Alliance Alert: We are encouraged by the early progress of New York’s Medicaid 1115 NYHER waiver and strongly support the state’s request for additional time to demonstrate the impact of providing health-related social needs services to Medicaid members.
While the initiative is still relatively new, it is already reaching thousands of New Yorkers. More than 1.5 million Medicaid members have been screened, approximately 78,000 people had received social services by mid-summer, and, most strikingly, the program has already delivered 35 million meals to Medicaid members in need of nutritional support.
These investments recognize a simple but critical reality: our health is shaped by much more than what medical or mental health services offer by themselves. Access to nutritious food, stable housing, transportation and other basic supports play an enormous role in helping people improve their health and wellness and remain successfully in their communities.
We are hopeful that the federal government will approve New York’s extension request and give the state more time to demonstrate how effective these services can be. The current demonstration has had a compressed implementation period, and we need sufficient time to understand how addressing health-related social needs affects people’s health, quality of life and longer-term healthcare utilization and costs.
The federal review and negotiation process will unfold over the coming months, including a public comment period and formal discussions between New York and CMS. The Alliance will be watching this process closely and will keep our members and partners updated as we learn more.
New York has begun building an important new connection between healthcare and the community supports people need to be healthy. Now we need the time to demonstrate just how much of a difference that approach can make.
New York Asks Feds to Extend $7.5B Medicaid Pilot Amid Federal Scrutiny
By Amanda D’Ambrosio | Crain’s Healthcare | October 2, 2026
New York asked federal health officials this week to extend its $7.5 billion Medicaid experiment that pays for social services — seeking to roll over unused federal funds that pay for groceries and rent amid the Trump administration’s attempts to curtail spending on Medicaid pilots.
The state Department of Health submitted an application on Wednesday to the U.S. Centers for Medicare and Medicaid Services for a five-year extension of its so-called 1115 waiver amendment, which allowed Medicaid to pay for nutrition, housing and non-medical transportation services. The state first received federal approval for the program under the Biden administration in 2024, but that approval expires on March 31, 2027.
The request is largely aligned with a draft proposal published in July. State health officials have requested extra time to prove that the pilot can improve health outcomes while lowering costs — as well as the ability to roll over unused federal funds approved by the previous administration, according to the application. The Health Department estimates $1.7 billion will remain unspent by the end of the current waiver period.
The state’s request comes as the Trump administration has attempted to reduce federal spending on new 1115 waiver demonstrations. Though some experts are cautiously optimistic the waiver will continue, questions remain about the future of the state’s program.
“The federal posture has changed significantly,” said Adam Herbst, a partner at the law firm Sheppard and a former deputy commissioner at the state Department of Health. While the federal government has signaled that it won’t authorize funding for new waiver programs, New York is asking for more time on an existing pilot — and approval of that request will depend on the federal government’s interpretation, he added.
“How much is the federal government going to distinguish an extension of an existing demonstration from a request for new authority?” Herbst said. “That’s the big question.”
A representative from CMS did not respond to a request for comment before publication.
New York received federal approval for its existing 1115 demonstration program in January 2024, along with $6 billion in federal funds to pay for social services, workforce investments and support for financially distressed hospitals. With state funding, the program’s total cost reached $7.5 billion.
State health officials have worked to roll out the existing demonstration under a compressed timeline, standing up infrastructure to pay community-based organizations while screening Medicaid members for eligibility in the program. The state has screened more than 1.5 million of 5.4 million eligible Medicaid members as of this August, according to the application.
Officials have also released some early data on services. Under the pilot, 78,000 Medicaid members have received social services as of mid-summer, State Medicaid Director Amir Bassiri said at United Hospital Fund’s annual Medicaid conference in July. The bulk of services have been nutrition-related, with the pilot program delivering 35 million meals.
In a letter to U.S. Health Secretary Robert F. Kennedy Jr. attached to the waiver request, Gov. Kathy Hochul pointed to the state’s “significant progress” towards reaching the program’s goals.
“However, because the [health-related social needs] initiative is still in its early years, additional time is needed to see the full impact on health outcomes and long-term cost trends, which will continue to be evaluated over the life of this extension,” Hochul wrote.
The federal government will review New York’s request in the coming months. CMS will post the application on its website for a 30-day public comment period, and after that period is up, New York will begin its formal engagement with the agency.
The state has requested to continue using federal funds for social needs while it transitions to a value-based payment model, effective April 2028. New York also asked CMS to phase out workforce initiatives under the 1115 waiver, in alignment with federal guidance. The state asked to spend its existing funds on the Healthcare Access Loan Repayment and Career Pathways Training programs, but to discontinue the initiatives by their planned end date of March 2031.