more affordable health insurance coverage.


With the benefit of the flexibility and resources that can be provided under New York's waiver

amendment application, we will achieve these results, not only in Brooklyn, but in communities

throughout the state. A true and enduring transformation of the nation's health care system can only be achieved if the federal and state governments work closely together. We in New York are united in support, eager to engage and do our part; we ask your help in securing a constructive partnership with our federal colleagues.


I respectfully request you approve, in an expedited fashion, New York's 11 15 waiver amendment

to fully implement the MRT action plan. This will allow us to continue to invest in the transformation of our state's health care delivery system, reduce costs for taxpayers and the federal government, and improve the quality of care for all New Yorkers.




cc: MRT Members, Congressional Delegation, Relevant White House Officials.