NYS Submits 1115 Medicaid Waiver Revised Proposal to CMS: What’s Next?

In direct response to feedback made during open comment period, NYS Department of Health has updated several of the key proposal strategies in the 1115 Medicaid Waiver proposal. Many of these changes are expansions and clarifications to the existing waiver proposal while much of the original proposal remains the same. The largest number of changes were around Strategy #1 which focuses on health equity system redesign. In this section, the state expanded targeted populations to include other such as those with physical, intellectual, and developmental disabilities, and they also clarified that the quality measures will include measures stratified by race and ethnicity. Other notable changes are the increase in additional funding for CBO capacity building, the removal of the statewide referral platform that the state was original looking into, and the state mentioned that they will not be defining the HERO and SDHN regions at this time and have acknowledged that CBOs who work in more than one geographic area will not be limited to participating in only one SDHN.

What’s Next? CMS is holding a federal comment period from September 19 through October 19, 2022. At the close of the comment period, CMS will review the comments submitted as well as the NYS proposal. As of right know there is now set timeframe as to the duration of the review process with CMS. However, on September 28th CMS announced approval of two state 1115 demonstration waiver proposal for Massachusetts and Oregon. These are the first two 1115 demonstration waivers approved by CMS in 2022 which may be a good indicator that CMS may view NYS’ 1115 demonstration waiver favorably. As information is shared, Care Compass will update partners. If you would like to read through the proposal as well as the changes, you can view the document on the Mediciad.gov website.

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