The Centers for Medicare and Medicaid (CMS) have officially approved New York State’s 1115 Medicaid Demonstration Waiver Amendment and changes are on the horizon for our region! Care Compass has been closely following the developments of the waiver. While this is very exciting news, some of the specifics remain unknown. For example, while we know there will be Social Care Networks, the details involved in that process are unknown but should be included within the RFP. However, the Care Compass mission and programs are well aligned with the vision of the waiver, and we are well-positioned to respond to the social care network RFP.

This pivotal initiative is designed to continue transforming and enhancing the state Medicaid program, with a total funding of up to $7.5B (with $6B in federal funds over a 3-year period). Here you will find a summary of the NYS Medicaid Waiver Demonstration along with links to the full press release by the state and the 239-page document from CMS.

Waiver Timeline

The waiver is currently scheduled to begin April 2024 and end on March 31, 2027.

• January 9, 2024 to March 31, 2024 is DY 0
• April 1, 2024 to March 31, 2025 is DY 1
• April 1, 2025 to March 31, 2026 is DY 2
• April 1, 2026 to March 31, 2027 is DY 3

*DY is Demonstration Year

Key Components

1. Integration of primary care and community-based organizations to improve quality and health outcomes.
2. Improve quality and outcomes for Medicaid members in geographic regions that have a history of health disparities and disengagement from the health systems.
3. Integrated primary care, behavioral health, and Health Related Social Needs (HRSN) to improve population health and health equity outcomes for high-risk individuals (focused on kids/youth, pregnant and postpartum individuals, chronically homeless, and individuals with SUD).
4. Workforce investments to create equitable and sustainable access to care.
5. Regional-focused value-based payment (VBP) programs and initiatives to improve health, outcomes, and health equity.

Four Key Elements

Within the waiver, there are four key focus areas that will receive funding; Social Care Networks (SCNs)/Health Related Social Needs (HRSN), Health Equity Regional Organization, Medicaid Hospital Global Budget Initiative, and Workforce Investment Organizations.

1. Social Care Networks – will provide Health Related Social Need (HRSN) services through a combination of fee-for-service and managed care delivery systems, with case management and referral services. The state will initially operationalize the benefits through non-risk arrangements with the aim of integrating the benefits into full risk managed care by the end of the waiver timeline. HRSN services will be predominantly evidence-based and will be categorized into two-tier levels based on screening results.
2. Health Equity Regional Organization (HERO) – is a statewide contracted entity that will develop regionally-focused approaches to reduce health disparities, advance quality and health equity, and support the delivery of HRSN services. The HERO will provide the following key functions:
   • Data aggregation, analytics, and reporting
   • Regional needs assessment and planning
   • Convene regional stakeholder engagement sessions
   • Make recommendations to support advanced VBP arrangements and develop initiatives that incorporate HRSN into VBP methodologies
   • Conduct program analysis, such as publishing initial health equity plans and health factor baseline data on Medicaid populations
3. Medicaid Hospital Global Budget Initiative – was developed to support financially distressed safety-net hospitals (located in the Bronx, Queens, Kings, and Westchester counties) as they transition to a global budget. This incentive will enable selected hospitals to focus on population health, healthy equity, and improve quality of care.
4. Workforce Investment Organizations – will be contracted through the state to develop a student loan repayment program that incentivizes certain healthcare workers, as well as develop a Career Pathways Training (CPT) program that focuses on career advancement and unemployed individuals.

Next Steps

With the state’s desire to operationalize the SCN’s by April 2024, there will be a tight turnaround for prospective organizations to submit their applications for the SCN role. With the formation of Care Compass Supporting IPA, we are well-positioned to move quickly on the RFP to apply to serve as the SCN for the Southern Tier region. As more information is released, we will keep our members apprised.

Questions? Please fill out the Contact Us form with any questions or comments you may have. If you are currently not an Open Network Member and would like to inquire about how you can become involved, please contact us today!

Resources

NYS Governor’s Press Release: https://www.governor.ny.gov/news/governor-hochul-announces-groundbreaking-medicaid-1115-waiver-amendment-enhance-new-york

CMS Approval Letter (plus CCN Table of Contents for the Waiver Document): https://www.medicaid.gov/sites/default/files/2024-01/ny-medicaid-rdsgn-team-appvl-01092024.pdf

1115 Waiver Acronyms and Terms as seen within the CMS Waiver Document

Helgerson Solutions Group: https://www.hsg.global/insights/1115-medicaid-waiver-approved-what-you-need-to-know

NYS Website (RFP will be listed here along with funding opportunities): https://www.health.ny.gov/funding/