Alliance Note: The NYS Medicaid Director, Amir Bassiri, outlined the next steps for the roll out of the 1115 New York Health Equity Reform (NYHER) Waiver yesterday at the United Health Fund’s annual Medicaid conference in New York City. Medicaid waivers allow states to create healthcare options or programs to serve groups of people with particular needs which typically would not be funded with federal Medicaid dollars. This allows states to demonstrate how well these programs support the intended group as well as whether the programs reduce overall costs to Medicaid. The goal of the 1115 NYHER Waiver is to advance health equity, reduce disparities, and support the delivery of social care to address social determinants of health. It is intended to focus on reducing disparities for children, pregnant and postpartum people, and “high-risk” adults
While the crowd was excited by the prospects of an effort which will inject $7.5 billion into our Medicaid system to support the state’s goal of improving health equity, many attendees, including myself, expressed concerns about how community-based organizations, like small peer run agencies, will be able to participate in the 9 regional Social Care Networks whose leads are slated to be announced this month.
Many questions were asked about how the waiver program will support business infrastructure and workforce improvements for the smaller organizations at the heart of community service delivery. Organizations who are not experienced with billing for Medicaid services, rather than receiving funding for services via grants or state contracts, must get support to ensure they can partner with Social Care Network leads to provide needed Health Related Social Need (HSRN) services. The Alliance continues to advocate for the inclusion of peers in workforce development efforts because we know peer services are an integral part of recovery care for people with major mental health and substance use challenges. We are also working to ensure people with lived experiences are represented at decision making tables in the 9 networks.
Conference attendees also voiced worries about how quickly the NYS Department of Health and the partner organizations, including the 9 Social Care Networks and Statewide Health Equity Reform Organization (SHERO), will be able to set up connections to community providers and begin offering services for nutrition, transportation, and housing. Bassiri acknowledged the current delays while outlining an ambitious goal of having 50% of Medicaid enrollees screened for HSRNs by March 2025.
The Alliance will continue to update our community on the waiver rollout as we get more information, including offering opportunities for community organizations to connect with Social Care Network leads and inform the work of these networks. See below for more information.
State’s $7.5B Medicaid Experiment to Kick Off this Month
By Amanda D’Ambrosio | Crain’s Health Pulse | August 1, 2024
Cash will finally start to flow this month from a federal program that enables the state to use Medicaid to pay for housing, nutrition and transportation.
The $7.5 billion pilot program, called the 1115 waiver, unlocks federal money to revamp the Medicaid program, allowing New York state to use Medicaid in ways it’s never been used before. The state will offer Medicaid benefits for rent payments, cooking tools and non-medical transportation, for example, to attempt to improve health among enrollees and address disparities.
After years of state planning, the money is starting to flow. Nine networks tasked with administering the pilot program are set to receive $500 million in contracts from the state in August, marking the official start of the revamp, said Amir Bassiri, New York state’s Medicaid director, in a presentation at the United Hospital Fund’s annual Medicaid conference on Wednesday.
Those networks, called social care networks, will consist of community-based organizations and medical providers that coordinate care – and payments – for the newly covered Medicaid services. The networks are spread across several regions, with multiple locations in New York City, Bassiri said.
“It will take an entire village to see this through,” Bassiri said.
The goal of the pilot program is vast: it is expected to screen the state’s 7 million Medicaid members for social determinants of health and provide services to address their housing, nutrition and transportation needs. The state is racing against the clock to get the program off the ground, as the waiver only extends through March of 2027.
The pilot program targets groups of individuals with high health risks, including pregnant individuals, people involved in the criminal justice system and those with severe mental illness or substance use. Those high-risk individuals make up 30% of all Medicaid enrollees, yet account for between 50% and 60% of spending, Bassiri said.
The pilot program stems from efforts to expand public health dollars by the U.S. Centers for Medicare and Medicaid Services. New York asked the federal government to approve a $13.5 billion, five-year program to test out new ways to use Medicaid dollars.
The state negotiated with the federal government for 15 months, ultimately scoring a $7.5 billion, three-year waiver in early January.
While addressing social needs is a cornerstone of New York’s pilot program, it also will deliver funds to financially distressed providers and allocate resources to training the health care workforce.
Many have expressed concerns about whether the state will be able to pull off the pilot program in an expedited timeline – concerns that Bassiri has acknowledged.
“We are a little behind our schedule,” Bassiri said at the conference Wednesday. “A lot of things are going to happen in August.”