N.Y. Stakeholders See Medicaid Proposal as Major Boost to CommunitySupports
Mental Health Weekly August 17, 2012
Members of New York state’s behavioral health community say they are
pleased with Gov. Andrew Cuomo’s request for a federal waiver that would
allow the state to reinvest $10 billion in anticipated savings from its
Medicaid Redesign Team (MRT) reforms to transform the state’s health
care system and provide community supports such as supported housing,
peer services, and workforce training.
Cuomo on Aug. 6 submitted the state’s Medicaid 1115 waiver amendment to
the Centers for Medicare & Medicaid Services (CMS) to fully implement
the MRT action plan, anticipated to lower health care costs over the
long term. The waiver application 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.
In general, Section 1115 demonstrations are approved for a five-year
period and can be renewed, typically for an additional three years,
according to CMS. Demonstrations must be “budget neutral” to the federal
government, which means that during the course of the project fed-eral
Medicaid expenditures will not be more than federal spending without the
New York’s Medicaid program, considered the largest in the country,
spends nearly $53 billion to serve 5 million people – twice the national
average when compared on a per recipient basis, according to a previous
report issued following
the release of the MRT’s action plan, “A Plan to Transform the Empire
State’s Medicaid Program.”
Through an executive order, Cuomo established the MRT and charged its
members with conducting regional public hearings across the state to
solicit ideas from the public on how the Medicaid system could be
changed to be more fiscally responsible (see MHW, Feb. 7, 2011, March
The MRT included advocates, community-based mental health organizations,
consumers and other stakeholders who made recommendations to redesign
and restructure the Medicaid program. “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,” Cuomo said in a
statement. “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.”
Key strategies highlighted in the waiver amendment include positioning
and preparing health care providers and consumers for longterm care
integration into managed care, and grants to establish health homes to
improve the quality of care for the state’s highest-need/highest-cost
patients. The waiver plan also includes the establishment
of interim behavioral health organizations to manage carved-out
behavioral health services.
Other Medicaid waiver plan highlights:
* The dedication of $525 million over the next five years toward health
home implementation, in such areas as
workforce development, locating members identified as eligible for
enrollment, and addressing gaps in health information technology (HIT)
* The funding would support a Health Workforce Retraining Initiative,
including $500 million over five years to support
workforce development for patient-centered medical homes and health
homes; long-term care, and training in culturally competent,
* $150 million annually, totally $750 million over five years, to expand
access to supportive housing services.
* Funding of $839.1 million over five years toward long-term
transformation and integration to managed care.
The creation of a statewide ombudsperson program would help to reduce
grievances and appeals and ensure that members have an independent voice
to help them.
Mental health input
The governor provided for an inclusionary process to receive input from
the field for the waiver proposal, said Harvey Rosenthal, executive
director of the New York Association of Psychiatric Rehabilitation
Services (NYAPRS) “Advocates
are really pleased with the proposal and the way [our] input was
received through local forums, regional meetings,
webinars, e-mails, and webbased surveys,” Rosenthal told MHW. “We were
very concerned that reinvestment would go purely toward medical
Rosenthal said that the state’s waiver amendment is consistent with the
triple aims of health care reform outcomes,
improved service quality, and lower costs. “We have to look beyond the
hospitals to the social determinants of health: housing, peer support,
and addressing economic instability, cultural barriers and [avoid]
social isolations,” he said.
The key aim is to move from a fee-for-service model into a Medicaid
managed care system and to have a service coordinator at the plan level
and the health home level, said Rosenthal. One of the state’s
predominant strategies is to save billions by providing alternatives to
the overuse of emergency room and hospital admissions, he said. “New
York ranks 50th in the country of [having the] most avoidable
readmissions,” Rosenthal said.
The state’s message to the federal government is to give the state an
advance payment of $10 billion “and let us reinvest to build up
community care,” he said. The state is putting its commitment and money
that the advocacy community believes are critical, said Rosenthal.
“It’s not enough to put funding into a good health care system if people
do not [avail themselves of those services],” Rosenthal added. “They’re
too busy battling crucial everyday issues about where to live, how
they’re going to eat, how
to find transportation and someone to explain to me why I need to see a
doctor and take these pills,” Rosenthal said.
Funding would support peer crisis services, supportive housing, cultural
competency, recovery-oriented workforce training – services “we long
believed are critical and are the front and center of the behavioral
health care system,” he said.
Lara Kassel is coordinator of Medicaid Matters New York, a statewide
consumer-oriented coalition that advocates on behalf of the state’s
Medicaid program and its beneficiaries. Kassel said she is pleased that
the state’s proposal includes
a Medicaid managed care ombudsman program that will help protect
consumers’ rights and assist individuals with disabilities and chronic
illnesses in accessing services in managed care.
Medicaid Matters, a member of MRT, advocated for the ombudsman program,
said Kassel, who added that the organization hopes to change the name of
the program. “We’re very pleased with the initiatives borne out of
Medicaid Matters, including peer support services,” she told MHW.
Phillip Saperia, CEO of the Coalition of Behavioral Health Agencies,
Inc., in New York, said he thinks CMS will respond to the waiver request
by early fall. “We’re excited about this whole reinvestment issue,”
Saperia told MHW. The Coalition,
also a member of the MRT, also had a hand in developing some of the
overall recommendations that are included in the waiver, he said.
Of key importance, said Saperia, is funding for the continued
development of health homes in the state. Some of the state’s health
home providers have started to hire staff and are receiving clients, he
said. “It’s incredibly expensive and labor-intensive,” said Saperia.
“The reinvestment plans would defray some of the costs that have been
The state’s proposal is “allowing the community to come up with creative
solutions” and funding support in the area of peer supports and wellness
coaches, and crisis services, said Saperia. “I don’t know [of any state
waiver] as comprehensive as this one,” he said. *