As of July 2023, New York is making significant strides in securing approval for its 1115 Waiver amendment proposal from the Centers for Medicare & Medicaid Services (CMS). The state is in final negotiations with CMS and expects to announce approval in the fall.
The updated waiver proposal is expected to run until March 2027 and infuse money over five years into population health, social care networks, workforce improvements and more.
Let’s take a closer look at the key points of the update.
Streamlined Proposal for Success
New York’s 1115 Waiver proposal is a streamlined version of the original proposal, emphasizing accountable and aligned investments to promote health equity and support the health and social care organizations that serve the state’s more than 7.4 million Medicaid members.
Social Care Networks for Medicaid Members
One of the most critical elements nearing agreement is the introduction of Social Care Networks (SCNs) to serve regional Medicaid-enrolled organizations. SCNs will bring together community-based organizations to manage social needs screening for all Medicaid members.
These networks will facilitate the delivery of approved Health-Related Social Needs (HRSN) services to qualifying members. HRSN services will encompass crucial areas like housing, nutrition, case management and transportation, tailored to individual health needs and outcomes.
Primary Care Improvement for Enhanced Health Equity
New York aims to implement a statewide primary care delivery system model that will ensure multi-payor alignment and enable advanced value-based payments (VBP). The proposed model will also prioritize the care of children and focus on reducing health disparities for vulnerable populations such as pregnant and postpartum individuals and high-risk adults.
By enhancing care coordination and integrating behavioral health, specialty care and HRSN services, the state aims to improve overall population health and health equity.
Workforce Investments to Strengthen Healthcare
Recognizing the pivotal role of a skilled workforce, New York is committed to investing in its healthcare professionals. The state plans to offer loan forgiveness for primary care physicians, psychiatrists, nurse practitioners, pediatric clinical nurse specialists and dentists.
Furthermore, career pathway training programs will be provided by high-performing workforce investment organizations (WIOs) to bolster direct care titles providing essential health, behavioral health and social care services.
Future Considerations
While significant progress has been made, some aspects of the proposal are still under discussion. Notably, funding to stabilize the safety net and advance accountability, as well as the creation of health equity regional organizations (HEROs), are areas of ongoing negotiation.
A Promising Future with NYS Waiver 1115
New York’s updated 1115 Waiver proposal signifies a promising future for the state’s Medicaid program. By prioritizing investments in population health, social care networks and the healthcare workforce, New York appears steadfast in its commitment to enhancing health equity and delivering better healthcare services for its residents.
For more information on how your healthcare organization may benefit from the amendment proposal, please contact Joseph Tomaino, CEO of Grassi Healthcare Advisors, at 212.223.5020 or jtomaino@grassihealthcareadvisors.com.
