NYAPRS Note: Last year, New York was poised to become the first state in the nation to restart Medicaid 30 days before prison/jail release for individuals with more extensive behavioral health and AIDS/HIV related conditions, one of NYAPRS’ top advocacy issues for the 2016-17 legislative session. Having gained legislative authorization, the state took steps to submit the necessary CMS waiver application to get required federal approval.
Some months later, NYS Medicaid Director Jason Helgerson withdraw that application, wanting more time to get a better sense that doing so wouldn’t give a Trump Administration the opportunity to undo existing Medicaid reforms, since CMS can make use of such applications to impose other changes in the applicant’s state Medicaid program.
The following piece suggests that NY is feeling encouraged enough about the new CMS posture to consider re-submitting our waiver application to implement the 30 day Medicaid restoration as well as changes related to children.
Helgerson will be offering an assessment of where NY’s Medicaid reform initiatives are and his sense of the impact of both last week’s state budget deal and possible federal budget and policy changes to our Medicaid program during his April 28th keynote address at NYAPRS’ Annual Albany Executive Seminar.
NYAPRS’ offer of a free registration for every 2 paid ones end this Friday. See event and hotel registration and Seminar program information at www.nyaprs.org.
Fears of Trump Reaction Waning as State Considers Medicaid Redesign
By Dan Goldberg Politico April 11, 2017
The Cuomo administration has delayed submitting its plans to redesign the Medicaid program for children over fears that the Trump administration might take the opportunity to upend the state's entire Medicaid program.
But those fears may be waning, allowing New York's health care business with the federal government to return to a more normal pace.
The state has been working for six years on an 1115 waiver, also known as a Medicaid waiver, that would allow for new benefits and programs aimed at children. It's a similar concept to the waiver that sparked the Delivery System Reform Incentive Payment program, which was aimed at adults.
But it was developed under the assumption that there would be a Democrat in the White House or at least a more conventional Republican, not one elected on the promise of blowing up Washington.
When Donald Trump was elected in November, Jason Helgerson, the state's Medicaid director, acting on the advice of outgoing Obama administration officials, pulled New York's pending waiver requests, related to criminal justice and HIV, and refused to submit the children's waiver.
His concern, he said Tuesday during a conference call, was that the Trump administration would use the requests as leverage to impose ideas such as work requirements or mandatory drug testing.
"That conversation could devolve into things not in New York's interests," Helgerson said.
Most of the state's Medicaid program is governed by waivers that have been negotiated with the federal government.
Those are contracts that the Trump administration has to honor but if the state opens up negotiations for an item related to children, the federal government could use it as an excuse to add other amendments that the more liberal Cuomo administration would rather avoid.
Helgerson doesn't think the merits of the state's plan for kids are an issue. Instead, he is worried "that it would invite a conversation wholly unrelated to the topic at hand."
Helgerson said he has been relieved that the Trump administration and Seema Verma, the new head of the Centers for Medicare and Medicaid Services, have taken a more conventional approach, allowing states to remain in control of their Medicaid programs.
"We haven't experienced anything that says they are going to impose an ideology on the state," Helgerson said. "If we continue to feel as we do today that things are maintaining a feel as they have in the past ... I think we will be in a position to move forward with the waiver amendment."
Helgerson said he'd like to wait another month or two just to make certain he has an accurate read on the Trump administration.